The inspection took place on 12 and 13 April 2016 and was unannounced. The Rivers is registered to provide accommodation and support to six people with a learning disability or autistic spectrum disorder who are aged between 20 and 35 years. At the time of the inspection there were six people living there. The Rivers is a large, detached property over two floors with stairs to access the upper level. Individual bedrooms with their own shower rooms and toilets are provided and spacious communal areas are available. The service has a secure garden on three sides and a large driveway providing parking for a number of vehicles. The service is in a residential area of Farnborough with easy access to the town centre facilities.
The service did not have a registered manager. 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.
The previous registered manager had left the service in December 2015 to take up another role within the provider organisation. A manager had been appointed and was present during part of the inspection. They had applied to be registered with CQC, but they had subsequently withdrawn their application shortly before the inspection for personal reasons. The manager in post was due to leave the service a few days after the inspection. The operations manager told us that a peripatetic manager (who moves from service to service on a short term basis) would be assigned to the service to support people and guide staff, until a new manager had been recruited.
People were kept safe because staff understood their responsibilities in protecting people and knew how to report any concerns and were willing to do so when needed. Staff put people first and were respectful in their interactions with people.
Risks to people had been identified and assessed. Measures were in place to reduce risks to people and staff were seen to carry out these measures in a consistent way.
There were enough staff deployed at the service to ensure people’s needs were met and to allow for spontaneous activities. The operations manager told us of the contingency arrangements to cover gaps in the staff rota.
People’s needs had been assessed before they moved into the service and were kept under regular review to ensure they were met. The service was equipped or adapted to meet the varying needs of people using the service.
Recruitment procedures had been followed effectively and the required checks on people applying to work at the service had been carried out. This helped the provider to ensure only those who were suitable to work with people were employed.
Staff told us they had received an induction into their role to ensure they understood people’s needs and how to meet them. Staff understood the responsibilities of their role and we saw staff put people first during our visit.
Staff had completed a variety of training to ensure they had the skills and experience to support people effectively. This included training such as fire safety, first aid, safeguarding people at risk and moving and handling people. Training was kept under review in order to meet people’s specific needs or newly identified needs.
Staff told us they received supervision from their line manager in order to discuss their role, any development needs and any other aspect of working in the service. This meant people were supported by staff who had received guidance in their role from their line manager.
Changes had been made to the medicines administration procedure in the service to help prevent medicines incidents. Medicines were now managed safely to ensure people received their medicines as prescribed. Staff had been trained to administer medicines and people received their medicines in the way they preferred.
People using the service had varying levels or methods of communication which were well understood by staff, and were clearly recorded and updated. Staff understood when people were giving their consent for support and when they were not. Staff understood the principles of the Mental Capacity Act 2005 and supported people to make their own decisions. Where people were unable to make specific decisions appropriate action had been taken in the person’s best interest as legally required.
Where people’s liberty was deprived, applications had been made to the local authority to ensure that this was lawful and carried out in the least restrictive way.
People were supported to have enough to eat and drink and to maintain a balanced diet. Some people needed to have their food and drinks monitored to ensure they received enough and this was in place. Where additional guidance was needed this had been sought from appropriate healthcare professionals such as a dietician or a Speech and Language Therapist (SALT).
People were supported to access healthcare services promptly if they developed any illness or appeared unwell. A number of healthcare professionals were involved in the support of people including a GP, dentist services, opticians and a chiropodist
People were supported by caring staff who treated them with dignity and respect in a family style atmosphere. Staff knew each person well, were able to describe their individual needs and interacted in a relaxed and friendly way.
Staff were aware of the need to provide people with privacy when they wished it and to provide support and care in a discreet way. Support plans were seen to provide clear guidance to staff about respecting people’s privacy whilst ensuring their safety.
The service was responsive to people’s needs and changes were made accordingly to improve the experience for people. Staff recorded what worked well for people, what did not work so well and what could be learnt from things not working well.
Some people were able to tell staff or others about anything they were unhappy with or to complain. For those people who were less able to speak of any dissatisfaction, they were still able to make their feelings known. Staff understood each person’s ways of communicating and used items of reference to help some people’s understanding.
People were provided with an opportunity to give their views about the service each year in an annual survey, which was completed with the support of their relatives or staff.
The service was well-led and had a clear management and staffing structure, which consisted of a manager, team leaders and a team of support staff. The operations manager also visited the service regularly to support and supervise the manager, to monitor the service and to support and guide people and staff.
The manager of the service and staff promoted an open, person centred service with a focus on putting people first. Accidents and incidents had been reported and managed appropriately in order to prevent them reoccurring and to promote people’s safety.
The quality of the service provided was kept under review and was monitored by the manager in post and the provider. This had identified improvements were needed, for example in the decoration of the service. Action had been taken to decorate and re-equip the kitchen and plans were being made to decorate the lounge and other communal areas.