The inspection took place on the 31 October and 3 November 2016 and was unannounced. Riverview is registered to provide care and accommodation for up to 10 people. On the day of the inspection eight people were living at the service. Riverview provides care for adults with a learning disability. The service particularly specialises in providing care for people with Autistic Spectrum Disorders.
The service had a registered manager in post. 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 provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. People were unable to tell us verbally about their experiences of the home, however, the difference the service was making to people’s lives was visible. People who had previously been restricted were now being supported in a different way, which gave them more freedom and an enhanced quality of life. We heard many examples of how people’s lives had changed for the better and about how many new opportunities they now had.
The home environment was tailored to individual needs and to help people to be as independent as possible. People who wanted or needed their own separate space were provided with facilities, which catered to their needs and were totally separate to the communal parts of the home. People who wanted the company of others were able to spend time in the communal areas with the right balance of staff support to keep them safe, whilst also allowing for a homely and relaxed environment.
Relatives and other agencies were without exception, extremely positive about the service and the care people received. Relatives told us about how people had moved from services where they had not been able to go out and had needed medicines to keep them calm and safe. We were told that since moving to Riverview people’s lives had changed and due to the care and the skills of the staff team people had progressed, experienced new opportunities and had more independence. Comments included, “ They used to be in a sparse room, now they have personal belongings, they never went out, now they go into town to the local coffee shop and people know them”, and “ The change has been dramatic, [….] eyes used to look sad, now they are smiling and bright, it is wonderful”.
Other agencies were very positive about the staff team and leadership of the service. We were told that staff embraced ideas and worked hard to ensure people were able to do the things they wanted. The overall view of other agencies we spoke with was that despite the complex needs of people they supported the service had managed to deliver excellent quality personalised care within a residential setting.
There was an extremely positive culture within the service. The management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the home’s philosophy and people were placed at the heart of the service. Staff demonstrated they understood and practiced this by talking to us about how they met people’s support needs. Staff spoke with commitment and used words like, “Individual” and “Independence” when they talked about people they supported.
Staff were highly motivated and inspired to offer kind and compassionate care and support. All the staff said they enjoyed their work and loved seeing people progress. We saw a number of examples of progress people had made since moving into the home. We saw how personalised care and a positive approach to managing behaviour had resulted in people having increased opportunities and enhanced well-being. Relatives said, “We never would have thought it was possible, they go out now and we even enjoy a meal together, that had never happened before”.
People were supported to express their views and have their voice heard. Staff were creative and used innovative methods to help people express their views and understand what was happening around them. One person had a personal timer to help them understand what was happening now and later. This helped reduce their anxiety and have control over their routines and lifestyle. Your voice meetings were held with people and information was available in a range of formats about issues relating to people’s care and the service. Pictures had been taken of builders working in the service and a contract drawn up with people so they could have their say on how they wanted these workers to behave when they were working in their home.
There were sufficient numbers of skilled staff to meet people’s needs and to keep them safe. Staffing levels were regularly reviewed and planned in line with people’s daily routines to help ensure they were able to do the things they needed and wanted. The provider had clear and effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. Relatives said they believed and trusted that people were safe, “Comments included, “The staff are so good at being consistent, before [….] came here, it was awful, they were very distressed, we worried for their safety, now we can sleep at night”. People were protected by staff who knew how to recognise signs of possible abuse. Staff said reported signs of abuse or poor practice would be taken seriously and investigated thoroughly.
Staff were well trained and said training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the staff team, and had a commitment to people and their relatives about what the service had said they would deliver. A relative said, “Everything they told us they would do, they have done, we have not experienced this in other services”.
People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook training and understood the importance of the safe administration of medicines. Staff said they undertook regular competency checks to test their knowledge and to help ensure their skills were up to date and in line with best practice.
Management and staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards (DoLS). Applications had been made and advice sought when necessary to help safeguard people and protect their human rights. When people were unable to consent to their care or support, or were unable to make decisions, discussions took place with relatives, other agencies and staff in the home to help ensure decisions were made in their best interest.
Staff worked really hard to enable people tocommunicate what they wanted and to reduce the need for behaviours that limited their opportunities. Behaviour management plans were in place for people to help staff understand the behaviour people may present, to recognise the triggers and signs and to safely manage the behaviours if they occurred. Staff had a good understanding of people’s behaviours and the guidelines in place to prevent behaviours from escalating. Staff said the number of incidents had significantly reduced for some people and they felt this was due to staff knowledge, training and consistency of care provided.
People’s health and dietary needs were well met. People were supported to maintain good health and when required had access to a range of healthcare services. Annual health checks were arranged and ‘hospital passports’ were in place to support any admissions to hospital. Hospital passports contained important information about the person to help ensure their needs were appropriately met if they should require an admission to hospital or another healthcare facility. People’s health needs were monitored closely and any concerns or changes were dealt with promptly.
People’s privacy was respected and staff provided dignified and compassionate end of life care. Extracts from thank-you cards sent to the staff included, ‘Thank-you for the love, care and unending support, you made […] comfortable, visited on your days off. You are a fantastic, caring and selfless group of people’. We also read feedback sent to the home by the local Hospice which included, ‘Very impressed by the care and compassion shown by the team’.
The service was very responsive to people’s specific and diverse needs. Other agencies told us they were always impressed with the creative and personalised care provided to people. Support plans were extremely clear and detailed, providing staff with step- by- step guidelines about people’s needs, preferences and daily routines. All the staff we spoke with had a very good knowledge of the needs of people they supported.
All the people who lived at Riverview were supported to lead a full and active lifestyle. We saw a number of examples of how people’s opportunities had increased in the time they had lived in the home. A relative said, “ It’s amazing, they do so much now” and “ The staff have been so innovative, [….] had no concept of time, the staff thought of ways of helping [….] understand here, now and next, they have so much more control now over the things they are doing”.
Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The provider promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour i