Archived: Richmond House

At the last inspection, the service was rated Good. However, we found people did not have a personal emergency evacuation plan in place, fire drills and full evacuation practice did not take place. Medicines were not managed safely. The registered provider did not carry out safe recruitment practices. We concluded these were breaches of Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At this inspection we found the service remained Good and was no longer in breach of the regulations.

The provider has systems in place to safely manage medicines within the home. Risk assessments were in place and kept up to date. People had personal emergency evacuation plans (PEEP).

There were enough staff to meet people’s needs. We made a recommendation regarding how staffing levels were monitored and recorded.

There was a robust recruitment process in place and staff received appropriate training.

People’s care and support was assessed and reviewed on a regular basis. We saw people had access to healthcare professionals.

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

We made a recommendation regarding the provider's CCTV policy in relation to obtaining and reviewing people's consent.

People’s privacy, dignity and independence was respected and promoted.

The provider had systems in place to assess and monitor the quality of the service. There were audits in place for areas such as; the environment, medicines, behaviours, supervision, training and complaints. Monthly and annual audits were completed in relation to people’s weight, activities, incidents, medical appointments and PRN medication.

Further information is in the detailed findings below.

Richmond House Residential Home is a care home without nursing. The care provider JS Care Limited is registered to provide accommodation for up to five people with dementia, learning disabilities or autistic spectrum disorder, mental health, older people, sensory impairment and younger adults who require personal care. The home has its own grounds with a rear garden, which is private and secure.

There was a registered manager in place who had been registered with the Care Quality Commission since 2011. 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. The registered manager was also the registered provider/owner.

Medicines were not always managed safely. Medicine Administration Records (MAR) were not always completed fully, handwritten MARs did not have two signatures and the service was not recording temperatures of the room where medicines were stored. We made a recommendation about medicines management.

People living at the service did not have Personal Emergency Evacuation Plans (PEEPs) in place. There had been no fire drills or evacuations for staff or the people who used the service.

The registered provider was not following safe recruitment procedures. Gaps in employment were not followed up and one staff member had not received their DBS at the time of inspection.

Risks to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. A number of checks were carried out to monitor the safety of the premises. We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

Staff received training to ensure that they could appropriately support people, and all staff had completed or were about to complete the Care Certificate. The Care Certificate is a nationally recognised set of standards that health and social care workers adhere to in their daily working life.

There were sufficient staff to provide the support needed and staff knew people’s needs well. Staff had regular supervisions and appraisals to monitor their performance.

Staff understood and applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards to ensure that people’s rights were protected. Care plans contained evidence of mental capacity assessments and best interest decisions.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for.

The service worked with external professionals to support and maintain people’s health. Care plans contained evidence of regular involvement by external professionals.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents were too few to identify any trends.

Staff treated people with dignity, respect and kindness. We observed people were happy with the care they received. Staff knew how to adapt their communication to have meaningful interactions with people.

We saw evidence to show the service provided people with information on advocacy services.

Care was planned and delivered in a way that responded to people’s assessed needs, including any specialist needs they had. Care plans were regularly reviewed to ensure people’s needs were met and relevant changes were added to care plans where needed.

People had access to a wide range of activities, internally and in the wider community.

The service had a clear complaints policy that was applied when issues arose. There was evidence of investigation of complaints and however outcomes were not documented.

Staff felt supported by the managerial staff.

The registered provider carried out regular checks to monitor and improve the quality of the service.

Care workers who administered medicines to people had received suitable training and had been assessed as to their competence. The manager confirmed that only care workers that had completed the assessment to administer medicines did so. Medicines were securely stored and discontinued medicines were disposed of by a pharmacy as described in the home's policy.

We found that the service had a system in place to reduce the risk and spread of infection. We found that the staff were well trained and knowledgeable in infection control and prevention. We observed staff putting on disposable gloves and aprons each time they went to help people with personal care. We also observed staff washing their hands before preparing food.

Staff told us they felt supported in their roles and were provided with regular supervision and the opportunity to enhance their skills through training.

We found there was an effective written complaints system available. The complaints procedure was freely available to all service users and their relatives and whilst verbal communication was difficult, one service user said they knew who to complain to if neccessary.

Our observations of the service showed that staff spoke with and interacted with people who used the service in a patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure that people understood what was going to happen.

There were good systems and processes, policies and procedures in place. Report writing in the care records was adequate and reflected the changes in care and treatment that people received. We also found that staff were supported and monitored in their working practice and had training and appraisals programmes in place.

The people who used the service appeared happy and comfortable with the staff in their interactions with them.