Rivers

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Processes were in place to ensure risks associated with closed cultures were identified and mitigated, and lessons were learnt to continually identify and embed good practice. There was an open and honest culture within the team, with channels to ensure clear communication. Audits were used to learn and improve practice and care. For example, following an audit which highlighted some poor recording of clinical tasks, further training was put in place across the organisation. Learning was passed on to staff in the form of care staff meetings, 1 to 1 supervision and through messages on the electronic system. This helped to embed learning into practice. The service was aware of their responsibility in relation to duty of candour. A relative told us, “After the last CQC inspection we got the outcome of that and saw an action plan. We were made aware of issues in the report and feedback.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. For a person that had moved to the service, a clear transition plan was completed. This included the person visiting the home. Records of people’s care needs were kept so they could be shared with other professionals if needed. A professional told us, “During my visit I was treated professionally and timely. The staff member had a considerable knowledge of the individual and was able to access additional notes when clarification was required.” People had hospital passports in place which ensured relevant information was passed over if people were admitted to hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. There were improvements since the last inspection and the service now shared and acted on concerns quickly and appropriately, including reporting to the local authority safeguarding team and the Care Quality Commission. People looked comfortable and relaxed with staff who supported them. Relatives told us their loved ones were safe. Comments included, “[Relative] is in a safe caring place.” And, “[Relative] is safe in the environment and happy no signs of frustration, care provided is really good.” Staff knew how to recognize and report any concerns. A member of staff said, “I would go to the manager. Confident something would be done.” Appropriate applications were completed to authorise a person being deprived of their liberty (DoL). We found 1 condition relating to 1 authorised DoLS was not being fully met. This was a recording issue and was rectified during the inspection.

The provider did not always work well with people to manage risks. People had risk assessments in place, with areas covered included physical health and well-being, specific health conditions, nutrition and hydration including choking and environmental safety including Emergency Evacuation Plans (PEEPS). Some additional information was required to ensure staff had clear guidance when supporting some people with a specific health condition. We did not find these shortfalls had impacted on people's care as staff knew people well, and the concerns identified were rectified during the inspection. The service supported positive risk taking and provided examples of this.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had systems to make sure people lived in a safe environment. There were regular in house safety checks. This included monthly room and equipment checks and weekly checks of the fire detecting equipment. Outside contractors carried out periodic testing of things such as the fire detecting system. The electrical installation and boilers. There was a maintenance team who were able to deal with emergency repairs. People had been consulted about the environment to ensure adaptations and reasonable adjustments were made. People personalised their rooms and were included in decisions relating to the interior decoration and design of their home.

The provider did not always make sure there were enough staff available. Although there were improvements since the last inspection, and staff now received training, effective support and supervision, we received mixed feedback from people, relatives and staff regarding staffing. A person, and some relatives, told us they did not always have free flowing conversations with staff due to English not being staffs’ first language. Some concerns were also raised regarding staffing levels. A person told us they do not always get their 1-1 hours. Another person told us staff did not understand them, and they sometimes have to wait for a member of staff for support. Some relatives told us there were times when there was not enough staff, although others told us staffing levels had improved. Some staff told us there were times when there were not enough staff. A staff member told us this meant people’s 1-1 support, and physiotherapy programmes were not always being completed. The concerns were discussed with the registered manager who provided assurances that people’s commissioned hours were being met. They told us they had requested reassessments of some people’s needs from the local authority to address shortfalls in support hours required to meet people’s changing needs. People were cared for by staff who had been safely recruited and received induction training when they began work. Staff told us they were able to shadow more experienced staff to support them to get to know people and how they liked to be cared for. A member of staff said, “You can shadow other staff. You do not do anything until you are comfortable.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. All areas of the home were observed to be clean. Staff received training, had access to the personal protective equipment (PPE) they required and were observed to be wearing this throughout our visits.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Some documentation around PRN (when required) medications was insufficiently completed and in 2 cases a certain medicine was not available for a person meaning the person did not receive it for one or more days. Storage of medication was appropriate, including for controlled drugs. Staff received training and competency checks.