We carried out a review of the data available to us about Riverside House on 6 July 2023. 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 Riverside House, you can give feedback on this service.
Riverside House is a residential care home providing accommodation and personal care for up to 12 people. The service provides support to people living with a learning disability or autistic spectrum disorder. At the time of our inspection there were 11 people using the service.
The service is a large adapted house with facilities over 4 floors. People have their own bedrooms and access to a variety of communal rooms and an enclosed garden.
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.
Right Support: The service was a busy, larger than average, household where people enjoyed a good quality of life. People were regularly in and out of the service, interacting with others, making use of their personal space and communal resources as they wished. They participated in individual and/or group activities within the service, at the main ‘Stepping Stones’ site, or in their wider community. Work was ongoing to adapt the environment in line with people’s sensory needs and changing mobility.
Some people had lived at Riverside for many years, they were happy and settled in their home. People were supported to maintain relationships with others who were important to them through regular visits, phone and video calls and celebrating special occasions. This included visiting family members who lived some distance away.
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.
Right Care: People’s activities were tailored to their interests, preferences and needs. A professional said, “Riverside are working hard to expand meaningful activities and are thinking of the individual’s specific needs, likes and dislikes and working with them directly to build on this.” We saw people were confident when interacting with staff, often leading interactions and joking with them. People spent time with others and engaged in activities when it suited them.
Each person had a named staff member [keyworker] who supported them with planning and decision-making. People were supported to access appropriate health and dental care; Medicines and incidents were reviewed regularly with external professionals to ensure any restrictions were in people's best interests. Legal authorisation had been sought as required when people were unable to consent to care. Staffing levels and staff training were reviewed in-line with activities and people’s needs.
Right Culture: People lived in an inclusive and caring environment where they were valued and relationships were based on mutual respect and kindness. The manager led by example, working openly and setting clear expectations for staff. People and staff were listened to and their ideas and suggestions were welcomed.
The staff we spoke with were compassionate and empathetic and understood people's needs and risks. Staff were very positive about working at Riverside and praised the manager for ongoing improvements in the service, a staff member described their achievements as, “remarkable”. Effective working relationships had been established with professionals and 5 out of 6 relatives said communication with Riverside was very good.
The provider was reviewing their governance and oversight arrangements to ensure they always had capacity to support services to make timely improvements when needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 12 November 2021) and there was 1 breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended the provider seek additional guidance in the principles of STOMP (stopping overmedication of people with a learning disability, autism or both). At this inspection we found the provider had acted upon this recommendation and STOMP (best practice) guidance had been followed.
Why we inspected
We carried out an unannounced inspection of this service on 24 and 29 September 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well Led which contain those requirements.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Riverside House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Riverside House is a residential care home providing personal care to 12 people living with learning disabilities and autism. The home is in a rural setting and accommodates everyone in one building.
People’s experience of using this service and what we found
People were at risk of not receiving personalised care that met their physical and emotional needs as their care, risk and medicines management plans had not been kept up to date to reflect their current support needs and prescribed medicines.
The provider had possibly missed opportunities to review the staffing levels of the service and changes in people’s needs to help prevent incidents and ensure people’s care remained inclusive and personalised. However, we observed staff effectively speaking to people and reassuring them when they became anxious.
Staff were aware of people’s prescribed medicines and administered them in line with people’s prescription. However, we have made a recommendation about the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) to help reduce the risk of people being over medicated.
People were supported by a staff team that had been safely recruited and knew them well. However, from our observation and speaking to staff we were not fully assured that sufficient numbers of staff were available to ensure people’s individual care needs were consistently being met. The provider had not ensured that effective infection control measures had been put in place to help reduce the risk of spread of infection.
The manager was aware staff morale and making progress in supporting staff with their professional development and support which was acknowledged and commented on positively by staff.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
People had lived at Riverside House for many years and enjoyed the family atmosphere of the home. However, the service was not fully able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. For example, it was not always clear how the provider had considered this guidance to ensure people were empowered to have maximum choice and control of their lives such as being supported to have greater and continued integrated access into the wider community.
Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People looked relaxed and happy living at Riverside House. Relatives reported and we observed that staff engaged with people in a friendly but professional manner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverside House on our website at www.cqc.org.uk.
Rating at last inspection (and update) The last rating for this service was Good (published 17 October 2017).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
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.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to people not consistently receiving personalised care based on their assessment of needs.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Riverside House is a care home registered for 13 people with learning disabilities. At the time of our inspection there were 12 people using the service.
We found the following examples of good practice.
¿ During a recent Covid-19 outbreak in the service, the provider followed their contingency plan for an outbreak to ensure people were supported by adequate numbers of staff.
¿ Staff had used a ‘Virtual Covid ward’ during the outbreak following referral from a GP. Staff monitored and reported people’s oxygen levels to a 'virtual Covid ward,' which enabled the early detection of deterioration in people’s health and to implement rapid intervention and treatment.
¿ Staff ensured the service was regularly cleaned and the environment was adequately ventilated.
¿ The service had established a procedure to prevent visitors from catching and spreading infections. A room had been utilised to enable the screening of visitors to the home with a separate entrance and facilities for changing clothes and donning and doffing Personal Protective Equipment (PPE).
¿ People were supported to stay socially engaged and not to become lonely. Staff helped people keep in touch with family members and to join in socially distanced group activities, or one to one activities, with a staff member.
¿ People's and staffs' temperatures were checked regularly, as well as monitoring for other Covid-19 related symptoms.
¿ The service had worked to enable people using the service to receive regular testing for Covid-19 taking into account their mental capacity and best interests.
¿ The service had had ensured communal space in the home was used to ensure people had a variety of settings for activities. This included setting up a café area in the basement for people to use for drinks and meals as an alternative to the dining room.
¿ Information was made available to people in a suitable format to explain why staff are wearing PPE.
¿ De-cluttering of some areas had been completed to enable more effective cleaning.
Riverside House is a care home for 13 people with learning disabilities. At the time of our inspection there were 12 people using the service.
We found the following examples of good practice.
• The service had established a procedure to prevent visitors from catching and spreading infections. A room had been utilised to enable the screening of visitors to the home with a separate entrance and facilities for changing clothes and donning and doffing Personal Protective Equipment (PPE).
• People were supported to stay socially engaged and not to become lonely. Staff helped people keep in touch with family members and to join in socially distanced group activities, or one to one activities, with a staff member.
• People's and staffs' temperatures were checked regularly, as well as monitoring for other Covid-19
related symptoms.
• The service had worked to enable people using the service to receive regular testing for Covid-19 taking into account their mental capacity and best interests.
• The service had ensured communal space in the home was used to ensure people had a variety of settings for activities. This included setting up a café area in the basement for people to use for drinks and meals as an alternative to the dining room.
At the last inspection on 21 May 2015, the service was rated Good. At this inspection we found the service remained Good.
Staff and management understood how to protect people from harm and abuse. Risks to people's safety were identified, assessed and appropriate action taken. People’s medicines were safely managed. People were supported by sufficient staff who had been recruited using thorough checks.
People were supported by staff who had training and support to maintain their skills and knowledge to meet their needs. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People were treated with dignity, respect and kindness and were involved in the planning and review of their care and support. People were supported to maintain and develop their independence.
People received individualised care which reflected their personal preferences, wishes and routines. There were arrangements to investigate and respond to complaints.
The registered manager was visible and accessible to people and staff. Quality checks were made with the aim of improving the service in response to people's needs.
Further information is in the detailed findings below.
The inspection took place on the 21 May 2015 and was unannounced.
Riverside House is a residential care home for 13 people. People living at the home have a range of needs including learning disabilities and mental health needs. At the time of our inspection there were 12 people living at the home.
The home had a 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.
People were protected from the risk of being cared for by unsuitable staff because robust recruitment practices were operated. Medicines were well managed. People were supported by sufficient numbers of staff who received appropriate training and had the right knowledge and skills to carry out their role. People were protected from the risk of abuse by staff who understood safeguarding procedures.
People were supported by staff with the knowledge and skills to carry out their roles, including knowledge of the Mental Capacity Act 2005. People were active in choosing menus and received support to eat a varied diet. People were supported to maintain their health through support in accessing healthcare and a working relationship between Riverside House and a local GP practice.
People were treated with respect and kindness, their privacy and dignity was respected and their desire for independence was understood and promoted.
People received individualised care through regular review and consultation by staff. People were enabled to engage in a range of activities of their choice. There were arrangements to respond to any concerns and complaints by people using the service.
The vision and values of the service were clearly communicated to staff. Quality assurance systems were in place to monitor the quality of care and safety of the home. As part of this, the views of people using the service were taken into account and responded to.
The people within the home had complex needs and we observed staff respecting people's wishes whilst understanding the care and support needed. We saw that people's rooms catered to their individual needs with some bedrooms being decorated with their personal belongings whilst others were minimal.
We looked at people's individual files which incorporated their care plans, risk assessments and health care needs. We found that they encompassed the safety and well-being of people who used the service.
Staff and people who used the service knew how to raise a concern or complaint and felt confident in doing.
We saw that staff had received all relevant training and had received regular supervision and an annual appraisal which ensured that staff had the necessary qualifications, skills and experience to support people who used the service.
One person told us, "I love living here". Care is personalised and there is a great respect within the home for creating individual personal space.
People told us they felt safe within the home.
We found there to be a good staff ratio and there was evidence of staff having suitable qualifications and training. Management at the home had appropriate systems in place to monitor the quality of care, health and safety.
We were told how people's privacy was respected and how the service provided a safe environment.