This inspection took place on 24 and 30 September 2015, with feedback on 12 October 2015 and was an unannounced inspection.
Scenario management - Riversmede is registered as a domiciliary care agency. The service provides personal care in a supported house for people with learning disabilities and behaviour that challenges. The three people who live in the supported house are either tenants or the landlord of the property. They have lived together for over 10 years. Staffing is provided 24 hours each day to support the people living in the supported house.
The service was last inspected in June 2014. The service was meeting the requirements of the regulations that were inspected at that time.
There was a registered manager in place. However she was in the process of cancelling her registration and the care manager was applying to become the 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.
We asked people and their relatives whether they felt safe being supported by Scenario management - Riversmede. One person said, “Yes, I am safe and happy. I like the staff. They are kind, yes.” A relative told us “[My family member] is so happy. I know he is safe. He is so happy and settled.” However this did not always reflect our findings.
Risk assessments were in place to reduce risks to people’s safety. Where potential risks had been identified the action taken by the service had been recorded. However some of the risk assessments were restrictive and had been in place for a long time. The assessments had not been reviewed to reflect whether the restrictive practice was still in use and still appropriate.
This is a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure people were not deprived of their liberty for the purpose of receiving care without lawful authority.You can see what action we told the provider to take at the back of the full version of this report.
We looked at how staff supported people. There were enough staff during some parts of the day. However staff hours were not used flexibly and restricted choices. Staff were also working excessively long stretches at a time, which meant people were at risk of not receiving appropriate care.
Medicines were given as prescribed and stored safely. However a record of medicines returned to the pharmacy had only recently been introduced. This meant it was not clear when previously unused medicines had been disposed of.
People’s health needs were met and any changes in health managed in a timely manner. We saw one person having a physiotherapy session and evidence of other people seeing health professionals as needed.
Staff did not have a full understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This meant people were deprived of their liberty unlawfully.
This is a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure people were not deprived of their liberty for the purpose of receiving care without lawful authority. You can see what action we told the provider to take at the back of the full version of this report.
People told us they liked the staff and the staff were ‘nice and good’. A relative told us, “[Family member] appears happy and comfortable with all his carers without exception. He likes them all.”
We saw staff interacted frequently and enthusiastically with the people in their care, treating people with respect and patience. People were relaxed and comfortable with the staff team and staff were attentive, responding to any requests for assistance promptly.
People were encouraged to choose what they wanted to eat. Staff made sure that people’s dietary and fluid intake was sufficient for good nutrition and where possible a healthy option.
Care records contained personal information to assist staff to make each individual’s care person centred. Risks were well documented but developmental strategies to extend peoples skills and choices were limited.
The staff team were experienced, and familiar with the needs of the people who they supported. Staff were aware of people’s individual needs around privacy and dignity. They made sure people’s privacy was assured when providing personal care and each person had the personal space they needed. Relatives felt they could trust staff and they were friendly and respectful. A relative told us, “We can trust the staff here. We know them and they involve us and keep us up to date with [Family member’s] care.”
Staff recognised the importance of social contact and activities. The activities people were involved in were varied and included swimming, trampolining, football, visiting restaurants and shopping. People said they enjoyed the activities. One person said “I like McDonalds and fish and chips. I go swimming sometimes.”
We asked people if they knew how to raise a concern or to make a complaint if they were unhappy with something. One person said, “Tell [one of the staff team or family].” Relatives said they knew how to make a complaint. A relative told us “We have a great relationship with staff and can talk to them about anything.”
Systems in place to monitor the service were limited. The manager told us she was developing these systems so they were more rigorous.
The staff team had frequent informal chats with people and their families about what they wanted from the service. This meant that people’s views were heard and relatives were kept up to date with any new information or changes with their family member.