Rivers

Updated 16 September 2023

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 Health and Social Care Act 2008.

Inspection team

Two inspectors and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Rivers is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Rivers is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a not a registered manager in post. A new manager had been in post for 4 months. The manager had been deployed to Rivers from another of the provider's locations where they are currently the registered manager. The manager was in the process of moving their manager’s registration to Rivers.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

Two inspectors visited Rivers on 20 July 2023. We spoke/ communicated with 2 people who used the service. Other people we met had complex physical and learning disabilities and were not able to communicate with us verbally. Their opinions were captured through the use of communication technology, reactions to observations and interactions they had with staff.

We spoke with 11 members of staff including the manager, deputy manager and the provider’s quality assurance and compliance manager. We reviewed a variety of records relating to people's personal care and support and the running of the service. These included 4 people's care and support plans, 5 people’s medicines records, 2 staff recruitment files and a variety of records relating to the management of the service including policies and procedures.

We sought feedback from the local authority, and an expert by experience spoke with 5 relatives about their family member's experience of the care provided.

Updated 16 September 2023

About the service

Rivers is a residential care home providing personal care to up to 17 people. The service provides support to younger adults with a learning disability, physical disability, and sensory impairments. At the time of our inspection there were 17 people using the service.

The care home accommodates people across 2 separate homes called Rivers and The Cabin, each of which has separate adapted facilities and are situated next door to each other. Rivers supports 9 people, and The Cabin supports 8 people.

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.

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 service is larger than current best practice recommendations. However, the size of the service having any negative impact on people was lessened as the service was being delivered within 2 separate houses.

Right Support:

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.

People were supported to be involved in decisions about their care and support. Staff were observed communicating with people in ways that met their needs and supporting them to make choices.

Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to take part in activities and pursue their interests.

People lived in a safe and clean environment, that met their sensory and physical needs. People benefitted from an interactive and stimulating environment. People were able to arrange and decorate their bedrooms in the way they preferred.

Staff supported people to access specialist health and social care support in the community. Staff supported people with their medicines, and worked with health professionals to achieve good health outcomes.

Right Care:

Recruitment procedures were robust. However, concerns were raised regarding staffing levels. The service was impacted by many changes within the staff team.

Although staff in general knew how to support people safely, they did not always have appropriate training and support to ensure people received safe care at all times.

People received their medicines from staff who knew them well. Staff generally followed systems and processes to administer medicines safely, however improvements were needed to ensure staff received appropriate training and competency assessments.

We found 1 safeguarding concern had not been escalated to the Local Authority appropriately, and the provider had not always notified us of significant events in line with their legal responsibilities.

People's care plans and risk assessments reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity, and understood and responded to people’s individual needs. Throughout the inspection we observed kind, relaxed, compassionate, and caring interactions between people and staff.

Right Culture:

Improvements were needed to make sure there were effective systems to monitor the quality of the service and plan improvements.

People told us they were pleased with the support that staff provided to them, although relatives raised some concerns about the service their loved ones received.

Staff and the management team at the service spoke positively about people within the service and wanted people to live their best lives. Staff demonstrated their knowledge of people and placed people's wishes, needs, and rights at the heart of everything they did.

The staff, manager and deputy manager were open, acting on queries and feedback throughout the inspection.

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 April 2019)

Why we inspected

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

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.

Enforcement and Recommendations

We have identified breaches in relation to good governance and notifications of incidents at this inspection.

We have made recommendations in relation to safeguarding and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.