We inspected Two Rivers Care Home on 26 July 2016. This was an unannounced inspection. At our last inspection in January 2014 the service was meeting the regulations inspected.

Two Rivers Care Home is registered as a care home for eight people and as a supported living scheme. The service has two supported living schemes (Holdenhurst and Cissbury Ring) located a short drive from the care home. On the day of our inspection eight people were living in the care home, three people at Holdenhurst and six people at Cissbury Ring.

People experienced excellent care and support. They were supported to live safe, fulfilled and meaningful lives in the way they wanted to.

People were supported with healthy eating and to maintain a healthy weight, with specialist diets when required. People who needed assistance with meal preparation were supported and encouraged to make choices about what they ate and drank. The support staff we spoke with demonstrated an excellent knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns

Staff told us they really enjoyed working in the home and spoke positively about the culture and management of the service. Staff told us that they were encouraged to openly discuss any issues. Staff said they enjoyed their jobs and described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided.

The registered manager had been in post since the service opened in 2008. 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 and associated Regulations about how the service is run.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were cared for. Staff listened to them and knew their needs well. Staff had the training and support they needed.

Staffing levels were sufficient to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act 2005, DoLS and associated Codes of Practice.

People participated in a range of different social activities and were supported to access the local community. They also participated in shopping for the home and their own needs, and some people had recently been on holiday together with staff support.

The registered manager and staff ensured everyone was supported to maintain good health. They took a very proactive approach to ensuring people's complex health needs were always met, and consistently ensured that when people needed specialist input from health care professionals they got it.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understan

We spoke with seven people who use the service. People praised the service and the care provided. Comments included, “it’s really good here” and “I’ve learnt a lot since being here.” We saw that staff provided support to people where needed and engaged with them in a friendly manner. We found that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare and meet people’s individual needs.

Everyone talked positively about the staff. They were described as “very nice”, “friendly” and “polite.” We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People told us they were happy with the communal environment and their rooms where they lived. We checked the environments of both premises, including recent refurbishments and extensions. We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People we spoke with had no concerns about support with medicines. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People informed us that staff and the manager listened to their views and provided a service which they wanted. People told us staff were responsive to them, for example, “staff are quite approachable.” We found that the provider had effective quality and risk management systems in place.

We spoke with two people who use the service, who fed back positively about it. For example, one person told us, “the staff are very caring.” We saw respectful and engaging interactions between staff and people who use the service.

There were systems in place to assess, plan and deliver individualised care and support to people who use the service. We focussed in particular on care and support to people whose behaviour challenged the service. Staff knew what could trigger these behaviours from individuals, and how to meet people’s needs and keep people safe when these behaviours occurred. There were individual guidelines in place in support of this.

Records were kept of any incidents of behaviours that challenged the service. It was evident that these were reviewed, to reflect on and improve services. The provider recognised that the reviews could be better documented, and that the staff team would benefit from further training about the consistent use of appropriate language within records.

People who use the service spoke positively about the staff. Comments included that staff treated people with respect and care. One person said, “I’m happy with the staff”. People said there was enough to do at the service. People, relatives and healthcare professionals felt the service enabled people to progress in terms of general health and welfare. One person told us, “I’ve made good progress here.” A relative said, “We do not have anything adverse to say about Two Rivers.”

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us, which was the case with some people at the service.

We saw many respectful and engaging interactions between staff and people who use the service. Staff responded, listened and provided reassurance when necessary. When a person exhibited behaviour that challenged the service, staff acted promptly to assist this person and minimise disruption to others.

People told us staff listened to them and enabled them to make choices. We saw staff constantly interacting and supervising people who use the service.

We observed and talked to people who use the service. We saw people were treated by staff with respect and dignity. People who use the service appeared to be happy and confident when interacting with staff. They told us that they were satisfied with care and treatment they were receiving.

We saw that people who use the service appeared confident when interacting with each other and staff. We saw that they got on well with staff. They told us they liked their home and were satisfied with their care.

We were informed by people using the service that staff had treated them with respect and dignity. People who use the service expressed no concerns.

People who use the service told us they were satisfied with their carers. We observed that carers (staff) knew people's needs and how to meet them. We saw people could express their views and were listened to by staff.

People using the service indicated that they felt satisfied with the service and staff. Their comments can be summarised as follows:

“Staff listen to me".

“I have relatives who come to see me".

"I like the staff."