This inspection took place on 17 and 18 December 2018 and was unannounced.

Rivers is a residential home specifically designed to provide open planned living for nine people, the home is registered together with another home called The Cabin, this home is situated next door and supports eight people. Both homes specialise in providing care to younger adults who have a learning disability, physical disability and sensory impairments. Each home is staffed 24 hours a day. The homes have a range of aids and adaptations in place to assist people who have mobility difficulties and all bedrooms are for single occupancy. Rivers & The Cabin have easy links into the local community, and access to a range of facilities such as full-sized Hydrotherapy pool and interactive sensory room that are situated within the grounds of the homes.

At the time of the inspection there were nine people living at Rivers and eight people living at The Cabin. The people we met had very complex physical and learning disabilities and not all were able to communicate with us verbally. We therefore used our observations of care and our discussions with staff, relatives and professionals to help form our judgements.

The care service has been developed and designed in line with 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." Registering the Right Support CQC policy

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.

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At this inspection we found the service remained Good.

Why the service is rated good

There was 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.

People living at Rivers and The Cabin told us they felt safe. Staff understood how to recognise and report signs of abuse or mistreatment. Safeguarding and whistleblowing policies and procedures were available for staff to access.

Detailed risk assessments were carried out to ensure people could make choices and keep their

independence. This also included environmental risk assessments such as fire maintenance and safe use of water outlets.

Recruitment processes minimised the risk of employing unsuitable staff. There were sufficient numbers of staff available to keep people safe and support people when they displayed behaviours that challenged.

People’s medicines support needs were clearly identified and staff delivered medicines in a personalised way. Staff were trained and competent to administer medicines, although we did make some recommendations, this included having guidance to ensure that “when required” medicines are given consistently.

Staff had received training on infection control and understood their role in preventing the spread of infection within Rivers and The Cabin. Staff knew the reporting process for any accidents or incidents. Lessons learned were shared with staff through team meetings and supervision.

People received effective care and support from competent and well-trained staff and supervision and appraisals were carried out regularly.

People told us that they had choices of food and that the quality of the food was good. Meal times were a positive social experience fo

This inspection took place on the 13 and 14 July 2016 and was an unannounced inspection. It was carried out by one adult social care inspector.

Rivers is set out in two separate buildings which are next to each other. Rivers can accommodate up to nine people and The Cabin can accommodate up to six people. The home specialises in providing care to adults who have a learning disability and concurrent physical disability. Each house is staffed 24 hours a day. The home has a range of aids and adaptations in place to assist people who have mobility difficulties. All bedrooms are for single occupancy. The home is located in extensive grounds with two of the provider’s other homes. Each home can access the on-site sensory room and hydro pool.

At the time of our inspection there were nine people living at Rivers and six people lived at The Cabin. The people we met with had very complex physical and learning disabilities and not all were able to communicate with us. We therefore used our observations of care and our discussions with staff, relatives and professionals to help form our judgements.

There was 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.

People were supported by kind and caring staff who took time to get to know people. A professional who visited the home said “The standards of care and attention I have witnessed over many years working within Cream Homes is absolutely outstanding.” A staff member commented “The home is beautiful and so are the staff and residents. Cream provides the best care I've ever seen.” A visiting entertainer described the home as “A fantastic place. The staff are amazing.”

Staff made sure people experienced a smooth transition when they moved to the home. A relative told us “The staff were amazing. They supported all of us and the transition was brilliant.” Staff knew people very well and they often tried to match staff to individual people which helped them develop meaningful and caring relationships with people.

People’s bedrooms were beautifully furnished and decorated in accordance with people’s preferences. A visiting professional said “I couldn’t believe it when I saw [name of person’s] bedroom. It is so beautiful. All pink and girly. Just like they had at home and loved so much.”

Staffing levels were good and staff understood people’s needs and provided the care and support they needed. There were sufficient staff available to people to enable them to take part in a range of activities according to their interests and preferences.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

The home was a safe place for people. Staffing levels were good and staff understood people’s needs and provided the care and support they needed.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People’s health care needs were monitored and met by staff who received excellent training and support. People received good support from health and social care professionals.

People were supported to eat well in accordanc