Archived: Two Rivers Care Home

About the service

This service is jointly registered as a residential care home and a domiciliary care service, which provides care to people living in supported living services. The residential part of the service is called Two Rivers and is registered to provide personal care and accommodation to 8 people. The care home is a house with a garden and access to the high street.

The supported living service supports 15 people in three shared houses. In each shared house people share the kitchen, lounge, and some bathrooms. There is sleep in staff and an awake staff who monitors the CCTV footage in people’s bedrooms and lounges from the residential part of the service. The services purposely supports Asian women who have learning disabilities, physical disabilities, and who are autistic.

People’s experience of using this service and what we found

Right Support:

People at times did not receive safe care. Risk assessments and care plans did not explore and explain fully what people’s needs were and how they should be supported by staff. When people moved to the service this was not completed in a planned, safe, and thoughtful way. Staff were not well trained to understand people’s needs outside of their personal care needs and to know when they needed to advocate for people. There was a lot of surveillance and restrictions in place which could undermine people’s rights and choices. People saw health professionals frequently to support with their health needs.

People were not supported to have maximum choice and control of their lives and managers, the provider and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

Work had not been completed to look at people’s life goals, their interests and what they found fun as individuals. No plans were made to try and make these goals and what people enjoyed happening. Some staff were thoughtless towards some people, and they did not promote the home as people’s own space. People had blanket routines such as what they ate, what they did, and when they went to bed rather than look at what individuals wanted to do and to make these routines happen. Some staff were thoughtful towards people, but people were not always being treated as adults. People ate nutritional food cooked by staff which people said they liked. But routines meant people could spend a long time in bed without access to drinks and on their own. People’s religious cultural needs were promoted at the service.

Right Culture:

The leaders of the home had not created a culture which established a safe and person-centred experience for people to live in. The provider was not effectively assessing the quality of the care at the home. They were not looking at what people’s experiences were like and considering what else could be done to reduce restrictions and make life more enjoyable. The provider and managers had made some improvement to processes to promote people’s safety and had started looking at staff skills and support following our feedback. But there was a lot to do, and more time will be needed to improve the service.

Based on our review of safe, effective, caring, responsive and well led the service was not able to demonstrate they were meeting the underpinning principles of right support, right care, right culture (RSRCRC).

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 31 May 2023).

Why we inspected

The inspection was prompted by a notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and dignified care. This inspection also examined those risks.

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 people’s safety, management’s response to safeguarding concerns, restrictive practices and the application of the mental capacity act, person-centred care, promoting privacy and dignity and failures in the leadership of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have requested an urgent action plan from the provider to understand what they will do to improve the standards of quality and safety at the service. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Two Rivers Care Home is a residential care home providing personal care to a maximum of 8 people. At the time of the inspection 7 people were living at the home. People had access to communal areas including kitchen/dining area, living room and a garden.

Two Rivers Care Home also provides care and support to people living in 3 supported living schemes under the same CQC registration. At the time of the inspection 16 people were using this part of the service and most of them received personal care.

The service provided care and support to women with varied of needs including women with a learning disability and/or physical disabilities, and autistic women.

People’s experience of using this service and what we found

Right Support:

Systems were in place to monitor and ensure people received their medicines safely.

Risks in relation to people's care and welfare were thoroughly assessed. This meant staff had the right guidance to support people safely.

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.

Staff supported people to make decisions following best practice in decision-making.

Right Care:

The service had enough appropriately skilled staff to meet people's needs and keep them safe. However, recruitment checks were not always performed consistently.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and knew how to apply it.

Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care.

People's care and support plans reflected their range of needs and this promoted their wellbeing and independence.

Right Culture:

The service evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Quality assurance systems helped the staff team to monitor the service they provided and promote ongoing learning.

However, quality assurance systems needed to be improved due to the concerns we found around staff training, statutory reporting of events/concerns and recruitment. Managers welcomed our feedback and had started making improvements.

Staff knew and understood people well and were responsive to their individual needs. This meant people received compassionate and empowering care that was tailored to their needs.

People and those important to them were involved in planning their care.

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 27 September 2019).

Why we inspected

We received concerns in relation to poor care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. However, we found no evidence during this inspection that people were at risk of harm from this concern.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Two Rivers Care Home on our website at www.cqc.org.uk.

Recommendations

We have made 2 recommendations around staff recruitment and quality assurance systems.

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.

Two Rivers Care Home is a residential care home providing personal care and accommodation to eight people with a learning disability. The home is on a residential street in a community setting and designed to promote people's inclusion and independence.

The provider, Suncare Recovery Limited, also has three supported living schemes located a short drive from the care home. On the day of our inspection there were 14 people living in the supported living services. The care home and supported living services are under the same registration with CQC.

All the services provided are for women, many of whom have additional mental health or physical disabilities. The service offers support to people from many nationalities as staff speak a range of Asian and European languages as well as English.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

People told us they enjoyed living at the care home and the supported living services. They felt safe with the support they received from the staff. We saw staff were kind caring and people and families confirmed this.

We found that whilst the service was well-led in many ways and the senior management team worked well together, there were some areas in which best practice was not followed. This included notifying CQC of all safeguarding concerns, ensuring long standing staff received refresher training and assessment of their competency in medicines.

There was a person-centred culture at the service. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

People were supported to access external health professionals to help promote good health and wellbeing. Health and social care professionals and family members praised the service provided and the ability of staff and the senior management team to work in partnership with them.

People were encouraged and supported to engage in activities within the community. In addition, at the care home there was a range of activities which took place which people living at the supported living service could access.

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 safeguarded against the risks of abuse and harm by the systems and by the staff. Risks to people were assessed and mitigated. There were enough staff to meet people’s needs and provide flexible, responsive care.

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 the service was good (published 18 January 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Two Rivers Care Home is registered as a care home for eight people and as a supported living scheme. The service has two supported living schemes (Holdenhurst and Cissbury Ring) located a short drive from the care home. On the day of our inspection eight people were living in the care home, three people at Holdenhurst and six people at Cissbury Ring.

People experienced excellent care and support. They were supported to live safe, fulfilled and meaningful lives in the way they wanted to.

People were supported with healthy eating and to maintain a healthy weight, with specialist diets when required. People who needed assistance with meal preparation were supported and encouraged to make choices about what they ate and drank. The support staff we spoke with demonstrated an excellent knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns

Staff told us they really enjoyed working in the home and spoke positively about the culture and management of the service. Staff told us that they were encouraged to openly discuss any issues. Staff said they enjoyed their jobs and described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided.

The registered manager had been in post since the service opened in 2008. 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 and associated Regulations about how the service is run.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were cared for. Staff listened to them and knew their needs well. Staff had the training and support they needed.

Staffing levels were sufficient to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act 2005, DoLS and associated Codes of Practice.

People participated in a range of different social activities and were supported to access the local community. They also participated in shopping for the home and their own needs, and some people had recently been on holiday together with staff support.

The registered manager and staff ensured everyone was supported to maintain good health. They took a very proactive approach to ensuring people's complex health needs were always met, and consistently ensured that when people needed specialist input from health care professionals they got it.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person living in the home. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere in the home.

Staff were well supported with training, supervision and appraisal which helped them to ensure they provided very effective care for people.

People and those important to them, such as their relatives or professionals were asked for feedback about the quality of the service.

The registered manager and staff knew what they should do if anyone made a complaint.

Person centred care was fundamental to the service and staff made sure people were at the centre of their practice. Care plans focused on the whole person, and assessments and plans were regularly updated.

People's individual preferences, needs and choices were always taken into account by the caring and compassionate staff.

The service was exceptionally well led. There was a clear set of values in place which all of the staff put into practice. The registered manager and director regularly completed very robust quality assurance checks, to make sure the high standards of care were maintained. There was an open culture and staff said they felt well motivated and valued by all of the managers.

Everyone talked positively about the staff. They were described as 'very nice', 'friendly' and 'polite.' We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People told us they were happy with the communal environment and their rooms where they lived. We checked the environments of both premises, including recent refurbishments and extensions. We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People we spoke with had no concerns about support with medicines. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People informed us that staff and the manager listened to their views and provided a service which they wanted. People told us staff were responsive to them, for example, 'staff are quite approachable.' We found that the provider had effective quality and risk management systems in place.

There were systems in place to assess, plan and deliver individualised care and support to people who use the service. We focussed in particular on care and support to people whose behaviour challenged the service. Staff knew what could trigger these behaviours from individuals, and how to meet people's needs and keep people safe when these behaviours occurred. There were individual guidelines in place in support of this.

Records were kept of any incidents of behaviours that challenged the service. It was evident that these were reviewed, to reflect on and improve services. The provider recognised that the reviews could be better documented, and that the staff team would benefit from further training about the consistent use of appropriate language within records.