Two Rivers

Updated 9 November 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.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by 2 inspectors and an Expert by Experience. 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

This service provides care and support to people living in 3 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Two 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. Two 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 registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in their current 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 reviewed the information we held about the service and sought feedback from the local authority.

During the inspection

We completed 3 site visits at the residential part of the service including an evening visit. We also visited the supported living service shared houses to talk with people and staff. We spent time in the service to see how people were treated and what their days and evenings looked like. For the care home we also assessed the accommodation. We reviewed 11 people’s care records, including their risk assessments, care plans, reviews, health records, daily checks, other plans, and documents related to their mental capacity and DoLS. Fire safety records were reviewed. A count of medicines took place and people’s accompanying medicine records were reviewed. Staff recruitment checks and training records were reviewed. We spoke with 6 people’s relatives, 9 staff, the deputy managers, registered manager, and acting manager and 5 people. We also spoke with 2 professionals.

Updated 9 November 2023

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.

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.