Archived: The Risings

The Risings is a five-bedroom detached house on the outskirts of Exeter. The service provides accommodation and support for up to five younger adults with a range of complex learning and behavioural difficulties. At the time of the inspection there were five people living there.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were very relaxed and interacted confidently with staff. Those who were able told us staff were kind and they felt safe. This was confirmed by relatives we spoke to.

People were supported to engage in a wide range of activities both within the home and the local community, which maximised their quality of life.

Staff promoted people’s privacy and dignity, enabling them to make choices and have as much control and independence as possible. Staff ensured people were supported with their communication, which meant they had a voice.

An open, transparent and positive culture helped people and staff feel valued and supported. There was a comprehensive quality assurance programme. Clear processes were in place to ensure effective monitoring and accountability.

We observed people were supported by sufficient numbers of suitably trained and competent staff.

There had been a lot of changes in the staff team, however this was now stabilising as recruitment and retention were improving.

Staff were recruited safely, and safeguarding processes were in place to help protect people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Care plans were detailed, person centred and reviewed regularly with people and their relatives where appropriate. The format had been revised, and they were now more person centred and easier to read. There were systems in place to ensure information about any changes in people’s needs was shared promptly across the staff team.

People received their medicines safely, and in the way prescribed for them. The provider had good systems to manage safeguarding concerns, accidents, infection control and environmental safety.

Staff worked effectively with external health and social care professionals to meet people’s healthcare and nutritional 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 Good (published 12 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Risings on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service 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. The registered manager was on annual leave on the day of the inspection, so we spoke with them on their return by telephone. The deputy manager was covering and available throughout the inspection.

There was a high level of confidence in the leadership and management of the service expressed by people, relatives and staff. Managers had a ‘hands on’ approach, and were always available to offer support and guidance. One relative told us how they had valued the support they themselves had been given when their family member moved into The Risings. The managers had told them, “Any problems you’ve got to run it by us”. They added, “I was there for nearly two hours. As a parent handing them over it’s difficult and they did help me. They told me, “Nothing’s changed except their address. You’re still their voice”.

The Risings had previously been the provider’s only service for children, which meant people needed to move into an adult placement when they were 18. Relatives and external professionals told us this had impacted negatively on those people affected and they had lost some of their skills and confidence. These people had wanted to return when The Risings re-registered as a service for adults, and were now beginning to regain the confidence and skills they had lost. This required a highly personalised and responsive approach, and relatives and health professionals confirmed the progress people had made.

The service placed a strong emphasis on a ‘person centred approach’, and ensured people, and their advocates where appropriate, were fully consulted and involved in all decisions about their lives and support. This meant people’s legal rights were protected. People’s individual communication needs were understood and all information provided in a format appropriate for them, which meant they could participate fully. We observed that staff were kind and caring and treated people with dignity and respect. A relative told us, “I can’t get over how all those people are treated so wonderfully…exactly the same whether they have family support or not…the young adults come first”.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with vulnerable people

There were enough staff deployed to meet people’s complex needs and to care for them safely. People were engaged in a variety of activities within the home and in the community and there were sufficient numbers of staff to support people to go out when they wanted to. This ensured people experienced a good quality of life. There had been some difficulty in recruiting staff to fill vacant support worker posts. The provider had reviewed pay and job roles, and at the time of the inspection a successful recruitment campaign was underway. It was anticipated the service would be fully staffed in the next few weeks.

A comprehensive induction and regular training meant staff were knowledgeable about their roles and responsibilities, and people’s individual needs. This included specific service related training which enabled them to understand and meet the complex needs of the people living at the Risings. One member of staff told us, “The training is brilliant, really good, especially autism awareness which is really important. The whole training programme is spot on”.

People received care and support in line with their individual care plans. Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s support plan showing how they should be supported to manage these risks. Risk assessments also supported people to take positive risks. This enabled staff to promote their independence and meant people could do what they wanted to do in a safe way, . Systems were in place to ensure people received their prescribed medicines safely and when required. The service ensured people had access to a range of external health and social care professionals, which meant their physical and emotional needs were met.

The provider had comprehensive and effective quality assurance systems in place to monitor safety and the quality of care. Managers actively sought feedback from people using the service, staff and their families, and we saw this information was used to improve the quality and safety of the support provided.