This inspection took place on 31 December 2015 and 5 January 2016. The first day of the inspection was unannounced and we told the registered manager we were returning on the second day. At our previous inspection in May 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.Rivercourt Project Short Breaks Service is a five bedded respite care home for adults with a learning disability who ordinarily live with their families, and respite is also offered to people who live with a partner or friend, or live alone. At the time of this inspection 30 people used the service for varying length of stays and five people were using the service on the two days we visited. The service can be accessed for day care only, if required. More than half of the people who use the service are living with autism, and two of the bedrooms are equipped with ceiling hoists to support people with mobility needs.
There was a registered manager in post, who has managed the service for over fourteen years. 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 delivered outstanding care and support in order to provide people with an enjoyable and safe respite experience, and offered opportunities to learn new skills, develop and maintain friendships and participate in fulfilling social activities within the service and in the community. Although people ordinarily attended the service for a maximum of 12 short visits each year, the provider ensured that these respite stays positively impacted on people's daily wellbeing. For example, people were supported by staff to express their views about difficult events in their lives through the use of therapeutic life story work. A person who used the service told us that staff provided the emotional support and encouragement they needed to cope with their health care concerns, which made it easier to manage at home. The provider supported people to access other health and social care services, and created additional local leisure facilities through setting up a social enterprise and disco evenings. The provider supported the relatives of people who used the service through quarterly relatives meetings, which were used for peer support and a chance to socialise with other family carers, in addition to discussions about the service.
There were policies and procedures in place to protect people from harm or abuse and staff were able to explain the actions they would take to protect people. Records confirmed that staff had attended relevant safeguarding training and external health and social care professionals had praised the registered manager and the staff team for their thoughtful work with people at risk of abuse.
Up-to-date risk assessments were found in the care plans we checked. The risk assessments were individualised and addressed a range of issues, including guidance about how to support people to maintain their safety when out in the community for activities, and how to support people with behaviour that may challenge the service. The registered manager and the staff team supported people to live as independently as possible, and the risk assessments demonstrated a balanced approach to considering the possible benefits and risks associated with various choices and activities.
The registered manager and the staff team were passionate about providing an outstanding standard of care and support that was compassionate, creative and personalised. There was sufficient staff available to provide people with individual support as required, and to take people out to places of their choice including restaurants, pubs, leisure centres, the cinema and parks. People were also supported by staff to participate in events and projects that benefitted the local community, such as a conservation and gardening scheme. Staff were safely recruited and systems were in place to involve people, and the relatives, during the recruitment process.
Medicines were stored and administered safely. Staff had relevant training and understood their responsibilities in regards to the secure and correct management of people’s medicines. Written guidance was in place to ensure that people were supported to receive their medicines in accordance with any instructions from health care professionals, and people’s own preferred routines were respected which meant that people who managed their own medicines at home were supported to maintain their independence during their respite stay.
People were supported by staff who had regular training and supervision, and an annual appraisal. The training programme addressed the specific needs of people who used the service, in addition to mandatory training such as food safety and the safe moving and positioning of people. Staff were enthusiastic and committed to meeting the needs of the people who used the service. They told us that the training was of a high quality and they felt well supported by the registered manager.
People were presented with choices about their food and drinks and staff were aware of individual likes and dislikes, as well as any specific dietary needs. People were supported to participate in menu planning, grocery shopping and the preparation of meals, snacks and drinks. There were also regular opportunities to eat out at restaurants, cafés and pubs. Where required, people were supported to eat and drink in a patient way that ensured their dignity.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff had received relevant training and understood how to protect people’s rights. There were no DoLS authorisations in place at the time of the inspection and the registered manager understood the necessary legal processes to follow if required.
We observed that people had positive and relaxed interactions with staff, who demonstrated a compassionate and knowledgeable understanding of people’s unique and sometimes complex needs. There was a happy and friendly atmosphere that was commented on by relatives and health and social care professionals. Staff described people’s hobbies, likes and dislikes, and any practices related to their cultural and/or religious backgrounds. They understood about people’s day- to- day lives including the college courses and day centre groups they attended, family relationships and important friendships.
Care plans reflected people’s needs and interests and had been developed by consulting with people and their representatives. People and their relatives were invited to care planning and review meetings, and their views were valued. People’s individual needs were regularly reviewed and the care plans were kept up-to-date. The service also gathered information from health and social care professionals involved in people’s care, and liaised with these professionals in order to effectively support people.
There was a very positive culture at the service. The registered manager had a clear vision about the values and quality of the service, which was shared by staff. The staff team benefitted from strong leadership and the registered manager led by example. Systems were in place to constantly improve the quality of the service, which included the development of valuable relationships with external organisations that assisted the service to learn about, develop and implement best practice.