20 July 2023
During an inspection looking at part of 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.