We carried out a review of the data available to us about Rivers on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Rivers, you can give feedback on this 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.
At the last inspection the service was rated Good. At this inspection we found the service retained an overall rating of Good with an outstanding rating in providing responsive care.
People continued to be protected from the risk of abuse and felt safe. Staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed.
People received their medicines as prescribed and the management of medicines was safe.
People continue to be supported by sufficient numbers of staff who had received adequate training for their role.
People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported these practices.
People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.
People who used the service, or their representatives, were encouraged to contribute to the planning of their care. People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner.
People received a high standard of individualised person centred care from staff who had an excellent understanding of their needs. They were supported to take part in a wide range of social activities of their choice that placed a strong emphasis on building independence and self-esteem. These included personal fitness regimes, voluntary work schemes and college courses.
People who used the service, or their representatives, were encouraged to be involved in decisions and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously
Further information is in the detailed findings below
We performed the unannounced inspection on 26 August 2015. Rivers is run and managed by Voyage 1 limited. The service provides accommodation and personal care for up to six adults (under 65 years) with learning disabilities and/or mental health needs. On the day of our inspection six people were using the service.
The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.
The last inspection we undertook was on 27 November 2013, the service was compliant in all areas inspected. During this inspection we found people were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority and ourselves when needed.
Risks to individuals were managed appropriately and staffing levels were sufficient to support people’s needs, people received care and support when required.
Medicines were given as prescribed and the management of medicines was safe.
People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.
People were protected from the risks of inadequate nutrition and referrals were made to health care professionals when needed.
People who used the service, or their representatives, were encouraged to contribute to the planning of their care and were treated in a caring and respectful manner. Staff delivered support in a relaxed and considerate manner.
People’s behaviour patterns were monitored regularly to allow staff to provide the most appropriate support for each individual.
Systems were in place to monitor the quality of service provision and people felt they could report any concerns to the management team, and they would be taken seriously.
People spoke positively about the service and the staff. One person said, 'It's good overall.' Another person said 'I sort of like living here, staff talk nicely to me.' A family member told us, 'It is the best place they (relative) have ever lived, I give it top marks.' A professional from the community mental health team told us 'The home is receptive to new ideas.' They also said, 'The home is very person centred.'
The manager told us that every person had a service user handbook and person centred support plan. People and their families were involved in how the care and support was delivered.
People's needs were assessed and person centred support plans were developed. Individual risk assessments were undertaken. Identified control measures were incorporated into support plans to manage and reduce risk.
Systems were in place for cleanliness and infection control. We saw audits which identified planned improvements. We also saw schedules and checks of cleaning activities..
We found that robust systems were in place that ensured appropriate levels of staffing were maintained. The provider supported staff with training needs.
A complaints procedure was in place. At the time of the inspection no complaints had been received.
All of the relatives we spoke with told us they were happy with the care and support their family members received. One relative told us, 'They [staff] are good at keeping me informed.' Another told us, 'I am happy with everything and confident they [staff] are meeting [family member's name] needs.'
Relatives told us that staff supported their family member's health and personal care needs and took prompt action to get them medical attention when it was needed. They also said that staff always treated their family members with respect.
Staff we spoke with told us the provider was good in terms of ensuring that staff training was up-to-date and that they really enjoyed working at the service, some of which had worked there for a number of years.
Relatives told us they had always been happy with the care and support they witnessed on their visits and have never had any concerns.