This inspection took place on the 25 July 2018 and was unannounced.

Seven Rivers is registered as a care home with nursing providing accommodation for up to 29 people who require nursing care. At the time of our inspection there was 29 people using the service.

There was 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.

At our last inspection in June 2017 the overall rating of this service was requires improvement. This is because we found the environment within the care home remained in need of refurbishment and redecoration. In addition, actions were required to mitigate the risks of potential harm to people from the risk of falls from windows, and call bell response times. We also found shortfalls in the support and training provided to overseas volunteers to meet people’s needs and ensure they had the skills and knowledge to protect people from the risk of harm.

At this inspection we found improvements had been made, notably a new service lift had been installed, people’s room and communal areas had been redecorated. In addition, on-going support and training was now being provided to overseas volunteers this included periodic progress reviews.

People and relatives valued the relationship they had with the management team and told us they found them approachable and supportive. Staff were kind, caring and there were systems in place to ensure that people’s human rights were respected and their rights to dignity and independence promoted.

People and or their representatives, where appropriate, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated, plans to achieve people’s goals and aspirations and their ability to make decisions.

The service was flexible and responded positively to people’s requests about their care and how it should be provided. People were supported to access social activities according to their personal choice, wishes as to how they lived their daily lives and preferences as to how their care was delivered.

The culture of the service was open, inclusive, empowering and enabled people to live as full a life as possible. The management team provided effective leadership to the service and enabled people to air their views through care reviews, meetings and their involvement in the recruitment of new staff.

This inspection took place on the 7 & 8 June 2017 and was unannounced.

Seven Rivers is registered as a care home with nursing providing accommodation for up to 29 people who require nursing care. They are also registered to provide personal care and both regulated activities were the subject of this inspection. Personal care is provided for up to 14 people with physical and learning disabilities, who reside within a supported living environment, within a block of flats managed by a housing association seven miles away from the care home.

There was 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.

At our last inspection in March 2016 the overall rating of this service was requires improvement. This is because we found the provider was not meeting legal requirements. For example, the overall management arrangements and auditing of people’s medicines in both the care home and supported living environments were ineffective at identifying the shortfalls which we found. This meant that steps had not been taken to mitigate the risks to people of not receiving their medicines as prescribed. We also found a continued lack of investment and planning for renovation, refurbishment, redecoration of the premises and renewal of furniture and fabric. This meant that people did not live in a well maintained environment.

At this inspection we found the environment within the care home remained in need of refurbishment and decoration. Whilst there was some improvement in the management of people’s medicines further action was required to improve the systems for the management of people’s medicines within the supported living service. In the care home, action was required to mitigate the risks of potential harm to people from the risk of falls from windows and call bell response times.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. The registered manager followed safe recruitment practices. People who used the service had occasionally been involved in the selection and recruitment of staff. However, we found shortfalls in the support and training provided to overseas volunteers who also lived at the service to meet people’s needs and ensure they had the skills and knowledge to protect people from the risk of harm.

People and relatives valued the relationship they had with the management team and told us they found them approachable and supportive. Staff were kind, caring and there were systems in place to ensure that people’s human rights were respected and their rights to dignity and independence promoted.

People and or their representatives, where appropriate, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated, plans to achieve people’s goals and aspirations and their ability to make decisions. The service was flexible and responded positively to people’s requests about their care and how it should be provided. People were supported to access social activities according to their personal choice, wishes as to how they lived their daily lives and preferences as to how their care was delivered.

The culture of the service was open, inclusive, empowering and enabled people to live as full a life as possible. The management team provided effective leadership to the service and enabled people to air their views through care reviews, meetings and their involvement in the recruitment of new staff.

During this inspection we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told th

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

We carried out this inspection to follow up and see if the provider had made and sustained the necessary improvements required with regard to cleanliness and the prevention of infection. We therefore focussed our activities on this area.

This is a summary of what we found-

Is the service safe?

People were protected against the risks associated with infection. We found that the relevant improvements had been made to ensure the service was clean and to ensure that people were protected from acquired infections.

Is the service effective?

We found there were areas of the environment, due to age and wear and tear that required urgent attention to enable effective cleaning to be sustained, meet people’s individual needs and promote their wellbeing.

Some people living with a disability were not able to communicate with us, but we spoke with four people who were able to tell us about the service. One person told us: “When I first came here I couldn’t do anything but now I’m self sufficient.” Another person said: “Within a couple of weeks of being here I thought how lucky I am because of the high standard of care.”

We found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We reviewed five sets of care records and found that people’s needs were assessed. We also found that care and treatment was planned and delivered in line with their individual care plan.

As part of our inspection we found that there were enough skilled, experienced and qualified to staff to meet people’s needs.

We found that people’s complaints were fully investigated and resolved, where possible, to their satisfaction.

When we looked at cleaning and maintenance in the building we found that there were not always effective systems in place to reduce the risk and spread of infection.

People that we spoke with told us that they were comfortable living at Seven Rivers and felt safe being there. They told us that they felt well supported by the staff who they said were kind and caring.

People that we spoke with told us that they were happy with the accommodation provided and were particularly happy with their own rooms.

People receiving care that we spoke with told us that they believed that staff understood their care needs well.