Rivers

Updated 27 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection visit on 8 January 2020 was unannounced. We returned, announced, on 9 January 2020 to complete the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and we sought feedback from the local authority care commissioners and external professionals who worked with the service.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service and observed interactions between staff and the people they were supporting. We observed a staff care handover meeting and spoke with four members of staff including the registered manager, care workers and operations manager. We spoke with a visiting healthcare professional and reviewed a range of records. This included two people’s care records and medicines records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We obtained feedback from an independent advocate who represented one of the people living at Rivers. We looked at training data, policies and procedures. The registered manager sent the inspector updates to confirm the work that had been carried out immediately following the inspection.

Updated 27 February 2020

About the service

Rivers is a residential care home providing personal or nursing care for people who have mental health needs, learning disabilities or autistic spectrum support needs. The care home is an adapted residential building, and there were 6 people receiving a service at the time of the inspection.

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.

The service was registered for the support of up to 6 people; and the building design was similar to neighbouring large domestic homes. There were deliberately no identifying signs or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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 usually in their best interests; the systems in the service supported this practice, although the provider’s policy on transport costs did not.

People’s best interests were not always identified by the provider; and best interest decision processes were not always in place. For example, there was no evidence that people had given their consent to pay travel charges decided by the provider. The registered manager told us they were supporting people to have the charges reviewed. Following the inspection, the provider told us they intended to review their transport cost recovery policy.

People received support to meet their assessed personal care and development needs; from staff who were well trained and supported by the provider. People were involved in choosing and cooking food they liked, and meal times were social occasions. The care home environment met people’s housing needs; and the staff team linked with external agencies to ensure people received the care and health support they needed.

People were kept safe by the provider’s procedures and by staff who understood how to protect people from potential abuse. Risks were assessed, and action taken to reduce them when necessary. Staff had background checks carried out when they were recruited, so the provider could be assured of their suitability to support vulnerable people. Medicines were safely managed, and the care home was clean and homely. When incidents happened, the registered manager reviewed them and identified any lessons that could be learned to reduce the chance of recurrence.

Staff supported people with kindness and respect; and people told us they liked the staff. People were involved in making decisions about how their care was provided, and the team supported people to raise issues about things they were unhappy about. Privacy and dignity was respected at all times.

People’s support was individualised, and they had access to varied activities of their choice. People’s communication needs were met by staff who took the time to explain things to them. Important family links were supported and maintained, and the service had received no formal complaints since the previous inspection.

The service had a positive atmosphere and people were supported to achieve their longer-term goals through a series of planned smaller steps. The registered manager understood how to deal with incidents in an open and transparent way and ensured the necessary notifications to other agencies had been made. The support team understood their roles and were committed to providing a high-quality service for people. The registered manager was linked into other agencies and forums, so they could keep up to date and continue to learn about how services can continue to improve.

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.

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 previous inspection this service was rated as good (report published 8 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.