Rivercourt Project Short Breaks

Rivercourt Short Breaks Service is a care home which operates as a respite service. It provides short stays and emergency accommodation and personal care for people with a learning disability and autistic people. It is registered to accommodate up to five people at a time.

People’s experience of using this service

People and their families were universally positive about the service. Family members spoke of the strong trust they had in the leadership and how the service was key to helping them maintain their caring responsibilities. People spoke of the times they had received support from the service during family emergencies. The service reached out to families to provide practical support during the COVID-19 pandemic. A family member told us “They’ve always been there for us. Without that help, I don’t know where I’d be.”

People told us their relatives always looked forward to visiting the service and expressed happiness when they knew they were due to attend. The service understood people’s communication needs and worked to help people develop these. People were actively involved in planning and preparing meals and drinks. People were supported to identify goals and skills they wished to develop, and the service worked with people and wider day opportunities to help them develop their skills and undertake meaningful activities and employment.

The provider managed risks to people in a way which protected their rights and opportunities, with a strong understanding of what people’s behaviour meant and how best to respond to this. An understanding of people’s communication needs was strongly integrated into every aspect of care and support. Staff were safely recruited, and staffing levels and skills were planned to safely meet people’s needs. There were suitable procedures to manage people’s medicines safely.

The service planned people’s stay and support in a way which reduced their risks from contracting or spreading COVID-19. There were suitable systems of testing and infection control, and the provider offered practical support to people and their families to participate in these.

The management of the service had a clear vision of how to develop the service in partnership with people and their families and worked closely with families and local services to do this.

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 support, right care, right culture

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right Support, right care, right culture.

Right support: The service’s unique model of care supported people’s choice and independence and provided person-centred care.

Right care: People were supported to be full participants in their local communities and develop work and training opportunities of their choice.

Right culture: The leadership of the service helped empower people and their families to shape local services to meet their needs.

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 outstanding (published 2 May 2019).

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.

Follow up

We will continue to review information we receive about this service in line with our monitoring activity, which will inform when we next inspect the service.

Rivercourt Short Breaks Service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. The service provides personal care for people with a learning disability and/or autistic spectrum disorder. 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. The service is registered to accommodate up to five people and approximately 40 people used the service for flexible periods each year.

The registered manager also managed Options, a nearby day services centre for people with a learning disability. This report also refers to Linking Hands, which is a social enterprise that the registered manager supported the relatives of people who used the respite service to set up. Some of the people who used Rivercourt Short Breaks Service also used Options. The ‘Linking Hands Choir’ consists of people who used the respite and/or day services centre and their relatives. Options and the Linking Hands social enterprise and choir are not within our scope of regulation.

At our previous inspection we rated the service Outstanding. We had rated safe, effective and responsive as Good, and caring and well-led as Outstanding. At this inspection we found the evidence continued to support the rating of Outstanding in caring and well-led and we have also rated responsive as Outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

The service continued to deliver outstanding care and support to provide people with an enjoyable and safe respite experience, and offered opportunities to learn new skills, develop and maintain friendships and participate in fulfilling social activities within the service and in the community. The provider ensured that people’s respite stays positively impacted on their daily wellbeing.

People were protected from harm or abuse by staff who understood how to protect people. Staff had attended safeguarding training and local health and social care professionals commented very favourably about the service’s ability to safely support people and provide stability during difficult periods in their lives. Risk assessments were thorough and provided relevant guidance for staff about how to mitigate identified risks. These assessments demonstrated a balanced approach to enabling people to live as independently as possible and take carefully considered risks. Medicines were safely managed. Sufficient staff were deployed to meet people’s needs and wishes, and staff were recruited via robust procedures. People who used the service and relatives were encouraged to participate in the recruitment process. Systems were in place to record and analyse any accidents or incidents, to enable the provider to learn from events and minimise the risk of future occurrences. The premises were clean and staff understood how to prevent cross infection.

People were supported by staff who had regular training and supervision, and an annual appraisal. Staff received mandatory training which included fire safety, food hygiene and infection control. The training programme also offered specific training to enable staff to meet the needs of people who used the service, for example autism awareness and a dysphagia course. The training programme included sessions where staff had face to face discussions with health and social care professionals to enhance their learning. Staff informed us they felt well supported by the management team. People were competently supported to meet their nutritional needs and supported to prepare their own snacks and drinks, where possible. The care and support plans contained detailed information about people’s preferences and how to meet any dietary or cultural needs. We observed that where necessary people were sensitively supported to eat and drink, in line with any guidance from health care professionals. Systems were in place to support people to meet their health care needs. The design of the care home appropriately met people’s needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. Staff had received training in relation to the Mental Capacity Act 2005 (MCA) and knew how to protect people’s rights. The management team understood the legal processes to follow if people who used the service were assessed to require a DoLS authorisation.

The registered manager and the staff team continued to be passionate about providing an outstanding standard of care and support that was compassionate, creative and personalised. People were supported in a respectful manner that promoted their entitlement to dignity and privacy. We observed very positive interactions between people who used the service and staff. The care and support plans demonstrated that people’s individual interests and aspirations were understood and met. Staff continued to demonstrate a thorough understanding of people’s hobbies, likes and dislikes, and any practices related to their cultural and/or religious backgrounds. They understood about people’s day-to-day lives including the college courses and day centre groups they attended, family relationships and important friendships. There was a strong emphasis on supporting people to integrate in the local community.

People’s needs and wishes were met in an outstandingly responsive way. The care and support plans continued to demonstrate that people who used the service and their representatives were supported to contribute to the planning and reviewing of their individual plans. People were enabled to learn new skills and benefit from a diverse range of experiences during their respite stays, through the service’s active approach to encouraging people to participate in different activities. These included baking and food preparation, grocery shopping, arts and crafts, gardening, pub lunches, bowling, trips to the park and outings to places of interest. The registered manager and staff team demonstrated that vibrant and innovative improvements had been implemented since the previous inspection, which included supporting people who used the service to creatively fundraise and participate in an amazing trip to South Africa to carry out voluntary work for a charity.

People and their relatives were supported to raise any concerns or complaints about the quality of the service. The registered manager and staff demonstrated that people were supported to meet their end of life care needs with compassion and dedication, in line with guidance and support from health care professionals.

The provider continued to demonstrate there was a very positive culture at the service, which was outstandingly well-led. The registered manager displayed a clear vision about the values and required quality of the service, which was shared by staff. The staff team benefitted from strong leadership and the registered manager consistently led by example. Systems were in place to continually improve the quality of the service. The registered manager continued to liaise with other professionals to enable the service to reflect on its practice and strive to achieve ongoing development and new improvements.

Further information is in the detailed findings below.

Rivercourt Project Short Breaks Service is a five bedded respite care home for adults with a learning disability who ordinarily live with their families, and respite is also offered to people who live with a partner or friend, or live alone. At the time of this inspection 30 people used the service for varying length of stays and five people were using the service on the two days we visited. The service can be accessed for day care only, if required. More than half of the people who use the service are living with autism, and two of the bedrooms are equipped with ceiling hoists to support people with mobility needs.

There was a registered manager in post, who has managed the service for over fourteen years. 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.

The service delivered outstanding care and support in order to provide people with an enjoyable and safe respite experience, and offered opportunities to learn new skills, develop and maintain friendships and participate in fulfilling social activities within the service and in the community. Although people ordinarily attended the service for a maximum of 12 short visits each year, the provider ensured that these respite stays positively impacted on people's daily wellbeing. For example, people were supported by staff to express their views about difficult events in their lives through the use of therapeutic life story work. A person who used the service told us that staff provided the emotional support and encouragement they needed to cope with their health care concerns, which made it easier to manage at home. The provider supported people to access other health and social care services, and created additional local leisure facilities through setting up a social enterprise and disco evenings. The provider supported the relatives of people who used the service through quarterly relatives meetings, which were used for peer support and a chance to socialise with other family carers, in addition to discussions about the service.

There were policies and procedures in place to protect people from harm or abuse and staff were able to explain the actions they would take to protect people. Records confirmed that staff had attended relevant safeguarding training and external health and social care professionals had praised the registered manager and the staff team for their thoughtful work with people at risk of abuse.

Up-to-date risk assessments were found in the care plans we checked. The risk assessments were individualised and addressed a range of issues, including guidance about how to support people to maintain their safety when out in the community for activities, and how to support people with behaviour that may challenge the service. The registered manager and the staff team supported people to live as independently as possible, and the risk assessments demonstrated a balanced approach to considering the possible benefits and risks associated with various choices and activities.

The registered manager and the staff team were passionate about providing an outstanding standard of care and support that was compassionate, creative and personalised. There was sufficient staff available to provide people with individual support as required, and to take people out to places of their choice including restaurants, pubs, leisure centres, the cinema and parks. People were also supported by staff to participate in events and projects that benefitted the local community, such as a conservation and gardening scheme. Staff were safely recruited and systems were in place to involve people, and the relatives, during the recruitment process.

Medicines were stored and administered safely. Staff had relevant training and understood their responsibilities in regards to the secure and correct management of people’s medicines. Written guidance was in place to ensure that people were supported to receive their medicines in accordance with any instructions from health care professionals, and people’s own preferred routines were respected which meant that people who managed their own medicines at home were supported to maintain their independence during their respite stay.

People were supported by staff who had regular training and supervision, and an annual appraisal. The training programme addressed the specific needs of people who used the service, in addition to mandatory training such as food safety and the safe moving and positioning of people. Staff were enthusiastic and committed to meeting the needs of the people who used the service. They told us that the training was of a high quality and they felt well supported by the registered manager.

People were presented with choices about their food and drinks and staff were aware of individual likes and dislikes, as well as any specific dietary needs. People were supported to participate in menu planning, grocery shopping and the preparation of meals, snacks and drinks. There were also regular opportunities to eat out at restaurants, cafés and pubs. Where required, people were supported to eat and drink in a patient way that ensured their dignity.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff had received relevant training and understood how to protect people’s rights. There were no DoLS authorisations in place at the time of the inspection and the registered manager understood the necessary legal processes to follow if required.

We observed that people had positive and relaxed interactions with staff, who demonstrated a compassionate and knowledgeable understanding of people’s unique and sometimes complex needs. There was a happy and friendly atmosphere that was commented on by relatives and health and social care professionals. Staff described people’s hobbies, likes and dislikes, and any practices related to their cultural and/or religious backgrounds. They understood about people’s day- to- day lives including the college courses and day centre groups they attended, family relationships and important friendships.

Care plans reflected people’s needs and interests and had been developed by consulting with people and their representatives. People and their relatives were invited to care planning and review meetings, and their views were valued. People’s individual needs were regularly reviewed and the care plans were kept up-to-date. The service also gathered information from health and social care professionals involved in people’s care, and liaised with these professionals in order to effectively support people.

There was a very positive culture at the service. The registered manager had a clear vision about the values and quality of the service, which was shared by staff. The staff team benefitted from strong leadership and the registered manager led by example. Systems were in place to constantly improve the quality of the service, which included the development of valuable relationships with external organisations that assisted the service to learn about, develop and implement best practice.

A single inspector carried out this inspection. The focus of the inspection was to answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

There were enough staff on duty to meet the needs of people using the service and a member of the management team was always available. Systems were in place to make sure that staff could learn from events such as accidents and incidents, complaints and concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The relevant staff were aware of the policies and procedures relating to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and understood when an application should be made.

Is the service effective?

People using the service told us they were happy with the care and support they received. One person told us, "I like coming here, it's always good. I go bowling and I help [staff member] with washing up." Relatives told us they were pleased with the how the service planned and delivered care. One relative said, "They have introduced [my relative] to new interests and experiences and given them confidence. The staff understand that each person is a unique individual."

Is the service caring?

We observed people being spoken with in a kind and encouraging way by staff. For example, people were encouraged and supported to participate in the inspection by speaking with us about their experiences of using the service or by showing us around the garden. There were policies and procedures in place to inform people of their rights and these were available in large print and/or pictorial formats, to meet the needs of people who use the service.

Is the service responsive?

People's needs were assessed before they used the service, which included information from people, their families, and other professionals and services involved. People were provided with written and pictorial information about the service, which included a service users guide, newsletters and guidance about how to make a complaint. We saw that complaints were responded to within the agreed timescales. Staff had received training in order to understand the use of Best Interests decisions.

Is the service well led?

A range of quality assurance processes were in place to make sure that people's feedback was used to improve the quality of the service. For example, people using the service and their relatives were sent annual surveys and the manager held quarterly meetings for relatives. People using the service had contributed their views to the quarterly newsletter. The manager monitored the needs of people using the service to ensure that the correct staffing levels were in place. Complaints were analysed and the subsequent learning was used for making improvements. People using the service said they liked the manager and the relatives spoke highly of the manager's leadership and managerial skills.

The dietary requirements for all people staying at the home were recorded as part of the assessment and care plan records. People were asked what they chose to eat.

Medication bought with an individual staying at the service was checked and recorded on medication records. Medication was kept securely in a lockable medicine cupboard in the staff room.

When staff started at the service they received an induction. Staff undertook mandatory training on an annual basis, including safeguarding and what to do in a medical emergency. All staff attend team meetings and received annual appraisals where their performance would be discussed and targets set for the coming year.

The service conducted audits to monitor the quality of the service it was providing. Regular feedback questionnaires were completed. Records showed that there had been no incidents at the service in the last two years. We looked at the complaints log and there had been no complaints made in the last twelve months.

All records looked at were relevant and up to date and stored securely.