Rivers

Rivers is a residential care home providing personal care to up to 17 people. The service provides support to younger adults with a learning disability, physical disability, and sensory impairments. At the time of our inspection there were 17 people using the service.

The care home accommodates people across 2 separate homes called Rivers and The Cabin, each of which has separate adapted facilities and are situated next door to each other. Rivers supports 9 people, and The Cabin supports 8 people.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice, and independence. The service is larger than current best practice recommendations. However, the size of the service having any negative impact on people was lessened as the service was being delivered within 2 separate houses.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to be involved in decisions about their care and support. Staff were observed communicating with people in ways that met their needs and supporting them to make choices.

Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to take part in activities and pursue their interests.

People lived in a safe and clean environment, that met their sensory and physical needs. People benefitted from an interactive and stimulating environment. People were able to arrange and decorate their bedrooms in the way they preferred.

Staff supported people to access specialist health and social care support in the community. Staff supported people with their medicines, and worked with health professionals to achieve good health outcomes.

Right Care:

Recruitment procedures were robust. However, concerns were raised regarding staffing levels. The service was impacted by many changes within the staff team.

Although staff in general knew how to support people safely, they did not always have appropriate training and support to ensure people received safe care at all times.

People received their medicines from staff who knew them well. Staff generally followed systems and processes to administer medicines safely, however improvements were needed to ensure staff received appropriate training and competency assessments.

We found 1 safeguarding concern had not been escalated to the Local Authority appropriately, and the provider had not always notified us of significant events in line with their legal responsibilities.

People's care plans and risk assessments reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity, and understood and responded to people’s individual needs. Throughout the inspection we observed kind, relaxed, compassionate, and caring interactions between people and staff.

Right Culture:

Improvements were needed to make sure there were effective systems to monitor the quality of the service and plan improvements.

People told us they were pleased with the support that staff provided to them, although relatives raised some concerns about the service their loved ones received.

Staff and the management team at the service spoke positively about people within the service and wanted people to live their best lives. Staff demonstrated their knowledge of people and placed people's wishes, needs, and rights at the heart of everything they did.

The staff, manager and deputy manager were open, acting on queries and feedback throughout the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published April 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to good governance and notifications of incidents at this inspection.

We have made recommendations in relation to safeguarding and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rivers is a residential home specifically designed to provide open planned living for nine people, the home is registered together with another home called The Cabin, this home is situated next door and supports eight people. Both homes specialise in providing care to younger adults who have a learning disability, physical disability and sensory impairments. Each home is staffed 24 hours a day. The homes have a range of aids and adaptations in place to assist people who have mobility difficulties and all bedrooms are for single occupancy. Rivers & The Cabin have easy links into the local community, and access to a range of facilities such as full-sized Hydrotherapy pool and interactive sensory room that are situated within the grounds of the homes.

At the time of the inspection there were nine people living at Rivers and eight people living at The Cabin. The people we met had very complex physical and learning disabilities and not all were able to communicate with us verbally. We therefore used our observations of care and our discussions with staff, relatives and professionals to help form our judgements.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen." Registering the Right Support CQC policy

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

.

At this inspection we found the service remained Good.

Why the service is rated good

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living at Rivers and The Cabin told us they felt safe. Staff understood how to recognise and report signs of abuse or mistreatment. Safeguarding and whistleblowing policies and procedures were available for staff to access.

Detailed risk assessments were carried out to ensure people could make choices and keep their

independence. This also included environmental risk assessments such as fire maintenance and safe use of water outlets.

Recruitment processes minimised the risk of employing unsuitable staff. There were sufficient numbers of staff available to keep people safe and support people when they displayed behaviours that challenged.

People’s medicines support needs were clearly identified and staff delivered medicines in a personalised way. Staff were trained and competent to administer medicines, although we did make some recommendations, this included having guidance to ensure that “when required” medicines are given consistently.

Staff had received training on infection control and understood their role in preventing the spread of infection within Rivers and The Cabin. Staff knew the reporting process for any accidents or incidents. Lessons learned were shared with staff through team meetings and supervision.

People received effective care and support from competent and well-trained staff and supervision and appraisals were carried out regularly.

People told us that they had choices of food and that the quality of the food was good. Meal times were a positive social experience for people. Where needed, other professionals were contacted for specialist guidance and support to meet people's needs. Care records showed staff shared information effectively with professionals and involved them appropriately.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA)

Staff treated people with kindness respect and compassion and care plans gave guidance on how to communicate appropriately with people. People told us they knew how to make a complaint and felt confident that any concerns would be taken seriously.

Records showed people had their needs assessed before they moved in to the home. People and their family members were invited to formal reviews of people’s care and staff encouraged people to access their community when they wanted to.

The leadership was visible and accessible. There was a management structure in place, which gave clear lines of responsibility and accountability. People spoke highly of the staff and management team. The providers approach to quality assurance included the completion of an annual survey. There were effective quality assurance arrangements in place to raise standards and drive improvements within both houses.

Further information is in the detailed findings below

Rivers is set out in two separate buildings which are next to each other. Rivers can accommodate up to nine people and The Cabin can accommodate up to six people. The home specialises in providing care to adults who have a learning disability and concurrent physical disability. Each house is staffed 24 hours a day. The home has a range of aids and adaptations in place to assist people who have mobility difficulties. All bedrooms are for single occupancy. The home is located in extensive grounds with two of the provider’s other homes. Each home can access the on-site sensory room and hydro pool.

At the time of our inspection there were nine people living at Rivers and six people lived at The Cabin. The people we met with had very complex physical and learning disabilities and not all were able to communicate with us. We therefore used our observations of care and our discussions with staff, relatives and professionals to help form our judgements.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported by kind and caring staff who took time to get to know people. A professional who visited the home said “The standards of care and attention I have witnessed over many years working within Cream Homes is absolutely outstanding.” A staff member commented “The home is beautiful and so are the staff and residents. Cream provides the best care I've ever seen.” A visiting entertainer described the home as “A fantastic place. The staff are amazing.”

Staff made sure people experienced a smooth transition when they moved to the home. A relative told us “The staff were amazing. They supported all of us and the transition was brilliant.” Staff knew people very well and they often tried to match staff to individual people which helped them develop meaningful and caring relationships with people.

People’s bedrooms were beautifully furnished and decorated in accordance with people’s preferences. A visiting professional said “I couldn’t believe it when I saw [name of person’s] bedroom. It is so beautiful. All pink and girly. Just like they had at home and loved so much.”

Staffing levels were good and staff understood people’s needs and provided the care and support they needed. There were sufficient staff available to people to enable them to take part in a range of activities according to their interests and preferences.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

The home was a safe place for people. Staffing levels were good and staff understood people’s needs and provided the care and support they needed.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People’s health care needs were monitored and met by staff who received excellent training and support. People received good support from health and social care professionals.

People were supported to eat well in accordance with their needs and preferences. The home employed a very enthusiastic cook who was committed to ensuring people had “good fresh food.” They were very knowledgeable about the people who lived at the home and they told us about each person’s needs and preferences.

People were unable to look after their own medicines. Staff made sure medicines were stored securely and there were sufficient supplies of medicines. People received their medicines when they needed them.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure peoples legal and human rights were protected.

There were effective systems in place to monitor and improve the quality of the service provided.