We completed this comprehensive inspection on 16 and 17 February 2017 and it was unannounced.

Riverbank provides accommodation and rehabilitation to people with complex mental health needs. The service is situated close to local amenities and is within walking distance of public transport. There are 24 bedrooms; 12 en-suite rooms providing high level support and 12 apartments with en-suite and kitchen facilities to aid daily living. There are also 12 independent flats attached to the service where people are supported by the staff. At the time of this inspection, there were 16 people living in the residential service and eight people living in the independent flats.

The service 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.

At the last comprehensive inspection in June 2016, we rated the service as Requires Improvement overall and found concerns in risk management, staff training and notifying us of issues that affected people who used the service. At this comprehensive inspection we found improvements had been made in all these areas and had been sustained.

How staff assessed, identified and managed risk had improved. A new system of risk management had been implemented and we saw there was more guidance for staff in the steps to take to support people when they made choices that carried a risk.

Staff had received training in how to manage conflict and de-escalate situations. There had also been improvements in staff training regarding people’s mental health conditions and needs. Staff told us the training had helped them to feel more confident when supporting people. We saw staff completed other training considered essential by the registered provider and they received supervision and appraisal.

Staff knew how to protect people from the risk of harm and abuse. They had completed safeguarding training and knew what to do if they witnessed abuse or poor practice.

We found staff were recruited safely with employment checks carried out before they started work. New staff received an induction and were introduced to people who used the service.

There were sufficient staff on duty during the day and night to meet the needs of people who used the service. People told us staff were friendly, caring and had time to sit and talk to them. We observed the staff approach encouraged independence and there was a friendly banter between them and people who used the service. We saw staff treated people with respect and as individuals, and supported them to maintain links with their family and friends.

We found people's physical and mental health needs were met. Staff supported people to attend appointments with their GP or mental health worker. Staff ensured people had their medicines as prescribed to help them maintain their mental health. We found medicines were managed well, stored safely and appropriately and ordered in a timely way so people did not run out of stock.

People’s nutritional needs were met. There was a chef on duty each day and menus provided choices and alternatives. The menus were reflective of the younger age group of people who used the service and when asked they told us they liked the meals provided.

People were supported to live as independently as possible. Staff encouraged people to participate in activities of daily living such as laundry, cleaning, shopping and cooking. They also assisted people to access community facilities such as support groups, leisure activities and college courses. Staff provided a range of activities for people to participate in within the service.

The culture of the service was open and inclusive. There was a quality monitoring system which consisted of audits and

Riverbank is situated within a residential area, close to local amenities and is within walking distance of public transport into Hull city centre. Riverbank provides accommodation and rehabilitation to people with complex mental health needs; there is also a supported living service managed from the location. There are 24 bedrooms within Riverbank; 12 en-suite rooms providing high level support and 12 apartments with en-suite and kitchen facilities to promote independence. The supported living service provides support to people who reside as tenants in 12 independent flats attached to Riverbank.

The service had a registered manager in post as required by a condition of registration. 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. Since the last inspection there had been a change in registered provider.

We undertook this unannounced inspection on the 14 and 15 June 2016. At the time of the inspection there were a total of 15 people living in Riverbank and one person receiving respite care. There were seven people occupying the supported living flats. At the last inspection on 13 April 2014, the registered provider was compliant with all areas assessed.

We found people did not always have full risk management plans regarding changing behaviours that could put them, the service and others at risk. This meant staff did not always have clear guidance in how to support people in crisis situations which could pose a risk to all involved. However, the process of upgrading the risk assessments had started. There was no full debriefing for staff following incidents so lessons could be learned. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found gaps in essential training and also in the mental health conditions which affected the people who used the service. There was a significant training gap in how staff were to manage conflict and aggression; given the number of incidents which had occurred in the service, this was very important. The registered manager had booked the training on two occasions but it had been cancelled by the training provider. We also saw staff had not received any personal development reviews in 2015 and 2016 so far, due to a change in registered provider. You can see what action we have asked the registered provider to take at the back of the full version of the report.

As a part of registration requirements, the registered provider must send notifications to the Care Quality Commission of incidents which affect the safety and welfare of people who use the service. We found this had not happened on a number of occasions which meant we were unaware of the incidents and did not have full information on some. When we receive notifications, it gives us the opportunity to check out how these are being managed. In this instance, we will write to the registered provider reminding them this is a breach of regulation and stressing the importance of sending these notifications.

Five days after the inspection, the registered manager sent us an interim action plan to address these shortfalls. This was a quick and positive initial response to the concerns.

We saw people received care that was person-centred. However, some assessments could be more detailed and recovery plan actions less standardised. There was some focus on rehabilitation but this could be improved to enable people to move on to independent living in a more timely way.

There were procedures to guide staff in how to safeguard people from the risk of abuse. Some staff were very familiar with these and had completed safeguarding training. Others required more training input which the registered

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. 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 supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and they told us they felt safe. Risk assessments and behaviour management plans ensured staff had guidance to support people when they had behaviours that could be challenging to themselves, other people and the service.

People had their medicines managed well so that they received them on time and as prescribed.

The registered manager set the staff rotas and they took people’s care needs into consideration when they made decisions about the number of qualified nurses and recovery support workers required. They also ensured there was a mix of skills, experience and knowledge in the staff team.

Comments about the staff from people who used the service included, “They help us to do plans and make decisions about how we want to progress, what activities of daily living we want to do. Once a week I go shopping and make a meal” and “I have never run out of my medicines.”

Is the service effective?

People were provided with information and choices regarding their daily lives and staff respected their decisions. Staff gained their consent prior to providing care and support to people.

People’s health and care needs were assessed with them and they were involved in developing their recovery plans.

Visitors confirmed they could visit their relatives in private and visiting times were flexible.

People’s care was coordinated with other health and social care professionals in the community and when admissions to hospital were required.

Comments from people who used the service and their relatives included, “The facilities here are for people with long and enduring mental illness. I felt I had lost my voice but I have now regained it. There is a lot more active involvement for service users”, “They use the ‘recovery star’ to gauge where you are at now and where you are on the star; you feel part of your progress”, “They are a different person since they have been in here” and “The staff sat with me all night. They involved the crisis team, got the paramedics here and made it so that I didn’t have to go into hospital.”

Is the service caring?

People were supported by kind and attentive staff. We observed staff speak to people in an encouraging and professional manner.

People’s preferences, likes, dislikes, routines and goals had been recorded and care and support was provided in accordance with people’s wishes and choices.

Comments from people who used the service included, “They are very nice and professional; they help you with any problem. I would say they are effective”, “They judge me as a person; they are non-judgemental” and “They have helped me so much especially in building up my relationship with my family. They let me go at my own pace and don’t rush me.”

Is the service responsive?

People were supported to be independent and take part in a range of activities in and outside the service.

People had access to a range of health and social care professionals such as consultants, GPs, community psychiatric nurses, social workers, dentists, opticians and podiatrists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

Comments from people who used the service included, “The staff help me to make appointments and they follow up test results; I’m getting well looked after here” and “The staff are really good. My keyworker is helping me sort out my problems and finances.”

Is the service well-led?

The service worked well with other agencies to make sure people received their care in a joined up way.

The service had a quality assurance system, which included audits and seeking people’s views. Some staff had lead roles in health and safety and infection prevention and control; They also carried out checks of the environment. There was a complaints process and people were made aware of this.

Staff told us they were clear about their roles and responsibilities, had access to training and were well supported by management. Staff had an understanding of the ethos of the service and worked well as a team.

Comments from people who used the service included, “I haven’t had any complaints so far” and “Staff listen to you; they are there for you.”

People who used the service told us they were supported in promoting their independence. They also told us they were able to make choices about everyday life. They told us they were able to go out when they wanted to, decide when to get up in the morning and when to go to bed at night. Comments included, "I am very happy here and the staff understand me" and "It's one of the best places I've been in and I feel I am improving" and "I have a programme to work to and this helps me build my self esteem."

People who used the service told us the care and support they received met their needs. They also told us that the staff were helpful and understood how to help them. Comments included, "I feel that the staff understand and help me" and "There is always someone around if I need help, even if this is during the night."

We saw that the quality of the environment had been completed to a very good standard and people who used the service told us they were extremely happy with their room and other facilities. Comments included, "I love my room and I've personalised it too" and "Yes I like my flat, I have everything I need."

People who used the service told us they felt safe in the home and their views and concerns were listened to.