We inspected Riverside & Roseberry Lodge on 16 and 23 February 2017. The first day of the inspection was unannounced, which meant staff and the registered provider did not know we would be visiting. We announced the second day of our inspection. When we last inspected the service in January 2015 we found that the registered provider was meeting the legal requirements in the areas that we looked at.

The home 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.

Riverside & Roseberry Lodge is registered to provide care and support to people in two separate bungalows. The service provides care, support and accommodation for up to 13 adults who have learning disabilities and / or physical disabilities. The service is close to all local amenities. At the time of the inspection there were 13 people who used the service.

We saw people received care and support in an exceptionally personalised way. Staff knew people well, understood their needs and the unique ways in which they communicated. Care was focused on people's wishes and preferences. This meant people were able to maintain their independence and achieved a good sense of self-worth and wellbeing. The impact this had on people was outstanding and had resulted in them being settled, content and helped them to lead as full and active lives as they wanted to.

Staff developed exceptionally positive and caring relationships with people and their families. Staff were very motivated and demonstrated a commitment to providing the best quality care to individuals in a compassionate way. People's privacy and dignity was maintained at all times during the inspection.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained. It was noted that two people who used the service had refused to have their water temperatures tested to make sure it was within normal limits. The registered manager told us they would rectify this and agree a regular suitable time with people to have their water temperatures taken.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, behaviour that challenged, going out independently and falls. This enabled staff to have the guidance they needed to help people to remain safe

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that

We inspected Riverside and Roseberry Lodge on 14 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Riverside & Roseberry Lodge provides support for up to 12 people with learning disabilities. It comprises of two bungalows connected internally by a corridor and each bungalow provides six places for people. In one bungalow there are six individual flats and in the other bungalows there are six single occupancy bedrooms. The service is also registered to provide personal care for people who live in their own home but as yet this does not happen.

The home had a registered manager in place and they have been in post for over five years. 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.

The service operates two distinct services, with more independent living services provided in the bungalow made up of flats. The bungalow with single bedrooms provides services for people who are dependent upon staff to assist them with all aspects of their personal care. Thus, staff both deliver personal care and provide support to assist, to develop impulse control, and to manage people’s behaviour and reactions to their emotional experiences.

Six of the people we met had difficulty communicating verbally and we could not engage in complex discussions about the service. Staff were able to interpret the non-verbal cues they provided and we were able to observe their experience of living at the home. The other six people we met were very able to discuss all aspects of the service, staff behaviour and their experiences.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training. The registered manager was in the process of reviewing all of the people who used the service to determine if people had capacity to make decisions. Where appropriate the manager was applying for DoLS. We found that for the more independent group of people staff struggled to make use of the capacity assessments. Staff felt people had capacity but the assessments they completed showed this was not the case. We highlighted the difficulty staff were having and the registered manager took action to ensure staff were able to understand the outcome of capacity assessments and what actions they needed to take. Staff were making ‘best interest’ decisions but the templates they had did not allow this type of information to be fully recorded. We heard that the provider was in the process of sending updated documentation, which would address this issue.

People we spoke with told us that staff made sure they were kept safe. The majority of the people we spoke with were extremely complementary about the service and told us how staff had enabled them to develop a wide range of skills.

We observed that staff had developed very positive relationships with all of the people who used the service. We saw that where people experienced high levels of anxiety staff were able to discreetly reduce the impact on the individual and those people around them. Interactions between people and staff were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.

We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to, were encouraged and supported to go out independently and others routinely went out with staff. People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.

The people living in the flats told us that the staff worked with them to help to reduce risks when going out and about. We saw there were systems and processes in place to protect people from the risk of harm.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

We saw that people living at Riverside and Roseberry Lodge were supported to maintain good health and access a range healthcare professionals and services. We found that staff worked well with people’s healthcare professional such as consultants and community nurses. People were encouraged to have regular health checks and staff supported people to attend appointments.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. The people we spoke with discussed their support plans and how they had worked with staff to create them.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who experienced both learning disabilities and mental health disorders. We found that the staff had the skills and knowledge to provide support to the people who lived at the home. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that four to five staff routinely provided support to 12 people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

The provider had developed a range of sytems to monitor and improve the quality of the service provided. We saw that the manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.

One inspector carried out this inspection. During the inspection, we spoke with four people, two relatives, the manager, operational manager and three staff. We looked at four sets of care records and twenty staff files. We also observed care practices within all areas of the home.

The service had a registered manager in post. The management of the home was good and we saw strong leadership and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health safety and welfare of people.

We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records

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

Is the service safe?

During our inspection we saw that people were treated with dignity and respect at all times by staff. All people we spoke with confirmed that they felt safe living at the home. People told us that they were happy living at the home.

Staff were able to describe the action they took to keep people safe. Staff were able to identify signs of abuse and the action which they needed to take if they suspected abuse had taken place.

We saw that the home was clean and well-maintained. All the people we spoke to told us this was always the case. We found that there was enough personal protective equipment at the home. Good procedures were in place to maintain and monitor infection prevention and control measures within the home.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people’s needs throughout the day. All staff and relatives we spoke with confirmed this to be the case. Good procedures were in place to manage staff sickness and annual leave.

During our inspection we found that staff were able to respond to people quickly. People received a consistent and safe level of support from the staff team.

We found gaps in the recording of information in people’s records, in audits and in kitchen cleaning schedules and safety checks. We found some records were unavailable during the inspection. Records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because records were incomplete. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Policies and procedures were in place. Some staff had been trained to understand where an application should be made, and how to submit one.

Is the service effective?

People living at the home had personalised care plans in place which were reviewed. Assessments specific to people were also in place. We found that people’s records provided significant detail about people’s daily routines, needs and preferences. We found that staff were very knowledgeable about people’s individual needs.

We could see that a range of health professionals were involved in people’s care as needed. Staff told us that they supported people to attend appointments when needed.

People and relatives we spoke with told us that they were happy with the care that had been delivered. We found that staff knew people well and were responsive when their needs changed.

Is the service caring?

People living at the home received personalised care from staff. Throughout our inspection staff were responsive to people and acted quickly when needed. Staff showed patience when delivering care and prompted people with tasks, such as cleaning their flats to help to maintain their independence.

We saw that care met people’s needs, wishes and preferences and was reflective of the care detailed in people’s care records. Staff sought people’s permission before care was given. People were given choice throughout the day, such as meal choices and activities.

Is the service responsive?

Each person at the home had individual activity schedules which detailed activities both at the home and out in the community. The home had two sensory rooms for people to use. We saw that people were regularly involved in a range of activities throughout the day.

During our inspection we saw that people were encouraged to spend time outside to enjoy the warm weather. We found that there was sufficient stimulation and equipment outside to keep people entertained. Staff stayed outside with people to ensure that they remained safe.

Is the service well-led?

People living at the home had the support of health and care professionals when needed. We found that regular reviews were carried out and detailed the professionals involved.

Staff and the manager told us that they felt well supported by each other. Many of the staff employed at the home had been in post for over five years. All staff were clear about their roles and responsibilities.

We found that appraisals, supervision, staff meetings and some training were not up to date for all staff working at the home. This meant that not all staff were supported to deliver care safely. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The home had a system in place to assure the quality of service they provided. Audits and risk assessments were in place. Although the provider had not carried out regular visits to the home, we found that the new operation manager was taking action to address this. Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

Feedback was obtained via meetings for people who used the service and from surveys given to staff, people and their relatives. A small number of complaints had been made which had been responded to appropriately.

What people said

People who were able to express their views told us they were satisfied with the care and support they received. People told us, this is the “Best home I have lived in. I absolutely love it here,” “I like it here. I am happy” and “I love it here.” A relative told us, “I am very happy with the care my relative gets.”

Staff we spoke to throughout our inspection spoke positively about working at the home. Staff told us, “We work well together as a team,” “We try to provide lots of activities for people” and “We involve all staff.”

Roseberry and Riverside Lodge was a home which was divided into two separate units. Six service users lived semi-independently in self contained flats in Roseberry Lodge with staff support. Six service users who had more complex needs lived in separate rooms with a higher ratio of staff support in Riverside Lodge. There were communal living rooms, quiet rooms, kitchens and sensory rooms in both units. Riverside Lodge had an assisted bathroom with a high/low bath.

The home was comfortable and staff and service users engaged positively with each other.

One service user told us;

"It's marvellous, the staff look after us"

Another service user told us;

"It's one of the best homes I have lived in"

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan and the home cooperated with other providers to ensure coordinated care.

People were protected from the risks of inadequate nutrition and dehydration.

Equipment was maintained regularly and staff were trained in it's use.

We spoke with three people who used the service. They told us they were treated well and the staff were good. One person said, “This is my favourite place to live”, another person said, “I like it here.”

We found that people were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable and that people were cared for and supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the home.

I have been here a year, I chose how to decorate my flat. I get on well with staff, I am going out today. Food is alright, you get a choice. I can have visitors. I get well looked after, I get my tablets from the staff, I go to the office, my care plan is kept there. It's a nice place to stay.

I like it here, I get lots of visitors, the food is alright, we get to choose what we want. I keep my flat clean, staff help me. I have heard of my care plan, I could talk to staff if I had any problems, the manager is nice.

I am going out today, I like living here, food is lovely, I am friends with other people who live here and the staff are lovely. I am well cared for and can see a GP if I need to. It's a nice place.