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Inspection carried out on 23 July 2019

During a routine inspection

About the service

The service was a large home, bigger than most domestic style properties. Riverview is registered to provide accommodation and personal care for up to nine young adults with learning disabilities, and at the time of our inspection there were nine people living there. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the layout of the service. This consisted of six self-contained flats and two rooms.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. In 2017 Riverview won a national best practice award for using innovative ways to reduce physical intervention and increase positive outcomes for people. The service used a PBS (positive behaviour support) approach which recognised the impact the environment and negativity had on people’s behaviour, and enabled staff to build a bespoke personalised environment for the individuals they were supporting. This had greatly reduced the stress and anxiety levels of people living at Riverview. Incidences of behaviour that challenges had reduced, and PRN (as and when required) medication had been required on just one occasion in the previous 12 months. A thorough analysis and investigation was completed if things went wrong, and any learning used to further reduce the risk of harm to people.

Without exception, people were supported to achieve their goals. The staff and management team were creative, committed and determined to support people to live independent lives and challenge the barriers to people with autism. The service promoted positive outcomes for people through positive risk taking. As a consequence, people were engaging with their families and local community, and achieving goals which had previously been unthinkable for them.

People were valued and plac

Inspection carried out on 31 October 2016

During a routine inspection

The inspection took place on the 31 October and 3 November 2016 and was unannounced.

Riverview is registered to provide care and accommodation for up to 10 people. On the day of the inspection eight people were living at the service. Riverview provides care for adults with a learning disability. The service particularly specialises in providing care for people with Autistic Spectrum Disorders.

The service had a registered manager in post. 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 provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. People were unable to tell us verbally about their experiences of the home, however, the difference the service was making to people’s lives was visible. People who had previously been restricted were now being supported in a different way, which gave them more freedom and an enhanced quality of life. We heard many examples of how people’s lives had changed for the better and about how many new opportunities they now had.

The home environment was tailored to individual needs and to help people to be as independent as possible. People who wanted or needed their own separate space were provided with facilities, which catered to their needs and were totally separate to the communal parts of the home. People who wanted the company of others were able to spend time in the communal areas with the right balance of staff support to keep them safe, whilst also allowing for a homely and relaxed environment.

Relatives and other agencies were without exception, extremely positive about the service and the care people received. Relatives told us about how people had moved from services where they had not been able to go out and had needed medicines to keep them calm and safe. We were told that since moving to Riverview people’s lives had changed and due to the care and the skills of the staff team people had progressed, experienced new opportunities and had more independence. Comments included, “ They used to be in a sparse room, now they have personal belongings, they never went out, now they go into town to the local coffee shop and people know them”, and “ The change has been dramatic, [….] eyes used to look sad, now they are smiling and bright, it is wonderful”.

Other agencies were very positive about the staff team and leadership of the service. We were told that staff embraced ideas and worked hard to ensure people were able to do the things they wanted. The overall view of other agencies we spoke with was that despite the complex needs of people they supported the service had managed to deliver excellent quality personalised care within a residential setting.

There was an extremely positive culture within the service. The management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the home’s philosophy and people were placed at the heart of the service. Staff demonstrated they understood and practiced this by talking to us about how they met people’s support needs. Staff spoke with commitment and used words like, “Individual” and “Independence” when they talked about people they supported.

Staff were highly motivated and inspired to offer kind and compassionate care and support. All the staff said they enjoyed their work and loved seeing people progress. We saw a number of examples of progress people had made since moving into the home

Inspection carried out on 9 May 2014

During a routine inspection

There were eight people living at the home at the time of the inspection. Our inspection was facilitated by the Registered Manager.

Below is a summary of what we found. The summary is based on our observations, on records we looked at and on the views of people we spoke with. If you want to see the evidence that supports our summary please read the 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?

This is a summary of what we found:

Is the service safe?

There were systems in place to ensure all staff had received safeguarding training and were aware of reporting processes. There were systems in place to ensure risks to people�s safety and welfare were identified and risk assessments were put in place to minimise such risks. There were systems in place to ensure appropriate procedures were in place in the event of a foreseeable emergency. Relatives we spoke with told us �I feel they can meet my relative�s needs�, �If there was a problem they would be straight to A&E� and �I have no concerns with my relative�s care. I feel they�re very well looked after.�

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes.

There was a relevant policy in place and the Registered Manager had experience in making and submitting applications. The Registered Manager was aware of upcoming changes to the legislation and had taken steps to anticipate these and gain further knowledge and advice.

Is the service effective?

People�s family members we spoke with told us staff understood the needs of their relatives. It was clear from our observations and from speaking with relatives that staff had a good understanding of people�s care and support needs and that they knew them well. We saw that staff knew how to respond to people�s behaviours and bring out the best in them. Relatives told us �They are doing everything they can to make my relative happy�, �The staff know my relative well. They try to help them be mobile and independent.� And �All the staff are very aware of my relative�s disabilities and have found ways of communicating with them. They are clued in to what they prefer.�

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed understanding, patience and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed. People�s routines and preferences were respected and personalised activities were organised for people to participate in. Relatives we spoke with said �They ask my relative what they want to do, if they refuse that is respected. They don�t push anything on them�, �The staff are excellent and very calm with my relative.� And �The staff are very caring.�

Is the service responsive?

Records showed that people�s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people�s wishes. There were highly detailed records of people�s preferred routines and how staff were to respect these. We saw records of the home responding to people�s changing needs and seeking advice and guidance from relevant healthcare professionals.

Is the service well-led?

Quality assurance processes were in place in the home. Relatives we spoke with told us they had been regularly asked for feedback and their opinions had been sought. We saw that several audits and internal inspections had been carried out and that any issues identified had been acted upon. Staff told us they were regularly asked for their feedback and felt their opinions were listened to and used to improve the home.

Inspection carried out on 19, 28 November 2013

During a routine inspection

Riverview was first registered with the Care Quality Commission (CQC) in April 2013. This was the first inspection since the service was first registered. The whole service, including care workers and people who lived there had moved into Riverview from Tower House. During our visit we spoke with two care workers, the assistant manager and the manager.

We visited the service on 19 and 28 November 2013. After our first visit on 19 November we received concerning information. This related to the admission of an individual without risk assessments. This meant that people were at risk. At our second visit we found that the person had been admitted without risk assessments having been fully completed but they had since been completed.

We saw that care workers respected people's privacy. Care plans contained useful information that helped care workers look at the individual in a person centred way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw information that showed there were effective recruitment procedures in place. For example, each file contained two references. We found that care workers had not received regular supervision and appraisals.

We found no evidence of an effective quality assurance system at Riverview. We saw some information that related to an action plan for Tower House, but could not be assured that the information related to Riverview.