Richmond Heights

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Care records were person centred but for some people they were not always clear or robust in identifying support needs or mitigating risk. A review of all records was already underway, and it was seen that those records recently audited were more comprehensive and detailed. People were supported to receive their medicines safely. However, protocols for as when required medicines (PRN) for some people needed more detail to guide staff when to administer. We shared some feedback about the recruitment procedures at the service. The registered manager took immediate action in response to the feedback. Notifications of some notifiable events had not always been submitted to CQC. The registered manager was now aware of their responsibilities to inform CQC of all events which affect the health, safety and welfare of people who use the service. There were enough staff available to meet people's needs. Staff received regular training to ensure their skills and knowledge were up to date and enable them to provide safe care. People were protected from the risk of infection, as staff followed safe infection prevention and control practices. The home environment and equipment were kept clean and safe. People were safeguarded from abuse and avoidable harm. Staff told us they felt supported by the senior team and felt confident to raise any concerns and that they would be acted upon. Staff were able to recognise possible signs of abuse and knew how to report such concerns promptly.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe at Richmond Heights and were confident any concerns would be appropriately responded to. One person told us, “If I was worried about anything we would discuss it together.”

Staff were aware of how to respond to accidents and incidents which included how to record and report incidents. The registered manager confirmed that all accidents and incidents are reviewed for lessons learned.

The provider had policies in place which were readily accessible to staff. There were monitoring systems in place to ensure that lessons were learnt from incidents such as accidents and incidents, complaints, concerns, whistleblowing, and investigations.

Assessments were completed before admission and staff gathered information about people's needs prior to them receiving support. The provider was responsive to meeting their needs to ensure safe support through discussions with partners about their care.

The registered manager informed us they undertook a comprehensive assessment before people moved into the home. This involved obtaining information from the person and those close to them regarding their routines and preferences and what works well for them and also what doesn’t work. Following admission staff continue to review this initial assessment to gain greater understanding of the persons’ needs, wishes and requirements to make sure they experienced a safe transition.

Professionals working in partnership with the service overall spoke positively about the way staff worked with them to address people’s changing needs. For instance, a visiting healthcare professional told us staff were responsive, acted upon their recommendations and communicated well with them. They told us, “The manager and deputy are extremely approachable. They are very receptive.”

Records showed staff communicated with other professionals and services and made sure people experienced smooth transitions when using or moving between healthcare and other care services. New admissions and people’s changing needs were discussed within the staff team during regular meetings. When needed, staff referred people to other services, such as GP, community mental health teams, speech and language therapy or social services for additional support.

Relatives told us they felt their family member was safe at Richmond Heights and this was also reflected by the people we spoke to. One person commented, “I feel safe here because of the surroundings and the people who are here.”

Staff were aware of the provider’s safeguarding policy and could identify signs of possible abuse and neglect. They confirmed they had received safeguarding training and knew how to report such concerns. Staff we spoke with did not have any concerns but said if they did, they were confident the management team would act appropriately. One staff member told us, “I would go to manager, mention the concerns and would also record it. If the person discloses that it was manager who was abusing/neglecting them I would approach the local authority with the concerns. I am also aware of the whistleblowing policy.”

Information about safeguarding people was visible around the service. We saw people were relaxed in the presence of staff and felt able to ask them for support. There was a calm and relaxed atmosphere and staff treated people with respect and kindness. We saw lots of positive interactions between people and staff.

We found some areas of care records required further attention to ensure people were not inadvertently put at risk by conflicting or insufficient information. The provider was working in line with the Mental Capacity Act. However, the information for some people in relation to their capacity was conflicting and further review was needed to ensure people were assessed correctly. Records showed incidents were investigated and referred to the local authority safeguarding team appropriately. However, some incident types had not been reported to the CQC by the provider. This was discussed with the registered manager who confirmed these would in future also be submitted to the CQC. Staff had completed safeguarding training. The provider’s safeguarding and whistleblowing policies guided staff about different types of abuse and how to raise a concern to ensure people were protected. Monitoring systems were in place to ensure that lessons were learnt from incidents.

Overall people and their relatives told us they felt safe and were supported to understand and manage risks. People believed staff would respond to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. One person told us, “They are there when I want them, and the nurses are there too.” While people and their relatives we spoke to said that they were generally happy with their care, our assessment found some elements of care recording required improving.

Staff were familiar with people’s needs, identified risks and understood how to support people safely. One staff told us, “Everyone has a risk assessment, if they’re at risk of falls, moving and handling, any wounds, nutrition etc. I follow these on a daily basis to support me in helping to keep them safe.” While staff raised no concerns regarding the management of risk, we found some records of care would benefit from additional information to support staff to manage risks more effectively.

We observed one person who would benefit from additional guidance in their risk assessment to support staff to further mitigate any risks of choking. This was actioned immediately by the registered manager. People were supported to do the things they wanted to do, and staff helped them to do this safely. We saw staff supporting people safely around the home and in activities. Staff were patient and supported people at their own pace. When one person became distressed staff were quick to intervene, give reassurance and offer an item to hold which offered an immediate distraction.

Risks were identified and were regularly reviewed and updated where there was a change in need. However, some care records including risk assessments required more detail to ensure staff had sufficient and accurate information to manage risks and support people safely. Systems in place for monitoring the nutritional intake for people at high risk of weight loss also required review to allow clearer oversight of whether planned care was being delivered. The registered manager was responsive to the concerns raised and immediate action was taken for the records identified and a review of other records was to be completed.

People were cared for in a safe environment that was designed to meet their needs. People had a range of equipment available to use. No concerns were noted with the cleanliness of the building. One resident commented, “My room is cleaned every day.”

Staff told us they received training in all relevant areas of health and safety. They demonstrated awareness of safety procedures and of their responsibilities around maintenance and health and safety in the home. One staff told us, “I assess the room in which we are in from a healthy and safety perspective, ensuring no slip/trip hazards and ensure everyone is safe.”

Overall the environment was safe, clean and well cared for and people’s rooms were seen to be personalised. The building was accessible for people with mobility needs and signage throughout was dementia friendly. Sluices were being used for general storage of equipment. We discussed this with the registered manager who took immediate action. Equipment and PPE (Personal Protective Equipment) was available in different areas of the service for staff to access easily.

There were systems for monitoring all aspects of maintenance and health and safety. Some recent checks had not been completed due to a recently vacated post but were now being attended to by an interim maintenance officer whilst recruitment was underway. People had individual personal emergency evacuation plans and fire safety measures were in place. The emergency record of people resident in the home required updating to reflect recent changes. This was actioned immediately by the registered manager. Equipment was available in different areas of the service for staff to access easily. Cleaning schedules were in place to ensure all areas were cleaned regularly.

We received mixed feedback from people and relatives about staffing levels. One person told us, “They are always there when you want them.” Whilst a relative commented, “I have noticed other patients shouting to go to the toilet and they have had to wait for ages for someone to come.”

Staff raised no concerns about staffing levels. One staff told us, “There are always days where you think an extra pair of hands would be brilliant. We are staffed to what they’re allowed to be staffed.”

Our observations showed there were enough staff to safely meet people’s needs and respond to their requests. Staff were visible and available in communal areas and people did not wait long for their support. Staff supported people at their own pace and treated people kindly and with respect.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, some areas of the process needed closer inspection. For example, to ensure there were no gaps in a staff member's work history. We shared this information with the registered manager who took immediate action. There were processes to make sure there were enough staff. Staffing levels were monitored, and people’s needs were reviewed in order to establish if staffing levels were sufficient. This meant people's changing needs were considered when deciding the appropriate ratio of staff and ensured safe staffing in the event of emergencies. There were processes in place to make sure staff received the support they needed to deliver safe care. This included induction, training, supervision, appraisal and support to develop.

Feedback from people and relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection.

Staff were trained and understood their roles and responsibilities regarding safe infection control practices. No concerns were raised about the availability of personal protective equipment (PPE).

The environment was safe, clean and well cared for. We noticed some items stored inappropriately in some rooms which could present a risk of cross infection. We raised this with the registered manager who actioned immediately. PPE was available throughout the building and easily accessible for staff.

The provider had policies and procedures in place regarding IPC and had systems in place to monitor practices. The home knew how to respond to risks and signs of infection and how to make sure infection outbreaks at the service would be effectively prevented or managed. There were arrangements in place to make sure the environment was cleaned by staff at regular intervals.

People told us they received their medicines safely and at the correct times. One person said, “I have my medication, and I get it regularly.”

Staff told us they received training and competency assessments to manage medicines safely. Training records confirmed this. Staff supporting people with their medicines, were aware of and followed safe practice including ensuring people with time critical medicines received them promptly. One staff told us, “We set an alarm to make sure people get their medicines on time.”

When people were prescribed medicines to be taken ‘when required’ (PRN) the guidance to support safe administration was not always detailed. This meant staff did not have enough information to tell them when someone may need the medicine placing people at risk of too many PRN doses or not having them when needed. The registered manager agreed to review the guidance for PRN medication to ensure that people received their medicines appropriately. There were safe arrangements in place for managing people's medicines. Guidance was available to staff and records were in good order, clearly recording when medicines had been administered, or the reason they were not administered. We saw medicines were kept safely and were well organised. Effective systems were in place to make sure people’s medicines were ordered and accurately recorded to ensure sufficient supplies of medicines were in stock. Medicine audits were completed by senior staff.