River Lodge

The service was able to demonstrate how they were meeting underpinning principles of Right support, right care, right culture.

About the service

River Lodge is a residential care home providing personal care. At the time of our inspection the home was providing personal care to 8 people who have a learning disability and or autistic spectrum disorder. The service can support up to 8 people in an adapted building.

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

Right Support:

People were at the heart of their own care and support. Staff supported people in a way which safely managed risk, but ensured people were able to live as independently as possible to enhance people’s quality of life. Staff provided effective support to help people live their life as they wished. People, where possible were supported to have ownership over their medicines, and practices had been improved to ensure medicines were managed safely. 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.

Right Care:

People were supported by staff who were caring and knew people’s needs well. Care plans were detailed and individualised and helped staff acknowledge what was important to people. Staff supported people in a way which was person-centred and focused on people’s strengths and abilities. Staff were trained and knew how to keep people safe. Staffing levels had been tailored to ensure people received personalised and effective support.

Right Culture:

There was a positive culture in the home which focused on people receiving a high standard of care to enable them to live fulfilled lives. People were involved in their care and treated as individuals with respect and dignity. The registered manager and management team were committed to making River Lodge a nice place to live and were passionate about ensuring people received tailored and compassionate care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 July 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

River Lodge is a registered care home for adults with learning disabilities. At the time of our inspection the home was providing personal care to eight people. The service can support up to eight people.

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

Staff had recently introduced further monitoring for one person due to an increased risk being identified. At the time of our inspection this had not been fully embedded, as staff were not consistently completing the required documentation.

The provider had infection and control procedures in place. Some areas of the home required refurbishment to help keep them clean, the provider however, had plans in place to complete the required works. We also found not all staff were bare below the elbow, however the provider confirmed they were when delivering personal care and completing cleaning tasks.

People’s risks were assessed and monitored and detailed in their care plan with specific guidance to support staff. Staff knew people and knew how to support them to meet their needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This was a targeted inspection that considered risks to people and the monitoring of those risks. Based on our inspection of risk we found people’s choice and independence was promoted through their risk assessments which formulated their plan of care. For example, we saw staff were guided by one person’s preferred way to communicate. People’s care plans included documentation which were person-centred and promoted people’s dignity, privacy and human rights, including easy read documents and pictorial formats, for example for explaining COVID-19. Staff shared values which encouraged people to have inclusive and empowered lives through their everyday routines.

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 requires improvement (published 7 July 2021).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about another location under this provider based on the monitoring of people’s risks. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

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.

River Lodge is a registered care home for adults with learning disabilities. At the time of our inspection the home was providing personal care to eight people. The service can support up to eight people in one adapted building.

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

People’s medicines were not always managed effectively. We found occasions where the number of medicines in stock did not match people’s medicine administration records. This meant people may not have had their medicines as prescribed. The infection and control procedures in place were not always effective.

The provider's governance systems in place were not always effective. Audits did not always identify errors or areas for improvement, including the medicine errors we found. Some recent audits could also not be located. There was no risk assessments in place for the location of personal protective equipment (PPE) and some documents stored at the home were not relevant and belonged to other homes. People were not always involved in the service.

We found systems and processes were in place to protect people from potential harm or abuse and risks to people’s safety were assessed, monitored and reviewed. People were supported by enough staff who reported accidents and incidents and actions were taken following them.

The provider was working to improve the culture in the home. Managers and staff were clear about their roles and they acted on the duty of candour. The provider worked in partnership with others to achieve good outcomes for people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s choice, control and independence was supported through adaptations made to their care and within the home. People’s care plans were person-centred and reflected their human rights. Their human rights were also promoted through day to day routines along with their dignity and privacy. Staff and leaders shared attitudes and behaviours which promoted inclusivity and encouraged people to have confident and empowered lives.

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 3 June 2019).

Why we inspected

The inspection was prompted in part due to concerns we received about the assessment and management of potential risk to people, staffing and management oversight. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach in relation to good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People’s support plans contained clear and easy to understand information about their needs and risks and how to support them effectively. Support plans were person centred and contained information about people’s preferences, daily routines and what was important to them. For those people who were unable to express their needs and wishes verbally, staff had detailed guidance on the behaviours, gestures and body language the person would use to communicate their needs or wishes. From talking to staff it was clear they knew people well. They were able to tell us about people’s changing needs and how the support provided had been adapted to respond to these changes.

The atmosphere at the home was positive and inclusive. We saw that people were well looked after, safe and happy at the home.

Medication was managed safely and people had access to a range of health and social care professionals in support of their needs.

People who lived at the home were given opportunities to express their views and where possible any suggestions for improvement were acted upon. Feedback on the service was positive and from our observations it was clear that people liked the staff and the place in which they lived. All of the staff spoken with had a positive attitude about the service and the care that they provided. During our visit, we had no concerns about the support people received and the manager and staff team appeared committed to providing a good service.

In June 2017, CQC published best practice guidance called ‘Registering the Right Support’. This good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism. During our visit, we found that the service was not designed in line with this best practice guidance. The service was situated on a campus style setting with two other services for people who have a learning disability. However, we could see that the service focussed on the values set out in the ‘Registering the Right Support’ guidance which advocates that people’s choice, independence and ability to live as life as ordinary in their own home should be promoted in service delivery.

Rating at last inspection: This was the first inspection for this service since it registered with CQC. The service had been registered with a different provider and had previously been rated as Good in November 2015.

Why we inspected: This was a planned inspection and the first for this service under the current provider.

Follow up: We will continue to monitor the service and will inspect again in accordance with our inspection principles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk