We carried out an unannounced inspection on the 23 and 26 January 2018.

We last visited the service in October 2015. We rated the service as good following that visit with an outstanding rating attached to our question whether the service was responsive.

Rivacre House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rivacre House provided personal care for up to 12 people with mental health needs. All bedrooms are single with en suite facilities. The home is a two storey building located near Ellesmere Port town centre, close to shops and local facilities. The home has twelve single bedrooms. At the time of our visit, 12 people were living at Rivacre House.

The service had a registered manager. 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.

People told us they feel safe living at the service and stated that staff were always around to assist them. Staff had a good understanding on the types of abuse that could happen and provided a good account of action they would take. Staff had a good understanding on how to raise concerns about poor care practice with other agencies.

The premises were well maintained, clean and hygienic. All equipment used in the building was regularly checked to ensure safety. People had individual evacuation plans in place in the event of needing to leave the building in an emergency. Risk assessments were in place for individuals. These were up to date and took the hazards they faced while being supported and from the environment into account.

Medication was safely managed. People told us that they received their medication when required and in some cases sought to become more independent in managing their own medication.

Accidents and incidents were recorded with patterns and trends identified to prevent re-occurrence in the future.

There were sufficient staff to meet the needs of people. Recruitment processes were robust and further sought to protect people who used the service.

Staff received the training they needed to perform their role. They also received supervision to monitor their work practice. A structured induction process was in place to enable new staff to settle into their role and become acquainted with the values of the service.

The registered provider adhered to the principles of the Mental Capacity Act 2005. Staff were able to outline its principles and had received training in this area.

The nutritional needs of people were met. Kitchen facilities were clean and hygienic and contained information about special dietary requirements that people had. People who used the service were able to influence the contents of menus and prepare meals for themselves on a one to one basis as part of gaining more independence.

Staff interactions with people were respectful and caring. Staff demonstrated a commitment to ensuring that people experienced the same opportunities to access the local community and to reach their aspirations.

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People felt cared about and felt that staff promoted their privacy. People felt their views were listened to and acted upon.

The registered provider had identified the factors that influence positive mental health and had responded to such situations. One person we spoke with was very positive about their lives at Rivacre House especially after the registered manager had responded in introducing measures to keep the person safe and to reassure them. Another person had been supported by the registered manager to follow their preferred diverse lifestyle and again this had posit

We carried out an inspection of Rivacre House on 5 October 2015 and this was unannounced.

Rivacre House was last inspected on 20 August 2014 and we found that the service met the regulations we inspected against.

Rivacre House is a purpose-built care home for people who have mental health needs. The home is a two storey building located near Ellesmere Port town centre, close to shops and local facilities. The home has twelve single bedrooms. At the time of our inspection there were 11 people who used the service. There is a large lounge and dining area and a separate conservatory on the ground floor and a smaller kitchen and lounge on the first floor.

There was a registered manager in place. 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.

During our visit we saw that the registered provider provided a safe environment for people to live and staff to work in. There was a warm atmosphere that was enabling and inclusive. People were able to come and go as they wished and staff supported them to make arrangements for appointments or social events.

Staff and the registered manager explained to us what they would do to keep people safe and how they protected their rights. Staff had been provided with training and showed an understanding about safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People said they liked living at Rivacre House and the staff were kind and caring. They said staff provided the support they needed to encourage them to be independent. Staff demonstrated an understanding of disability and how factors such as personal history and gender identity impacted upon mental health. People were encouraged to discuss their health and worries with staff. They had access to community based health professionals as required on order to help keep them well. There were opportunities for people to take part in group activities but they were also encouraged to develop personal interests.

Staff protected people from the risks associated with poor nutrition and hydration as they encouraged them to eat and prepare a balanced diet. People were able to choose meals that met their likes, dislikes and preferences. They were positive about the choice and quality of food available and liked being involved with shopping.

Records that we looked at were comprehensive and kept up to date. Support plans contained detailed information on each person and how their care and support was to be delivered. The information was regularly reviewed with the person who used the service. This meant that people received personalised care in line with their wishes and preferences.

People received supported from staff that had gone through the appropriate recruitment processes to that ensure they were of suitable character to carry out their job. The staff were knowledgeable about the people they supported and knew all about their social, physical and mental health needs. They had the appropriate knowledge, skills and qualifications to do the job. Staff had had access to an induction, training programme and ongoing support.

The management team were approachable, responsive, and encouraged feedback from people who used the service. They also monitored the service provided in order to improve on its quality and effectiveness.

Our inspection team was made up of one inspector. We looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that staff treated people who used the service with respect. We noted that the needs of people were addressed at all times. Interactions between staff and people who used the service were friendly, respectful and positive. Staff demonstrated patience in reassuring and interacting with people. People who used the service told us that they felt safe living there. We saw that risk assessments designed to keep people safe were updated regularly and with the involvement of the people they related to. Staff told us that they had received training in safeguarding and this was confirmed through training records. As a result the service is safe.

Is the service effective?

The service is effective.People had links with local advocacy services although people were able to voice their own views and opinions through house meetings. People told us that they were listened to.

People’s health and care needs were assessed on a regular basis and this work was done into conjunction with the people they related to.

Is the service caring?

Our observations noted that staff were attentive to the needs of the people and that their work focussed exclusively on people’s needs. People we spoke with told us that staff cared about them. They told us that they were “great”, “caring”, and “alright”. As a result the staff team is caring.

Is the service responsive?

The service responds to the needs of people. The service had a quality assurance processes in place which sought to include all the views of those connected with Rivacre House. This was done through supervision and appraisal of staff, quality audits from the provider and other audits.. Staff considered that they were listened to and supported by the provider. We saw evidence in healthcare records which demonstrated that as soon as new health conditions arose, the staff team ensured that people received prompt referrals to medical agencies. More general health check-ups were available to people as well. We also saw evidence through care plans that as needs changed; plans were amended and reviewed on a regular basis. We saw that given the specialism of the service in supporting people with their mental health, that this was a paramount consideration.

Is the service well-led?

The service had a manager who was registered with us to carry out their roles. We noted that the service always told us when there were significant incidents. The service remained was part of a larger organisation which had systems in place to ensure that people received a person centred level of support. We saw evidence in care plans that the service worked with other agencies to ensure positive outcomes for people. Staff told us that they felt supported by the manager in their role .As a result the service is well-led.

We spoke with three people who lived at Rivacre House. All stated that they felt safe living there and that the staff were very good and listened to them. They felt that their needs were met and that staff responded to the wishes of individuals. Records suggested that people are fully involved in all aspects of their support and are able to maintain their independence. People considered that recent re-decoration within the building and refurbishment had been a positive move.

Other comments made included:

"It is a lovely quiet place and I can have my own space"

"The quality of food is marvellous"

"Sometimes I don't like some food but I do get an alternative"

"Staff are great, helpful and always listen to me. They are very approachable"

"I am aware of my care plan. I have my own plan in my bedroom and I am fully involved in my support"

"Staff are good and helpful"

"Staff always have time for you. They are good cooks and it is brilliant"

"The care here is the best I have experienced"

"I cannot think of anything that can improved upon"

A compliment book was available and included recent comments from relatives. Comments included:

"All staff are marvellous"

"I cannot fault the staff team"

The service was found to be compliant with all of the outcome areas we examined with the exception of one. Details of this are outlined later in this report.

We spoke with five people who used the service during our visit to Rivacre House. All of them said that felt safe living at the home and felt involved by the staff in the planning of their care and when decisions were made in relation to changes and events at the home. We looked at four care plans that reflected what people who used the service had told us. Comments from them included

"My carer involves me in everything"

"I feel relaxed and comfortable here"

"I feel very safe here"

We spoke with the registered manager and two other members of staff on duty during our visit. All of them told us that there has been a massive improvement with the service since our last visit and enjoy their jobs. They told us there was enough staff on duty at all times so that the people who used the service get good quality care. Comments from staff included

"I help the residents to make the right choices for them"

"The management are extremely supportive"

We saw the staff interacting in a positive manner with the people who used the service. We reviewed records that showed staff training in areas such as safeguarding and the Mental Capacity Act(2005) was current. Evidence showed that quality assurance checks which sought the views of people who used the service, their family and/or friends and staff were done annually.

We have received no concerns about the service.

We met seven people who were living at Rivacre House and we spoke to two people about their opinions about living at the home. They were all very positive about living there and all said that staff were very good. They told us they were familiar with the staff that supported them and knew their names as they had all worked at the service for many years.

They told us that the staff supported them in doing various things and they said that they had some activities like bingo and bowling to go to.

They both said they enjoyed the food and one person told us they like to cook their own food and another person told us about how they helped with the shopping lists for the home. They told us they sometimes attend meetings with the staff and one person said they got involved with talking about food later in the day. They told us that some things had got better especially the food and they told us about the menus and individual choices they had been asked to complete.

People told us that they felt safe and had no concerns about their care. They said if they had concerns they would tell somebody usually their keyworker.

Following the homes previous unannounced inspection the home has also received several visits from the local authority’s contracts and monitoring team. They have shared their findings following each of their visits and they have been able to identify improvements into the management of the home.

We spoke to people who live at the home and asked their views about their home and how it was run.

They felt the standard of care provided by the staff was very good. People told us that staff who support them treat them well. They told us that they know all the staff as they had been there for a long time and they were all very respectful and always knocked on their bedroom door.

Everybody told us they would ask to talk to somebody in the office if they were unhappy and that they knew how to make a complaint.

People living at the home made the following comments:

"I love it here, it’s a lovely place”

“The staff are lovely my key worker always does what she says she will do for you, I can rely on her.”

Some people made various suggestions to make things better for them at the home for example:

“I’ve asked a few time can we have a pool table or five a side table for something to do in the day.”

“I’d like more healthy options for food, today it was either frozen sausages and chips or egg and chips.”

“It would be good to have more staff so we could do more and go out more on trips.” ”I ‘d like lunch served later at 12mid day rather than 11.30am.”

We had contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the home. They had no issues of concern to report about the service. Following our inspection we have shared our findings with the local authority.