Richmond Care

Richmond Care is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

People’s experience of using this service and what we found

Medicines were now being managed safely at this inspection. Practices and processes had improved, assisted by a more consistent nursing team. Risks to people's health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were reduced as much as possible.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout. Infection control procedures were in place and staff used PPE effectively. Additional cleaning had been introduced during the COVID-19 pandemic.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Electronic care plans and risk assessments provided staff with relevant information so that appropriate care could be provided for people. The service had good working relationships with local GP practices and mental healthcare professionals. The service worked in partnership with people, their families and staff. We received positive feedback from people and staff about the service.

The service had good governance arrangements in place and completed regular internal quality checks. When we identified potential weaknesses in the medication audit a more robust tool was immediately adopted. Findings from audits were reviewed by the registered manager and used to drive improvement within the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 20 April 2021. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The provider had segregated the two units in the care home to support social distancing and minimise cross contamination. The provider had allocated a staff team to each unit. Each unit provided fully self-contained accommodation and facilities and had its own entrance and exit.

The care home had introduced temporary measures to help observe social distancing, for example, up to two staff at a time could use the staff room, and only one person who used the service could use the lift, and they had to wear a mask.

Staff held weekly meetings with people to share and discuss information on the pandemic, good hygiene practice and local restrictions.

The home had a designated infection control lead and infection control champions among its staff group. These staff helped maintain good infection control standards in the care home.

Staff had access to a range of facilities away from the residential units. These included a staff room, a changing room and lockers. Staff had temperature checks on arrival for their shifts. Staff changed into a uniform when they arrived at work and changed out of their uniforms when they finished their shifts.

Cleaning rotas covered a 24-hour period with cleaning duties shared between the cleaning staff, support staff and night staff.

Further information is in the detailed findings below.

People’s experience of using this service:

Medicines were not being managed safely. A recent medicine audit had not picked up the errors we found.

The number of staff available during the day and at night was sufficient to ensure people’s needs were met in a timely way at the time of the inspection, due to additional resources in the home. We were not confident that normal staffing levels would meet people’s needs, especially with people’s increasing dependencies.

The home was clean. Audits in this area were fit for purpose and any identified failings were rectified.

Environmental health and safety checks had been carried out but had not identified some of the issues we identified. The system for reporting and addressing repairs required to the home needed to be formalised.

Risks to people’s health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were mitigated as much as possible.

The management and staff understood their obligations under the Mental Health Act 1983 and worked within these legislative frameworks.

Care plans reflected that care was being delivered within the framework of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been applied for when necessary.

People told us they felt safe and well cared for at the home. Staff knew people well and had developed close, caring relationships. Staff were aware of their responsibilities to safeguard people.

Recruitment practices were safe and staff received the training they required for their roles.

People and their relatives were involved in making decisions about their care.

People who were independent were able to access the community and engage in meaningful leisure and social activity. There were less opportunities for people who required support from staff to do this.

Audits of the service were in place and were undertaken, although these were not always used effectively to monitor and improve the quality and safety of the home.

The manager was using available resources such as the local registered manager network and meeting with relevant health professionals for advice and guidance.

We identified two breaches of the regulations and we made three recommendations. These included introducing a formal process to determine staffing levels, improving the way required repairs were reported and dealt with and engaging people more in meaningful social activities.

The home met the characteristics of a rating of “Good” for two key questions and “Requires Improvement” for three key questions. Our overall rating for the home after this inspection was “Requires Improvement”.

Rating at last inspection: At the last inspection in October 2016 the home was rated Good (report published 31 October 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Please see the ‘action we have told the provider to take’ section at the end of the report.

Follow up: We have asked the provider to complete an action plan detailing how they will make improvements to ensure the regulations are met. We will work with our partner agencies, including the local authority, to review the progress made by the provider. We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Richmond Care is a nursing home with 20 beds that provides care and support for people with enduring mental health problems and/or substance misuse issues. The accommodation is situated over three floors and includes a number of communal areas and a large garden.

There was a registered manager in post. 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.

People told us they felt safe and the service was caring. There were systems in place to manage risk and protect people from abuse. Staff were aware of their responsibilities and knew what actions they needed to take to ensure people were protected.

Overall there were sufficient numbers of appropriately trained staff on duty to care for people. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Medicines were safely administered by staff who had received appropriate training, including an annual check of their competence.

Equipment, such as hoists, bathing aids and pressure relieving mattresses were available in the home and these helped promote people's safety and comfort. There were new procedures in place to ensure standards of cleanliness were monitored and maintained.

Our inspection of the building showed it was a safe environment in which to care for vulnerable people with the exception of some damaged floor coverings and a broken window restrictor.

Staff were appropriately trained and skilled and demonstrated a good understanding of their roles and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

Staff understood the importance of encouraging people to make choices, where they were able to, and always sought consent before undertaking any care. There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. Staff were trained in the principles of the MCA and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

Most people we spoke with were happy with the quality and choice of food provided at the home.

People were supported to maintain good health and where needed specialist healthcare professionals, such as dieticians, were involved with their care.

People who used the service were very positive about the care they received. People told us the staff were caring and their dignity and privacy were respected.

Care plans were person centred and were reviewed regularly by the trained nurses. Staff cared safely for people with a variety of complex health problems.

Records showed people were involved in range of activities. However, some people told us they were sometimes bored at the service.

There were systems in place to ensure complaints and concerns were fully investigated.

Quality assurance processes such as audits were in place to ensure that the service delivered high quality care that met people's needs.

We found that the provider had systems in place to obtain and review the consent of people who used the service. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Care plans and risk assessments were in place for each person to ensure people experienced care, treatment and support that met their needs and protected their rights.

People who used the service, staff and visitors were protected against the risks of unsafe premises. People were protected from the risks of unsafe or unsuitable equipment because relevant checks were performed to ensure that equipment was safe to use.

There were enough qualified, skilled and experienced staff to meet people's needs. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. The provider had systems in place to regularly assess and monitor the quality of service that people received.