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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.

Reports


Inspection carried out on 20 July 2017

During a routine inspection

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 carried out on 12 April 2016

During a routine inspection

This inspection was unannounced and took place on 12 April 2016. At the last inspection in October 2013, we found the provider was meeting all of the requirements of the regulations we reviewed.

Richmond Court is registered to provide accommodation for up to 30 people who require personal care and support. On the day of the inspection there were 28 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.

People were not always supported by sufficient numbers of staff so their needs were not always met in a timely manner. However, people told us they felt safe, risks were assessed, managed, reviewed and learning had taken place following incidents or accidents. People received their medicines as prescribed by their GP and systems used to administer, manage and store medicines were safe.

People received support from staff who had received training relevant to their role and had the skills and knowledge to provide effective support. People were asked for their consent before care and support was provided. The registered manager had assessed people’s capacity to make certain decisions and people’s rights and freedom were protected. People were happy with the food and drink provided and had access to relevant healthcare professionals when required.

People described staff as caring. Staff understood people’s likes and dislikes and supported people in a way that they preferred. People’s dignity was protected by staff who were discreet and mindful of the need for privacy. Relatives and friends were welcome to visit at any time and gave positive feedback about atmosphere of the service.

People and their relatives contributed to planning and decision about their care. A programme of activities was offered daily, although some people felt there could be more variety. People were supported to follow their interests and arrangements were made for people to receive visitors from their church or religious group. People and their relatives knew what to do if they were unhappy about any aspect of their care and there was a system in place for the management of any complaints received.

People and their relatives expressed positive views about the way the home was managed. Staff were offered opportunities to give feedback about the service and felt listened to by both the registered manager and the provider. There were systems in place to monitor the quality of care provided as well as the environment and improvements to the building were underway at the time of the inspection.

Inspection carried out on 1 October 2013

During an inspection to make sure that the improvements required had been made

We spoke to two people who were using the service. Both people praised the members of staff for the care they received. Both people said that they were satisfied with the way staff looked after their medicines.

We found that systems were in place to ensure the safe handling of medicines for the people using the service.

Inspection carried out on 15 July 2013

During an inspection to make sure that the improvements required had been made

A pharmacist inspector carried out this inspection to check whether improvements had been made. We found that there had been very little progress in ensuring that the management of medicines reduced the risks associated with the handling and administration of medicines to people who lived at the home.

Inspection carried out on 15 May 2013

During a routine inspection

On the day of the inspection, there were 27 people living at the home. We spoke with 11 people, one relative, four staff members and the home manager.

People were asked for their consent before care and support was provided. One person said, “They ask me what I want, the staff are good like that.”

People received care that met their needs. One person said, “This place is smashing, you cannot fault a thing.” People had access to other healthcare professionals when needed.

Arrangements were not in place for the safe handling of medicines.

We found that staff had been supported in different ways. One staff said, “I asked for dementia training and I got it.” People we spoke with were complimentary about the staff.

Systems were in place to monitor the quality of the service. One person told us, "I can't complain about anything."

Inspection carried out on 30 October 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people. There were 25 people living at the home on the day of the inspection. We spoke with seven people, one relative, five staff, the deputy manager, and the home manager.

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We found that people were encouraged to be independent in different ways. One person said, “I am quite independent and I have complete freedom to do what I like.”

We found that people’s care records were not always detailed, although staff delivered care that met people’s needs and preferences. One person told us, “They are very caring, I am happy here.”

We found that arrangements were in place to ensure that people were safeguarded from abuse.

We found that there were enough staff to look after people on the day of the inspection. One staff said, “It is manageable at the moment.”

We found that systems to monitor the quality of services were effective at identifying shortfalls in the home and action was taken to make improvements.

Inspection carried out on 27 July 2011

During an inspection to make sure that the improvements required had been made

This was a focused visit to look at the actions taken to address the compliance action which we issued following our previous planned review of compliance.

People who we spoke to during our previous visit were satisfied with the care they received and we did receive many positive comments.

We have received information from visiting professionals who have recently conducted a review at the service. They told us feedback from people and their relatives was positive and people were ‘happy’ with the care they received.

Inspection carried out on 24 March 2011

During a routine inspection

People using the service told us that staff respect their privacy and dignity, and were encouraged and supported to maintain their independence. We observed that the routine in the home was relaxed and this was supported by comments made to us. People were engaged in a range of activities, and also supported to access the local community, on their own or with friends and family.

People told us they felt safe, and that if they had concerns they are confident that the staff, manager and service provider would act to put things right. None of the people we spoke with at the time of our visit had any concerns about their care.

Staff members spoken with were aware of how to recognise potential abuse, and they told us they wouldn’t hesitate to report any issues to the manager. People were positive about how staff cared for them.

We spoke with some visitors during our visit, and they told us about their experiences whilst their relatives have lived at this service. They made positive comments about the care their relative received and about the staff team and manager who were described as “caring and skilled”. The visitors did not have any concerns about the care people received, but some comments were received about the laundry service and clothes going missing.

People told us they have regular meetings which enable them to raise any issues about the service and suggest improvements about the way the service is delivered. People told us they thought the home was well run by a manager and staff who care about everyone’s needs.

Reports under our old system of regulation (including those from before CQC was created)