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

Rivelin House is registered to provide accommodation, nursing and personal care to adults with physical and learning disabilities. The home can accommodate up to eight people. It is situated in the Shiregreen area of Sheffield, close to local amenities and transport links.

There was a manager at the service who had commenced in post 26 October 2018. The manager had applied to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The previous registered manager left the service 21 September 2018. The registered providers peripatetic manager for the north region was covering the registered managers absence until the new manager had been inducted into their post.

The registered provider was working within the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Our last inspection of Rivelin House took place on 24 March 2016. Whilst the service was rated Good overall, the Well Led section was rated requires improvement. This was because the previous registered manager was managing two homes and split their time between the two services. Staff we spoke with told us that there was a lack of coordination and organisation in the registered manager’s absence. In addition, we found records were not always well maintained and the systems in place to monitor the quality of the service had not identified and addressed these concerns.

This inspection took place on 20 November 2018 and was unannounced. This meant people living at the home, and staff, did not know we would be visiting.

At this inspection, we found sufficient improvements had been made and issues reported on in the Well Led domain had been addressed.

At our last inspection, we rated the service Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

People who lived at Rivelin House had limited or no verbal communication. We saw they were happy to be with staff and staff were respectful and kind in their approach. People’s relatives spoke positively about the standard of care and support their family member received.

Staff were aware of their responsibilities in keeping people safe.

Medicines were managed safely.

There were robust recruitment procedures in operation to promote people’s safety.

Staff were provided with relevant training and supervision so they had the skills they needed to undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s support plans contained relevant person-centred information to inform staff. The support plans had been reviewed to ensure they were up to date.

Relatives of people receiving support were confident in reporting concerns to the staff and manager and felt they would be listened to.

There were quality assurance and audit processes in place to make sure the

Rivelin House is a care home in the Shiregreen area of Sheffield. The home provides nursing and personal care to adults who are living with a physical or learning disability. The home is registered to provide care for up to eight people with accommodation provided in seven en-suite rooms spread across two floors. There is also a separate self-contained flat at the back of the home providing accommodation for one person using the service.

The service was last inspected in January 2014 at which time it was compliant with all the regulations we assessed. We inspected this service on the 24 March 2016. The inspection was unannounced. There were eight people using the service at the time of our inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

During the inspection we found that staff understood how to identify and respond to safeguarding concerns to keep people safe. People’s needs were assessed and risk assessments put in place to guide staff on how to minimise risks.

Recruitment checks were completed and sufficient staff were employed to meet people’s needs. There were systems in place to ensure people received their medicines as prescribed.

New staff had an induction and on-going training to equip them with the skills and knowledge needed to carry out their roles effectively.

People were supported to eat and drink enough and access healthcare services where necessary.

Staff understood the needs of the people they were supporting and there were systems in place to share information about people’s changing needs.

We observed staff to be kind and caring and received positive feedback from relatives of people using the service. People were supported to make decisions and maintain their privacy and dignity.

There was a system in place to ensure people could raise concerns or make complaints if necessary.

We received positive feedback from staff about the registered manager; however, at the time of our inspection they were managing two homes and split their time between the two services. Staff we spoke with told us that there was a lack of coordination and organisation in the registered manager’s absence.

We identified gaps in recording and found that records were not always well maintained. We were concerned that the systems in place to monitor the quality of the service had not identified and addressed these concerns.

Before people received care they were asked for their consent and the provider acted in accordance with their wishes. People told us they were never pressured by staff into doing anything. One person commented, “They always explain and ask for my permission. I am satisfied.”

Care was planned and delivered in a way that protected people from unlawful discrimination. Support workers had a good understanding of equality and diversity. We observed staff to be respectful of people; they were friendly and offered appropriate support when people needed it. Staff kept people occupied by giving one to one support and playing games with them. There was an atmosphere of homeliness and calm.

Appropriate arrangements were in place in relation to medicines management. A named nurse was responsible for the ordering and auditing of medication at the home.

Staff and the manager told us all new starters completed a comprehensive induction that took account of the knowledge required to deliver care and support to people at the home.. One person said, “Here staff know what we need. They give us support. They give us good advice. I like living here.”

There was an effective complaints system which took account of comments and complaints by people. One person said, “I have no complaints. They are marvellous. If I don’t like anything I tell them they are very good. Sometimes I can be awkward but staff don’t make me feel bad. They are alright.”

On the day of our inspection the home was occupied by five people. We met all of them and had conversations. Some people were unable to verbally communicate with us, however their body language was interpreted by the staff who cared and supported them. Others joined in with the care staff and us in conversation. We spent time observing people using SOFI.

People were supported in promoting their independence and community involvement. We observed staff encouraging people to help themselves as much as they were able to. The staff also facilitated community involvement by organising transport and escorting people shopping.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Where people needed additional support to carry out day to day activities, they were allocated an appropriate number of competent staff.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. One person said, “I tell them if I am not happy. I put my foot down. I am not worried.”

People who use the service and staff were asked by the provider for their views about the quality of service. The staff said they had monthly meetings with the people who lived at the home and sometimes the provider joined in. One person said, “We often chat about what happens here. I appreciate the staff and what they do

A short period of time was spent observing the care that people received to determine their experiences of care. This was because we were unable to verbally communicate with people because of their complex needs.

We saw that people were well dressed and their clothing was age appropriate.

We saw during our observations that staff encouraged people to make everyday decisions and listened to people's requests. For example, one person was assisted into the dining room. Staff then spent time asking the person what they would like for breakfast. The person made their choices and then also requested what size portion they wanted. Staff sat with people, in the dining room and lounge and pleasantly talked with them, answering questions when asked and instigating conversation with people. One person said, " I am very happy here and don't want to go anywhere else".

We observed the relationships between staff and people who lived at the home. This

showed that staff had positive regard for people. They were informal, but respectful in the way they spoke to and of people. We saw that people who lived at the home responded positively to the staff's approach. We didn't see people appearing fearful of staff and people presented as comfortable in staff's presence.

Time was spent observing the care that people received to determine their experiences of care. This was because a number of people were unable to verbally communicate with us, because of their complex needs.

We saw that people were involved in meaningful daytime activities of their own choice, which had been planned in accordance with their wants, needs and capabilities. For example, on the visit one person was attending a new luncheon club. Another person had recently visited London and Leeds United football ground.

We saw that people who lived at the home were supported to maintain and develop relationships, because they were supported to visit relatives.

We saw that all of the people who lived at the home were well dressed and their clothing was age appropriate.

We saw during our observations that staff encouraged people to make everyday decisions and listened to people’s requests. For example, the times people got up and what they did during the day.

During our visit we saw staff put a film on the TV for people who were sat in the lounge. Staff sat with people, pleasantly talking with them, answering questions when asked and instigating conversation with people. For example, one person requested a drink, which was provided and everyone else was offered a drink.

One person said, “can I stay up today, I’m being good?”. Another said they’d lived at the home a long time and that they love it here. They started to cry and said “I will be really upset if I have to leave here. Please tell them to let me stay”.

We saw that people were cared for in the way that was described in their care plans, to ensure their individual and diverse needs were met.

We observed the relationships between staff and people who lived at the home. This showed that in the main staff had positive regard for people. They were informal, but respectful in the way the spoke to and of people. We saw that people who lived at the home responded positively to the staff’s approach. We didn’t see people appearing fearful of staff and people presented as comfortable in staff’s presence. However, we observed one member of staff whose manner was abrasive. This information was provided to the manager as evidence and for her to act on.