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Scenario Management - Riversmede Good

Reports


Review carried out on 8 July 2021

During a monthly review of our data

We carried out a review of the data available to us about Scenario Management - Riversmede on 8 July 2021. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Scenario Management - Riversmede, you can give feedback on this service.

Inspection carried out on 9 January 2019

During a routine inspection

What life is like for people using this service:

People who lived in supported houses provided by Scenario Management and relatives felt confident in the management team and how the service operated. There were sufficient staffing levels that afforded people responsive and dignified support that allowed people to follow their interests and daily life.

The management team had safe recruitment procedures to ensure staff were suitable to work with vulnerable adults. We saw staffing levels matched each person’s requirements to maintain continuity of care and provided support for people to follow their choices in day to day living and the local community.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

Risk assessments provided instructions for staff members when they delivered care for people supported within the houses and when out in the community.

Care records we looked at were of a good standard, detailed and personalised to the person’s needs and wishes. There was evidence of a multi-disciplinary approach to create a detailed plan so that people who lived in supported housing had support from health and social care professionals.

People supported by the Scenario Management were treated with respect by caring staff. This was confirmed by people we spoke with who lived there and a relative. Comments included, “[Relative] has come on so much since being here they do so much with him.” Also, “They have been so good and kind to me since being here.”

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. We discussed the principles of the MCA and consent with staff and found they had a good awareness.

We found Scenario Management had systems in place to ensure they met people’s diverse and cultural needs. Those who lived in supported housing told us staff and the management team respected their customs and their way of life. Care records we looked at evidenced people and where appropriate relatives were fully included in their support planning.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included staff meetings and auditing of the service. This enabled the service to be monitored and improve areas that were identified through their quality monitoring processes.

The service worked in partnership with other organisations to ensure they followed good practice and people in their care were safe.

There was a complaints procedure which was made available to people and their family when they commenced using the service. People we spoke with told us they were happy with the support they received.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 02 March 2017).

About the service:

Scenario management Limited is registered as a domiciliary care agency which provides supported housing for people with learning disabilities and behaviour that challenges. Staffing is provided 24 hours each day to support the people. They also provide an outreach service to people in the local community.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme or if any issues or concerns are identified.

Inspection carried out on 25 January 2017

During a routine inspection

This inspection visit took place on 25 January 2017 and was announced.

At the last inspection in September 2015 we asked the provider to take action to make improvements because we found a breach of legal requirements. This was in relation to people being deprived of their liberty for the purpose of receiving care without lawful authority. We also made recommendations to improve health and safety, person centred care, consent and capacity and governance of the service. The provider sent us an action plan saying how they would meet the legal requirements and recommendations. During our inspection visit on 25 January 2017 we found these actions had been completed.

Scenario Management Limited is registered as a domiciliary care agency which provides a supported house for people with learning disabilities and behaviour that challenges. Staffing is provided 24 hours each day to support the people living in the supported house. At the time of the inspection visit there were three people who lived in the house.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and took necessary action as required. Staff had received safeguarding training and understood the process and procedure to follow.

We asked one person who lived at the house and relatives whether they felt safe being supported by Scenario Management - Riversmede. One person said when asked if they felt safe, “Yes I do.” A relative said, “I know [relative] going to be safe and well there.”

Risk assessments were in place and now reviewed on a regular basis to ensure people were safe. Where potential risks had been identified the action taken by the provider had been recorded.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

There were appropriate numbers of skilled staff deployed to meet the needs of the three people who lived at the house. Staff had been safely recruited and were supported by the management team with regular supervision and access to training courses.

We looked at how medicines were administered. We found procedures followed were safe. The management team ensured only staff that had been trained to manage and administer medicines gave them to people

The manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA). Staff showed a good knowledge of the people they supported and their capacity to make decisions.

Staff we spoke with were able to describe how individual people preferred their support to be delivered and the importance of treating people with respect. One staff member said, “You have to be patient and talk slowly, we have developed ways to communicate with each other and get along great.”

People were provided with support to be as independent as they wanted to be. For example staff provided guidance and support for a person to help in the kitchen and dining area. One staff member said, “It is hard but [person who lived at the house] really enjoys helping out.”

We found people had access to healthcare, mental health services and social care professionals and their healthcare needs were met.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included staff meetings, meetings with health and social care professionals and quality audits.

Inspection carried out on 24 and 30 September 2015

During a routine inspection

This inspection took place on 24 and 30 September 2015, with feedback on 12 October 2015 and was an unannounced inspection.

Scenario management - Riversmede is registered as a domiciliary care agency. The service provides personal care in a supported house for people with learning disabilities and behaviour that challenges. The three people who live in the supported house are either tenants or the landlord of the property. They have lived together for over 10 years. Staffing is provided 24 hours each day to support the people living in the supported house.

The service was last inspected in June 2014. The service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. However she was in the process of cancelling her registration and the care manager was applying to become the registered manager. 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.

We asked people and their relatives whether they felt safe being supported by Scenario management - Riversmede. One person said, “Yes, I am safe and happy. I like the staff. They are kind, yes.” A relative told us “[My family member] is so happy. I know he is safe. He is so happy and settled.” However this did not always reflect our findings.

Risk assessments were in place to reduce risks to people’s safety. Where potential risks had been identified the action taken by the service had been recorded. However some of the risk assessments were restrictive and had been in place for a long time. The assessments had not been reviewed to reflect whether the restrictive practice was still in use and still appropriate.

This is a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure people were not deprived of their liberty for the purpose of receiving care without lawful authority.You can see what action we told the provider to take at the back of the full version of this report.

We looked at how staff supported people. There were enough staff during some parts of the day. However staff hours were not used flexibly and restricted choices. Staff were also working excessively long stretches at a time, which meant people were at risk of not receiving appropriate care.

Medicines were given as prescribed and stored safely. However a record of medicines returned to the pharmacy had only recently been introduced. This meant it was not clear when previously unused medicines had been disposed of.

People’s health needs were met and any changes in health managed in a timely manner. We saw one person having a physiotherapy session and evidence of other people seeing health professionals as needed.

Staff did not have a full understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This meant people were deprived of their liberty unlawfully.

This is a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure people were not deprived of their liberty for the purpose of receiving care without lawful authority. You can see what action we told the provider to take at the back of the full version of this report.

People told us they liked the staff and the staff were ‘nice and good’. A relative told us, “[Family member] appears happy and comfortable with all his carers without exception. He likes them all.”

We saw staff interacted frequently and enthusiastically with the people in their care, treating people with respect and patience. People were relaxed and comfortable with the staff team and staff were attentive, responding to any requests for assistance promptly.

People were encouraged to choose what they wanted to eat. Staff made sure that people’s dietary and fluid intake was sufficient for good nutrition and where possible a healthy option.

Care records contained personal information to assist staff to make each individual’s care person centred. Risks were well documented but developmental strategies to extend peoples skills and choices were limited.

The staff team were experienced, and familiar with the needs of the people who they supported. Staff were aware of people’s individual needs around privacy and dignity. They made sure people’s privacy was assured when providing personal care and each person had the personal space they needed. Relatives felt they could trust staff and they were friendly and respectful. A relative told us, “We can trust the staff here. We know them and they involve us and keep us up to date with [Family member’s] care.”

Staff recognised the importance of social contact and activities. The activities people were involved in were varied and included swimming, trampolining, football, visiting restaurants and shopping. People said they enjoyed the activities. One person said “I like McDonalds and fish and chips. I go swimming sometimes.”

We asked people if they knew how to raise a concern or to make a complaint if they were unhappy with something. One person said, “Tell [one of the staff team or family].” Relatives said they knew how to make a complaint. A relative told us “We have a great relationship with staff and can talk to them about anything.”

Systems in place to monitor the service were limited. The manager told us she was developing these systems so they were more rigorous.

The staff team had frequent informal chats with people and their families about what they wanted from the service. This meant that people’s views were heard and relatives were kept up to date with any new information or changes with their family member.

Inspection carried out on 4 June 2014

During a routine inspection

On the day of our visit we spoke with the owner/manager, staff, relatives and people who used the service (although they had limited verbal communication and we were unable to have a detailed conversation) and relatives. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, observing interaction with staff and people living in the house and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

A relative we spoke with told us they felt their rights and dignity for their relative were respected. They said, �They are all really caring and we feel he is safe and well looked after by people who are well trained.�

We saw systems were in place to make sure the management and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The deputy manager had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

People�s health, support and care needs were assessed with them and their relatives. Support plans were developed with the best interest of the person using the service. This meant people were able to be supported within their home and out in the community to follow their chosen interests.

A relative we spoke with said, �They are always out with him and provide support and help so that he can achieve what he wants to every day. They are all lovely people.�

The manager and staff members we spoke with had a good awareness of people�s care needs. We discussed with staff the individual needs of people. Comments included, �We have supported the three men for a long time now and have developed good relationships so that we understand the complex support they need.�

Is the service caring?

We spoke with relatives about the service. We asked them for their opinions about staff who supported people who lived there. Comments were positive and included, �They are all fantastic, we are so happy knowing W� is cared for so well.� Also, �They keep us informed of anything that goes on. The owner and staff are wonderful.�

We spent part of the day in the home observing staff interaction with people as they were preparing to go out for the day. People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people

When speaking with staff it was clear they genuinely cared for people they supported. One staff member said, �We have a family atmosphere here. We have staff who had worked here for years and all support each other.�

Is the service responsive?

The service worked with other agencies including social services, nurses and healthcare professionals to make sure people received care and support in a coherent way. This meant people received the right care and support to remain as independent as possible even though receiving 24 hour care.

We saw literature informing people of the complaints procedure. The manager told us a recording system was in place to investigate, record and reach outcomes for any complaints they received. People could therefore be assured complaints would be investigated and action taken as necessary, if any issues were raised. However no complaints had been received by the service. We also spoke with relatives who confirmed they have never had to make a complaint.

Is the service well-led?

There were a range of audits and systems put in place in by the management team to monitor the quality of the service being provided. This helped to ensure people received a quality service at all times.

We had responses from external agencies including social services .They told us they had a working relationship with the manager and staff to make sure people received their care and support they required.

Inspection carried out on 30 July 2013

During a routine inspection

Scenario management Limited began in response to the needs of one person when other services were not meeting his needs. His relatives arranged for him to purchase a house and a staff team to support him in his home. Later other people with specialist care needs, learning disabilities and behaviour that challenged, became tenants in the house. The staff team expanded to meet the needs of the individuals. Staffing levels were high in Riversmede supported house to meet the needs of the people living there and to effectively manage any behaviours that challenged. This enabled people to access educational, social and leisure facilities.

We spoke with a range of people about Riversmede supported house. We met all three people living at Riversmede. Although they had limited verbal communication and were unable to have a detailed conversation there was clear evidence that they were living a fulfilled and active life. Staff supported each individual to engage in the community activities they enjoyed.

We observed the care, support staff provided to people during our visit. We saw staff supporting people quietly, calmly and sensitively. Records showed that people went out and about on most days, involved in a variety of activities. Support staff encouraged people to eat healthily as much as possible and provided a variety of home cooked meals.

Quality assurance systems were in place to monitor the care and support people received and to gain the views of people living at Riversmede and their relatives.

Staff received formal supervision and appraisals where they discussed their care practice, skills and development needs. They also received regular training to assist them with updating their skills and knowledge.

Inspection carried out on 27 September 2012

During a routine inspection

Scenario management Limited began in response to the needs of one person when other services were not meeting his needs. The relatives arranged the purchase of a house and provided a staff team to support him, This gradually led to supporting other people who had behaviour that challenged.

We met all three people living at Riversmede. We spoke with a range of people about the home. They had limited verbal communication and were unable to have a detailed conversation about the care and support they received. However it was clear that they enjoyed a busy and fulfilled lifestyle, going out and about with staff support.

We spoke with the provider, relatives and staff. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced. Relatives told us that they were happy with the care. One relative told us that their family member had a good life at Riversmede and that he was always happy to go back there. Relatives and staff that we spoke with told us routines in the home were flexible.

We observed the care and support provided to people during our visit. We saw staff supporting people sensitively and effectively. Staff were responsive to the needs of the people they were supporting and had time to spend with people. Relatives told us that any health issues or changes in care were discussed with them, so they always felt involved.