You are here

Richmond Court Care Home Inadequate

We are carrying out checks at Richmond Court Care Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Inadequate

Updated 8 September 2017

This inspection was unannounced and took place on 20 and 21 July 2017. At the last inspection in April 2016, we found the provider was meeting regulations but improvements were required in relation to staffing levels.

Richmond Court Care Home is registered to provide accommodation for up to 30 older people, some of whom are living with dementia, who require personal care and support. On the day of the inspection there were 23 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks were not consistently assessed or managed which meant some people were at risk from avoidable harm. Where incidents had taken place, people’s care plans and risk assessments had not always been reviewed or updated and action had not always been taken to mitigate the risk of future events. Although staffing numbers were sufficient to meet people’s basic care needs staff were not always deployed in a way that meant people’s care and support needs were met in a timely way. People received their medicines as prescribed and systems used to manage medicines were safe. People told us they felt safe and staff knew how to report concerns for people’s safety.

The provider had not acted lawfully when seeking people’s consent for care and support. People’s capacity to make certain decisions had not been assessed or recorded and care records did not reflect how decisions had been made in people’s interests. Staff did not always have the skills and knowledge to provide people with safe, consistent care. People were not always offered a choice of meals and records used to monitor risks to people’s hydration were not completed accurately, which may place them at risk. Where people required support from relevant health care professionals, this was not always identified and referrals were not always made in a timely way.

While most people felt staff were kind and caring we observed a number of interactions and practices which demonstrated people’s dignity was not always maintained by staff who supported them. People told us they were not always involved in day to day decisions about their care. Where people had specific cultural needs staff were aware and people received food specific to their dietary preferences.

People did not receive care that meet their individual needs. People were not supported to have choice and control of their daily lives and were not encouraged to make decisions that reflected their preferences. There was a feeling of resignation amongst the people we spoke with who felt staff made choices on their behalf which had a detrimental effect on the quality of their lives.

People were not supported to take part in activities or hobbies that interested them. There were minimal opportunities for engagement available to people which meant people did not receive person centred support. People and their relatives had been involved in the assessment, planning and review of their care. People and relatives knew how to complain if they were unhappy about any aspect of their care and support.

Systems used to monitor the quality of the service had not been fully effective at driving improvement or identifying concerns. People continued to be placed at risk of harm as the communication systems within the home were not effective in ensuring risks or changes to people needs were escalated by the registered manager. As a result action had not been taken to mitigate future risk to people’s safety. Improvements were required to the environment of the home in order to make it more ‘dementia friendly’.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Inadequate

Updated 8 September 2017

The service was not safe.

Risks had not been assessed and/or managed to reduce the risk of avoidable harm. Action had not always been taken in response to incidents and injuries to protect people from future harm.

Staff were not always effectively deployed to ensure people received timely support with personal care or pastimes.

People received their medicines as prescribed, and systems used to manage medicines were safe.

People felt safe and were supported by staff who knew how to report concerns for people’s safety and well-being. However these concerns had not always been escalated appropriately by the management team.

Effective

Requires improvement

Updated 8 September 2017

The service was not effective.

People were not always asked for their consent before care was provided.

People’s capacity to make decisions about their care and support had not always been assessed, which meant decisions made may not be in their best interests. Some people had their rights restricted unlawfully.

People were not always offered a choice of meals, and records used to monitor risks to people’s hydration were not completed accurately, which may place them at risk.

Where people required support from healthcare professionals to manage their health needs, referrals had not always been made in a timely way, which placed people’s health at risk.

Staff received training relevant to their role but did not always support people in a way that reflected their individual needs.

Caring

Requires improvement

Updated 8 September 2017

The service was not always caring.

People did not always receive dignified support from staff.

People were not always given the opportunity to be involved in day to day decisions about their care.

We observed occasions where people received personal care based on an established staff routine rather than in response to their individual needs.

Visitors were welcomed in to the home and staff knew them by name.

Responsive

Inadequate

Updated 8 September 2017

The service was not responsive.

People did not receive care and support that reflected their individual needs and preferences.

There was a task focused culture within the home, which meant people had a lack of choice and control over their daily lives.

People were not supported to partake in activities or pastimes relevant to their individual needs and interests.

Where possible people and relatives had been involved in the assessment and planning of their care and support.

People knew how to raise concerns if they were unhappy about the care they received and there was a system in place to manage complaints.

Well-led

Inadequate

Updated 8 September 2017

The service was not well-led.

Systems developed by the provider to monitor the quality of care people received were not effective in identifying the issues highlighted during the inspection.

People continued to be placed at risk because information about serious incidents or risks to people’s health, safety and well-being had not been addressed by the registered manager.

Although the provider had sought some feedback from people and staff there was little evidence to suggest this had been used to drive improvements.