River View

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People were supported to have maximum choice and control of their lives and staff sometimes supported them in the least restrictive way possible and in their best interests; however, systems in the service did not always support this practice. Best interest decisions were not in place for one person and the language used in their support plan may be interpreted in a restrictive way.

We made a recommendation about this.

Right Support: People had a clear communication plan detailing how best to support them. tailored visual schedules were in use to support their understanding. People were assisted with their medication in a safe and appropriate manner. Staffing was provided at safe levels that enabled people to access the community and activities with support from trained, competent staff.

Right Care: Care and support was person centred, and records reflected people's goals and outcomes. although these could be made more consistent. Staff training and supervision was relevant, we observed people positively engaged with the staff team and the atmosphere in the home was welcoming and warm.

Right Culture: Audits should be reviewed to ensure they capture all regulatory requirements and ensure risks are mitigated.

We made a recommendation about this.

The service had recently undergone considerable change in relation to transition and staffing changes. Now the staff team were more consistent and transitions for people undertaken, the registered manager spoke positively of embedding policy and practice regarding the areas for improvement we found. Staff told us they felt very supported by the registered manager.

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 good (published 31 July 2018.) At this inspection the rating has remained the same.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has remained as good.

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

We have made a recommendation relating to the Mental Capacity Act and also in relation to audit processes.

Follow up

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

The home is a semi-detached house that has been adapted to meet the needs of the people living there. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place, who were responsible for two locations owned and run by the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Both locations are adjoining each other and the larger property River Cottage is used to store some records relating to the staff team at River View.

River View was last inspected by CQC in March when the service was rated as Good. At this inspection we found the service remained Good and met all the fundamental standards we inspected against.

At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service Good.

Family members told us they felt their relatives were safe and there were sufficient staff to meet people's needs. There was now a more stable staff team following recruitment and we saw that people were supported by a consistent staff team.

Medicines were safely stored and the registered manager immediately addressed two minor issues we found in relation to medicine records.

People had risk assessments that described the measures and interventions to be taken to ensure people were protected from the risk of harm. The records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP and care manager.

Staff told us they felt well supported in their role; they received induction and training. Staff had not always received supervision in 2017 due to management changes at the service but we saw from the start of 2018 with a new registered manager and team leader recruitment that supervision occurred regularly and was planned for the rest of the year.

People had choice and control of their lives and staff supported them in the least restrictive way; the policies and systems in the service supported this practice.

Staff were aware of the importance of supporting people with good nutrition and hydration. Staff told us they supported them to eat healthily and reduce weight where this was a concern. We saw that people were encouraged to shop for and prepare their own meals with staff support.

People had access to healthcare services, in order to promote their physical and mental health. We saw that people were supported to have annual health checks and to attend health screening appointments.

The premises were homely and suitable for people's needs. People were involved in decisions about the decoration and the provider had taken steps to make the environment more accessible in response to changes in people's needs. The environment and equipment was regularly checked and serviced.

There were detailed, person-centred care plans in place, so that staff had information on how to support people. ‘Person-centred’ is about ensuring the person is at the centre of everything and their individual wishes, needs, and choices are taken into account.

People were able to take part in a range of activities of their choosing and which were meaningful to them. People were supported to look for volunteering roles and training to support them to develop the skills for employment. People were supported to play an active role in their local community, which supported and empowered their independence.

There was a complaints procedure in place, should anyone wish to raise a complaint. There were opportunities for people to raise concerns through meetings and discussions with the staff team. Staff knew how to access advocacy services if they needed them.

There was a quality assurance system, which enabled the provider to monitor the quality of the service provided.

We received positive feedback about the registered manager, staff and the service as a whole. Comments from people, relatives, staff and other professionals indicated there was a positive, person centred culture within the service.

River View provides care and accommodation for up to three people with learning disabilities. It is located in a quiet residential area, near the River Derwent, in Shotley Bridge, Consett.

The home had a registered manager in place. 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 also managed another service close to River View. The registered manager worked Monday to Friday and shared their time between both services.

There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and the action they would take if abuse was suspected. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were completed to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. We saw that care plans clearly highlighted risks associated with behaviours that challenged. Control measures had been developed to ensure staff managed any identified risks in a safe and consistent manner.

We saw that staff had received supervision on a regular basis and an annual appraisal.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There were enough staff on duty to meet people’s needs.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that where appropriate an assessment of a person’s capacity had been completed, however this was not specific to decisions such as health, welfare and finance.

We found that safe recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were caring, calming and encouraging with people.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed regularly; however nutritional screening was not taking place.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

We saw people’s care plans were very person centred and written in a way to describe their care and support needs. These were regularly evaluated, reviewed and updated.

There was a plentiful supply of activities and outings for people. People were encouraged to pursue their hobbies and interests. People went on holidays.

The registered provider had a system in place for responding to people’s concerns and complaints. People were asked for their views.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture. Senior management visited the service on a regular basis; however did not complete a formal audit or keep a record of the visits as such we could not determine what checks had been made.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

Is the service safe?

People told us they were treated with respect. One person said 'Everyone is great and helpful.'

We found regular checks were made of the premises to see if they were safe. Records detailed when actions were taken to minimise risks to people.

We saw staff received regular supervision and support to meet people's needs.

Is the service effective?

People's health and care needs were assessed with them, and they or their representatives were involved in writing their plans of care. We saw these plans were written to engage and meet the needs of the people who lived there.

We saw each person had a file entitled 'My Life' which documented their activities and achievements.

The premises had been sensitively adapted to meet the needs of people who lived there and minimise risks of harm to them.

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Is the service caring?

Staff told us they had worked with people for a long time and watched them growing up so they knew them well to provide the right support.

We found plans in place to manage people's challenging behaviours which minimised risks to other people and staff.

People's preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own transport, which helped to keep people involved with their local community.

We looked at what people said in their meetings and comments made on the comments cards had been dealt with. We found the responses had been open and changes made. This meant people were being listened to and valued in their home.

One person told us how they could change their daily activity plan and talked confidently about how that would happen.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

We found systems in place to ensure all staff received the required information to carry out their daily work.

They also told us they were very happy with the support they received from staff at the home. They said, 'The staff help me keep healthy. They give me advice about exercise and healthy eating." Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

River View had robust recruitment procedure in place to protect the people who used the service.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We reviewed the evidence the provider sent to us and found it demonstrated the provider was now compliant in this area. The provider had procedures in place to ensure important events were reported to the Care Quality Commission without delay.