River View

River view is a residential care home providing accommodation and personal care. The home accommodates up to 5 people in two adjoining houses. At the time of our inspection 5 people with learning disabilities were living at the houses.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

We received positive feedback from people, they told us they were happy living at River view. They told us they felt safe, led busy life’s and had positive relationships with their staff team.

People did however, receive personalised support and staff knew people very well. Care plans were in place, but people had three different plans each which was confusing. Some information was person centred but this wasn’t always consistent across all three. We have made a recommendation that plans need to be reduced and improved.

People were supported to build and maintain important personal relationships that mattered to them, with both their peers and relatives.

The environment was very clean and homely and was in the process of being re decorated in places using people’s preferred choices of décor.

Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required.

Medicines were managed well, safely administered and recorded accurately.

There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.

Individualised risk assessments were in place. Staff were confident to raise concerns appropriately to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

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

Appropriate healthcare professionals were included in people’s care and support as and when this was needed. People were supported to have enough to eat and drink.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings, phone calls and emails. People had good links to the local community through regular access to local services.

People were supported to be independent, their rights were respected and access to advocacy was regularly available. Support was provided in a way that put the people and their preferences first. Information was readily available for people in the correct format for them, including easy read.

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 outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 2 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the registered provider and the handling of safeguarding concerns. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected the service in January 2016 and rated the service as Good. At this inspection we found the service remained Good.

Victoria House Residential Home provides accommodation with personal care for up to five people. The service provides care to people with learning disabilities and at the time of this inspection there were three people living at the home.

The service had a registered manager in place. 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.

Staff showed their caring approach to people using the service and in their support to people’s families and wider social networks. We were told of how the service had supported people and their families to maintain regular contact through the use of technology and supported people to visit their loved ones. We saw written feedback from close family members that was exceptionally moving in relation to the support provided to their relative and the whole family.

We observed staff ensuring people’s dignity was maintained and staff were skilled in ensuring people’s anxiety was managed by consistently following support plans.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. People we spoke with told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks and meetings were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely and administered to people in a safe and caring way. We saw that the service was beginning to support people to manage their own medicines as far as they were able and had developed pictorial stories to begin this process.

We found there were sufficient care staff deployed to provide support to people in a way that met their needs. Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and forward planned . Staff told us they felt supported by the management team at the service.

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

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking and specialist support had been sought where needed.

The service was moving to a more personalised support plan approach and were trialling a new approach from the provider. We saw that very good easy read plans were in place for people but more work was needed to ensure positive behaviour support plans were consistent and detailed enough information to enable staff to support people in a manner that met their needs and priorities. The registered manager agreed and told us they would continue to feedback and work on the plans as part of the trial process.

People accessed a wide range of activities and people were supported with employment and learning opportunities.

The service had good links with the local community and local organisations.

People and staff were positive about the management of the service. The registered manager and team leader had a daily presence at the home.

The provider had an effective complaints procedure in place. People who used the service were aware of how to make a complaint and met together regularly with the staff team to talk about issues about the house, staff team and living together. Feedback systems were used to obtain people’s views about the quality of the service.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the quality of care plans identified on our previous visit on 17 June 2014.

During our inspection on 29 March 2015, we spent time speaking with the director and team leader. We also spent time observing people and staff. We looked at the care plans, medication documentation, risk assessments and person-centred support plans of four people. We found that improvements had been made and that there was a robust system in place to ensure that people were protected from risks to their health, safety and welfare. If you want to see the evidence that supports our summary please read the full report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and staff who worked there, and looking at records.

Is the service caring? ' Two people told us they were given choices about how their care and support was provided and that these were respected by the service. We spoke with two people who used the service who were complimentary about the staff and stated they could raise any issue with them.

Is the service responsive? - The service regularly sought views of people who used the service using the service and visitors via questionnaires and meetings. The home had a complaints policy and procedure that was accessible and people told us they could raise any issue with the managers or staff. We saw that staff were prompt to seek additional support from healthcare specialists if support was required for people who lived at Victoria House.

Is the service safe? ' The service had safeguarding policies and procedures in place and the manager and staff we spoke with knew how to respond to any concerns that were raised with them. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and appropriate applications had been submitted and records were held accordingly. We discussed the implication of a recent court judgement in relation to Deprivation of Liberty Safeguards and the manager had sought advice from the local authority into its relevance for people who used the service .

Is the service effective? ' We saw that care plans had a person centred format, and they showed how people's views and preferences about their care had been recorded. However risk assessments and care plans had not always been updated when they were due and this meant people and staff could be at risk of care not being delivered correctly. People were supported to undertake a variety of activities and work placements, and two people we spoke with were looking forward to upcoming holidays they were having with staff from the service.

Is the service well-led? ' We saw that staff had a training and supervision programme in place and there was a regular programme of staff meetings. We saw that a recent change in the shift pattern for staff had been discussed and staff confirmed they were happy with this change. One staff member told us it benefitted the people who lived at the service as they had consistent staff throughout the day which meant they could go on all day activities.

What people told us ' We spoke with two people who lived at the service and spent time with another person who had communication difficulties. Some of the comments included:

'The staff go out of their way to be kind';

'I love my keyworker'

'I'd talk to my keyworker if I was worried about anything';

I'm going on holiday soon in a caravan for a week, I can't wait' and

'I feel safe here, it's a much nicer place that where I have lived before.'

Staff had a positive attitude and we saw good interaction with people who were being supported to undertake various activities. Staff told us they received training, supervision and appraisal on a regular basis.

There were systems in place for checking the safety and quality of the service and we saw that staff members had a good knowledge of infection control procedures. We saw the environment, whilst still being homely, had equipment available to reduce the risks from poor infection control.

Records were held securely and the manager was taking measures to ensure fire equipment checks were properly recorded.