All inspections: Richmond Residential Care Limited

This inspection took place on 30 October 2015 and was unannounced.

The service is registered to provide residential care for up to 40 older people. At the time of our inspection 27 people were using the service, including some people living with dementia.

There was a registered manager in place at Richmond Residential Care Home at the time of our inspection. 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.

People were not fully protected from the risks associated with medicines as procedures designed to reduce risks to people were not followed and sufficient stocks of medicine were not always available. We also found individual risks associated with people’s care and support were not always identified in care plans and risk assessments.

In addition, care plans did not always reflect the care and treatment people needed, and where care plans were accurate, staff did not always follow them. This resulted in people not always receiving the responsive and personalised care they required.

When people lacked the capacity to consent to their care and treatment we found that decisions had not been taken in line with the Mental Capacity Act (MCA) 2005. Information about people’s day to day needs was not always recorded and used effectively to update staff as to any changes in people’s care and treatment.

Systems to check on the quality and safety of service provided had not yet been fully embedded, and had not identified all shortfalls in the service. Care plans and other records associated with the service were available, however, sometimes not all records were kept confidentially.

People had their views and choices respected and were included in making decisions about their care and support. People knew how to raise concerns, suggestions and complaints. People could take part in organised afternoon activities and some people could pursue their own interests. However, when the activities coordinator was not present, people experienced varying levels of engagement and stimulation because staff members varied in how much they engaged people in everyday conversation

People received care and support from staff who showed respect for people’s privacy and dignity. Overall, the staff team’s approach to people was caring. Staff received support, supervision and training to help them understand the needs of people using the service. People enjoyed their meals and choices of food and drink were provided which met their dietary requirements. People’s health care needs were supported by other professionals when required.

Sufficient numbers of staff were available, however at certain times of the day they were not always effectively deployed to meet people’s needs. Staff were aware of how to raise concerns to keep people safe and staff working at the service had been subject to pre-employment checks that helped ensure they were suitable to work there.

The registered manager had an open and approachable management style. The registered manager was coordinating a number of improvements planned for the service, including updating furnishings as well as management and information systems.

As part of our inspection we met with five people who used the service and three relatives. We spoke with a senior carer, two other care staff and the acting manager. Following our inspection we spoke with the home owner about the service. We sat with people over lunch and talked to them about what it was like to live at Richmond Residential Care Home and asked for their views about the food. We also examined care plans and other records. There were 26 people using the service at the time of our inspection. A summary of what we found is set out below.

Is the service safe?

A relative told us, 'We visited lots of other homes before we chose this one and we think out of all of them this is one of the best.' The relative told us care staff had made changes to their relative's medicine to make it easier for them to take. This helped to ensure the person's medical condition could be safely treated. The service had policies and procedures in place which care staff followed to ensure people's medicines were administered safely.

We spoke with another relative who told us they visited six or seven days a week. They said, "I have never seen care staff treat anyone inappropriately.' They said, 'The care here is good. People are well treated and because the home is local we have been able to keep our family together which is important.'

We asked several people if they felt safe living at the care home and they said they did. One person told us they had lived on their own and had fallen at home. They said they felt safe at the home because there were people who could help them.

We spoke with staff about the quality of the service provided. They told us they thought the quality of care was good. Care staff were able to tell us about their role in protecting people from the risk of abuse.

There were no Deprivation Of Liberty Safeguard authorisations (DoLS) in place. The deprivation of liberty safeguards are a legal framework designed to ensure that people lacking capacity who are being cared for, or treated by others, should be deprived of their liberty only in accordance with the law.

Care staff we spoke with told us maintenance staff carried out repairs quickly and ensured people's care was provided in a safe and appropriate environment.

Is the service effective?

Care plans showed peoples' needs had been assessed. Care plans described what people needed help with and how many staff were needed to support the person for example transferring from a chair to their bed with a hoist if they were unable to walk. We saw sensor mats in some rooms designed to alert staff if someone fell.

Specialist healthcare professionals had been involved in assessing people who were at risk because of their condition for example of choking.

The service used an electronic care planning system to plan people's care. The system prompted care staff to review people's care plans monthly.

The views of people who used the service, their relatives and staff were obtained by surveys and the home owner told us how the service acted on the responses received.

Is the service caring?

We observed staff at several points during the course of our inspection. We saw staff treated people as individuals. When we spoke with care staff they told us the quality of the care they provided was important to them. We saw staff support people to eat at lunchtime at a pace the person was comfortable with.

Relatives told us staff were very caring. One relative told us they had looked at several care homes to find somewhere suitable and felt staff were very caring.

Is the service responsive?

People's care plans were reviewed regularly and relatives told us they had been involved when the plans were developed. One relative told us care staff contacted them if anything happened to affect the care of their relative.

Care staff we spoke with told us there were key workers for people who used the service. This meant a member of care staff was identified who supported people to make appointments, for example, at the dentist or made sure they were supplied with toiletries and other personal items.

Care plans were held on a computerised system and reviewed monthly. People's care was adjusted as a result of falls or other incidents which had been recorded on incident forms or risk assessments.

Is the service well led?

The home owner regularly visited the service unannounced to discuss the quality of the service with staff, visitors and people who lived in the home. They also carried out supervision meetings with senior care staff and discussed improvements to the service at senior staff meetings. Staff and relatives told us the home owner was actively involved in assuring the quality of the service. We saw records of unannounced visits where they had recorded the views of staff and relatives about the service. The views of people who used the service, relatives and staff were surveyed and analysed to enable the home owner and service manager to monitor the quality of the service.

The provider had plans in place for evacuating people if required in an emergency. They had also developed a contingency plan to enable the service to be provided following an emergency.

A reporting process was in place which enabled the manager to identify incidents and risks.

On the day of our site visit to Richmond Residential Care Home there were 30 people living at the home.

We spoke with two people who live at the care home. The first person told us that: 'I'm very well, the staff are very nice, and I'm quite happy.' The second person said: 'I've got a nice room, and the staff are OK.'

Many of the people who live at Richmond Residential Care home had dementia, and were unable to answer questions or provide us with their views about living at the home. As a result we carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us sitting in the dining room and observing for a period of 40 minutes over the lunch period. This enabled us to see how the staff spoke with people who live at the home, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff had good relationships with the people who live at the care home. We saw staff offering support and encouragement in a pleasant, friendly and helpful manner.

We looked at ten outcomes from the Health & Social Care Act (2008). We found the staff to be knowledgeable, and our observations showed staff to be caring and focussed on the people who live at the care home.

On the day of our visit to Richmond Residential Care Home there were 28 people living at the home.

We spoke with two people who live at the care home to gain their views of living at the care home. We also observed the staff at various times throughout the day, to see how they interacted with people, and whether they treated people with respect.

We asked if people were happy living at the care home and we were told: 'I'm quite happy thank you. I've got everything I need, and the staff are very nice and very friendly.' A second person said: 'I've got no complaints. The staff treat me well, and I'm quite happy.'

Our observations of staff interacting with people showed that there was a level of respect and understanding, with staff taking the time needed to reassure people who might have become anxious or disorientated as a result of their dementia.

We spoke with two people who live at the care home about their care, and they said they thought they were well cared for. One person said: 'I only have to ask and the staff will help me.' A second person said: 'Everyone is very caring, I couldn't ask for better.'

Our observations during our inspection visit did not raise any questions or issues with regard to peoples' safety at the care home. We asked several people if they felt safe living at the care home, and they said that they did.

We carried out this responsive inspection because we had concerns that this service had not been visited since 13 October 2009.

There were 29 people living at the service when we visited on 02 February 2012. We spoke with seven people who lived at the service, three staff and with others who have regular contact with the home to ask for their comments and observations. We spent time in the company of people who lived at the home observing their experience of care and assessing the quality of support they received.

People told us that they were able to visit the service before they were admitted and that they were involved in the admission process. They felt able to express their views and preferences and said these were taken into account by staff.

We received some positive comments about the quality of support and care provided. One person said, "I'd given them 10 out of 10 if more staff were available.' And, 'The staff are friendly and the place is clean.'

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Richmond Residential Care Limited

All Inspections

30 October 2015

During a routine inspection

11 June 2014

During a routine inspection

5, 13 September 2013

During a routine inspection

10 October 2012

During a routine inspection

2 February 2012

During an inspection in response to concerns

Reports under our old system of regulation