The Rivers

The Rivers is a residential care home that was providing accommodation and personal care to six younger adults with a learning disability or autistic spectrum disorder. The service was registered to care for six people.

The Rivers is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and care provided, and both were looked at during this inspection.

People’s experience of using this service:

• Although the registered manager ran a well organised service, the providers audits had not identified the registered manager had not notified CQC when Deprivation of Liberty Safeguards (DoLS) applications had been authorised. During the inspection we spoke with the registered manager to ensure CQC was notified in these cases.

• The provider sought the views of people’s relatives and took opportunities to improve the service. Staff were supervised, supported and clear about what was expected of them. Audits and checks were carried out, so any problem could be identified and rectified.

• The provider had processes in place for recruitment, staffing levels, medicines management, infection control and upkeep of the premises which protected people from unsafe situations and harm.

• Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken. The registered manager worked with the local authority safeguarding adults team to protect people.

• Staff were trained and supported to be skilled and efficient in their roles. They were very happy about the level of training and support they received and showed competence when supporting people.

• The premises provided people with a variety of spaces for their use with relevant facilities to meet their needs. Bedrooms were very individual and age and gender appropriate.

• Staff promoted people’s dignity and privacy. Staff provided person-centred support by listening to people and engaging them at every opportunity. Staff were very kind and caring and people using the service were calm.

• Support plans were detailed and reviewed with the person when possible, staff who supported the person and family members. Staff looked to identify best practise and used this to people’s benefit. Staff worked with and took advice from healthcare professionals. People’s health care needs were met.

• People had a variety of internal activities (such as music and cooking) and external activities which they enjoyed on a regular basis.

• 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidelines. 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.

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

Rating at last inspection:

At the last inspection the service was rated Good (21 September 2016). At this inspection, the overall rating has remained the same.

Why we inspected:

This was a planned inspection to confirm that this service remained Good.

The Rivers is a large, detached property over two floors with stairs to access the upper level. Individual bedrooms with their own shower rooms and toilets are provided and spacious communal areas are available. The service has a secure garden on three sides and a large driveway providing parking for a number of vehicles. The service is in a residential area of Farnborough with easy access to the town centre facilities.

The service did not have a registered manager. 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.

The previous registered manager had left the service in December 2015 to take up another role within the provider organisation. A manager had been appointed and was present during part of the inspection. They had applied to be registered with CQC, but they had subsequently withdrawn their application shortly before the inspection for personal reasons. The manager in post was due to leave the service a few days after the inspection. The operations manager told us that a peripatetic manager (who moves from service to service on a short term basis) would be assigned to the service to support people and guide staff, until a new manager had been recruited.

People were kept safe because staff understood their responsibilities in protecting people and knew how to report any concerns and were willing to do so when needed. Staff put people first and were respectful in their interactions with people.

Risks to people had been identified and assessed. Measures were in place to reduce risks to people and staff were seen to carry out these measures in a consistent way.

There were enough staff deployed at the service to ensure people’s needs were met and to allow for spontaneous activities. The operations manager told us of the contingency arrangements to cover gaps in the staff rota.

People’s needs had been assessed before they moved into the service and were kept under regular review to ensure they were met. The service was equipped or adapted to meet the varying needs of people using the service.

Recruitment procedures had been followed effectively and the required checks on people applying to work at the service had been carried out. This helped the provider to ensure only those who were suitable to work with people were employed.

Staff told us they had received an induction into their role to ensure they understood people’s needs and how to meet them. Staff understood the responsibilities of their role and we saw staff put people first during our visit.

Staff had completed a variety of training to ensure they had the skills and experience to support people effectively. This included training such as fire safety, first aid, safeguarding people at risk and moving and handling people. Training was kept under review in order to meet people’s specific needs or newly identified needs.

Staff told us they received supervision from their line manager in order to discuss their role, any development needs and any other aspect of working in the service. This meant people were supported by staff who had received guidance in their role from their line manager.

Changes had been made to the medicines administration procedure in the service to help prevent medicines incidents. Medicines were now managed safely to ensure people received their medicines as prescribed. Staff had been trained to administer medicines and people received their medicines in the way they preferred.

People using the service had varying levels or methods of communication which were well understood by staff, and were clearly recorded and updated. Staff understood when people were giving their consent for support and when they were not. Staff understood the principles of the Mental Capacity Act 2005 and supported people to make their own decisions. Where people were unable to make specific decisions appropriate action had been taken in the person’s best interest as legally required.

Where people’s liberty was deprived, applications had been made to the local authority to ensure that this was lawful and carried out in the least restrictive way.

People were supported to have enough to eat and drink and to maintain a balanced diet. Some people needed to have their food and drinks monitored to ensure they received enough and this was in place. Where additional guidance was needed this had been sought from appropriate healthcare professionals such as a dietician or a Speech and Language Therapist (SALT).

People were supported to access healthcare services promptly if they developed any illness or appeared unwell. A number of healthcare professionals were involved in the support of people including a GP, dentist services, opticians and a chiropodist

People were supported by caring staff who treated them with dignity and respect in a family style atmosphere. Staff knew each person well, were able to describe their individual needs and interacted in a relaxed and friendly way.

Staff were aware of the need to provide people with privacy when they wished it and to provide support and care in a discreet way. Support plans were seen to provide clear guidance to staff about respecting people’s privacy whilst ensuring their safety.

The service was responsive to people’s needs and changes were made accordingly to improve the experience for people. Staff recorded what worked well for people, what did not work so well and what could be learnt from things not working well.

Some people were able to tell staff or others about anything they were unhappy with or to complain. For those people who were less able to speak of any dissatisfaction, they were still able to make their feelings known. Staff understood each person’s ways of communicating and used items of reference to help some people’s understanding.

People were provided with an opportunity to give their views about the service each year in an annual survey, which was completed with the support of their relatives or staff.

The service was well-led and had a clear management and staffing structure, which consisted of a manager, team leaders and a team of support staff. The operations manager also visited the service regularly to support and supervise the manager, to monitor the service and to support and guide people and staff.

The manager of the service and staff promoted an open, person centred service with a focus on putting people first. Accidents and incidents had been reported and managed appropriately in order to prevent them reoccurring and to promote people’s safety.

The quality of the service provided was kept under review and was monitored by the manager in post and the provider. This had identified improvements were needed, for example in the decoration of the service. Action had been taken to decorate and re-equip the kitchen and plans were being made to decorate the lounge and other communal areas.

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

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Is the service safe?

People were protected from the risk of inappropriate or unsafe care. This was because the provider had effective systems in place to assess, plan, review and monitor the care and support provided to people who use the service. In addition procedures were in place to identify, assess and manage risks to the health, safety and welfare of people and others in relation to activities and incidents. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Relatives of people who used the service were confident about people's safety being maintained by the provider. One relative told us 'My relative wouldn't be there if we weren't both happy about it. They are very happy, extremely active and I know they feel safe'. People confirmed they felt secure in the service. One person said, 'I've been here a long time and I feel very safe'.

Safeguarding procedures were robust and staff understood how to safeguard people they supported. First aid equipment was available in the service and staff had received appropriate training to deal with minor injuries. Staff were familiar with the service plan called 'dealing with emergencies' which included guidance on maintaining the health, safety and welfare of people in the event of an emergency. This included evacuation procedures.

We found that the service recruitment policy had been adhered to. This meant that the provider had taken proper steps to ensure that suitable staff were recruited by this service and were provided with appropriate training and experience for the role.

Is the service effective?

People's care needs were assessed with them and their relative or representative when appropriate. We noted that care plans were detailed, had been regularly reviewed and reflected peoples care and support needs and aspirations.

All staff had received training to meet the needs of the people who use the service. Examples of training included infection control, the safeguarding of vulnerable adults (SOVA), safe moving and handling, the Mental Capacity Act, first aid and fire safety.

We spoke with two people and two relatives of people who use the service. They were complimentary about the care received. One person we spoke with said, 'The people here are very nice and the staff. They know what I like to do and what food I like. They always check to make sure I am OK. They look after me very well and I don't want to move'. It was clear from our observations that staff had a good understanding of people's care needs and were committed to providing quality care.

All of the people who use the service were registered with a local GP practice and we saw detailed health plans for each and evidence of attendance at GP and dentist appointments. One relative that we spoke with told us, 'The personal and medical care is brilliant. They are registered with a local surgery and the service manages their health really well. They have never been so well'.

Is the service caring?

People were supported by kind and supportive staff. We witnessed numerous interactions between people and staff and without exception support was provided in a caring way that promoted people's independence and upheld their dignity.

Relatives confirmed the caring approach taken towards them and their relatives. One relative said, 'I went there for the Halloween celebration and met some of the other relatives which was really nice. They also celebrated my relative's birthday with a party. The manager and staff really made an effort to make it special'. Another relative told us, 'The staff have all been very kind and they certainly know how to bring out the best in my relative. Although I don't go to the 'Rivers' that often, I am in regular contact with the manager and the staff. I'm impressed by how organised they are and communication is very good as far as I'm concerned'.

In conversation with staff one of them told us, 'Nothing is more important than our people's safety and happiness'.

There were systems in place to ensure people who use the service and their relatives could provide feedback to the provider about the quality of the service received. People and their relatives were confident that when concerns were raised these had been addressed.

Is the service responsive?

The service had a number of effective formal systems in place to monitor care quality including the support plan review process, the accident and incident recording process and complaints and comments. Activities in the community were also assessed for effectiveness and satisfaction levels. We saw evidence that the service had adapted timetables and procedures on the basis of feedback from these systems.

Staff meetings were held to discuss care issues and related matters.The provider regularly sought feedback from relatives. The registered manager told us, 'We communicate with people's families regularly and if there are any problems we deal with them straight away. The annual satisfaction survey is an important means for us to check whether we are getting things right as far as relatives are concerned'.

One relative that we spoke with told us, 'Communication with the staff and manager is first class. They let me know about things that I need to know and they always respond quickly when I contact them with a problem'.

Is the service well-led?

The registered manager demonstrated a thorough knowledge of their role. During our inspection they were accessible to people and staff and exuded calm assurance and expressed genuine interest in the activities that were undertaken.

Records were well maintained and easy to locate and navigate. The provider has specialist support available to the service in respect of behaviour analysis and management which was evidently well used.

Quality monitoring procedures were effective and staff presented as caring, dedicated and professional. Records we reviewed showed that relatives and members of the community were complimentary about the service and its staff and manager.

We found people were involved in their care and treatment and the service had planned people's care in a way that ensured their safety and welfare. The service had ensured all staff were trained in safeguarding and knew how to report concerns. Staff were provided with the tools and support to carry out their role to a high standard and the service had systems in place to assess and monitor the quality of the care provided.

In this report the name of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time.