Archived: Richmond Court Care Home

Updated 28 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was prompted in part by notification of concerns raised by the local authority who had visited the home in response to a whistle-blower who had contacted us. Whistleblowing is the term used when someone who works for an employer raises a concern about malpractice, risk or wrongdoing, which harms, or creates a risk of harm to people who use the service.

The inspection included an early morning visit to enable us to see how people were being supported by night staff. The inspection took place on 20 and 21 July 2017 and was unannounced.

The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who use this type of service. As part of the inspection we looked at the information we held about the service. This included statutory notifications, which are notifications the provider must send us to inform us of certain events such as safeguarding concerns, serious injuries and deaths. The provider had sent us a Provider Information Return (PIR) before the inspection. A PIR is a form that asks the provider to give key information about the home, what the service does well and improvements they plan to make. We also contacted the local authority and commissioners for information they held about the service. This helped us to plan the inspection.

During the inspection we carried out observations of the care and support people received. We used the Short Observational Framework for Inspection (SOFI) to observe how care was provided for people who were unable to speak with us. We spoke with 12 people who lived at the home, two relatives, one healthcare professional, five staff members, the deputy manager, the support manager, the registered manager and also the provider. We looked at eight records about people’s care and support, three staff files, medicine records and systems used for monitoring the quality of care provided including accidents and incidents.

Updated 28 December 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.