Archived: Richmond House

Richmond House is a transitional and short stay service. This is usually for respite care or while awaiting other care provision to be arranged. The provider is registered to provide accommodation for up to 20 persons aged 65 and over who require personal care at this service. At the time of the inspection there were 12 people using the service.

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

Overall, medicines were managed safely. Action was taken at the time of the inspection to improve medicines records. Staff were trained in medicines management, but their competency was not formally checked. We have made a recommendation about medicine competency checks. The premises were clean, and staff showed a good awareness of fire safety. However, fire training updates were overdue. Plans were made at the time of the inspection to rectify this. People were happy and felt safe at the service. They were supported by staff who were trained to recognise and report any signs of abuse. Overall, staffing numbers were enough to keep people safe. Most individual risks were managed appropriately. Some risk management records had not been updated when changes occurred.

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. Staff received appropriate training and support to enable them to carry out their roles effectively. Staff supported people to access healthcare and maintain good nutrition. People enjoyed their meals and said there was plenty of choice.

People told us staff were caring and treated them well. Staff understood the importance of treating people with dignity and respect. Independence was promoted, and people’s privacy was respected. Staff knew

people well and used effective techniques to reassure people. Some people said they would like more activities and were sometimes bored.

Auditing and quality assurance processes were in place to enable the service to identify where improvement was needed and in the main, these were effective. The registered manager was open and transparent and created a culture which was friendly and welcoming.

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

Rating at last inspection

The last rating for this service was Good. (report published 17 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Richmond House is a 20 bedded rehabilitation and respite unit. People stay at the service for a short time, which is usually about six weeks. Leeds City Council is registered to provide accommodation for up to 20 persons who require personal care.

At the time of this inspection the home had a registered manager. 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 care plan for one person staying on respite required strengthening. Other care plans contained sufficient information and we saw evidence of regular reviews.

Risks to people had been appropriately assessed, managed and reviewed. Building maintenance checks had been carried out on a regular basis and systems were in place to ensure fire safety had been appropriately managed. People receive their medicines at the correct times as prescribed. Relevant documentation was in place to ensure this was well managed. The registered manager told us they would look to introduce staff medication competency checks.

People and staff told us staffing levels were sufficient to meet people’s needs. Our observations confirmed this. Appropriate recruitment checks had been completed which meant people were protected from individuals who are unsuitable to work with vulnerable adults.

People received prompt access to healthcare support when this was required. The service had a team of health professionals including a nurse, physiotherapist and occupational therapist on site to oversee people’s rehabilitation.

People living at Richmond House were deemed to have capacity at the time of our inspection. We saw evidence of a recent mental capacity assessment and application to the local authority for Deprivation of Liberty Safeguards (DoLS). Staff received training in these areas and were able to demonstrate their knowledge.

People and relatives we spoke with were overwhelmingly positive about the staff who cared for them. We saw warm interactions between staff and people and throughout our inspection. People received encouragement from staff who supported their rehabilitation. Staff knew how to respect people’s privacy and dignity and people confirmed this happened.

Activities and themed events were taking place in the home. We saw gardening had been added to the activities schedule in response to people asking for this. People had been able to grow their own produce and enjoyed this as part of their meals. People were complimentary about the food and drink on offer. Soup, snacks and drinks were available between meals for people and visitors.

Complaints were well managed as they were fully recorded and appropriate action had been taken including identifying learning outcomes. The registered manager had taken appropriate action to ensure people had sufficient information about how to complain. The registered manager had a weekly surgery which people and relatives were invited to attend to provide feedback about the service they received. People, relatives and professionals were asked to complete surveys about the quality of care provided at Richmond House. The results from these were positive. Where any concerns were raised we saw appropriate action being taken.

Quality management systems were found to be effective as they were used to identify areas for improvement. Action plans were created based on the findings from audits and we saw these had been completed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

People who used the service told us they felt safe and were well cared for and supported by care workers. We spoke with a relative of a person who used the service, who told us, "I feel supported by the staff here, I trust them. A weight has been lifted off my shoulders since my relative (person's name) came here."

People were protected from unsafe or unsuitable equipment because the equipment used in the service was serviced and maintained. We looked at a number of service records and certificates which showed maintenance tests and services were carried out.

We saw staff had been booked on a mental capacity act and deprivation of liberty safeguards (DoLS) training course. We were told by the manager there was not anyone staying at Richmond House currently who was subject to deprivation of liberty safeguards authority.

Is the service effective?

People's health and care needs were assessed where possible with them or their relative. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

Staff considered people's privacy and dignity when providing care. Staff spoke in a respectful manner and knocked on people's doors before entering their rooms. We observed the lunch time meal and found it to be a pleasurable, social experience. People were engaged in conversation with each other and staff were on hand to offer assistance when it was required.

We were provided with the results of the recent 'Richmond House Customer Questionnaire', the results of this were mainly very positive. For example the majority of people said staff listened to them with one saying they usually did, and everyone said they were able to choose what time they went to bed. Comments from the questionnaire included, "Can't complain about anything, excellent service." and "Staff are so kind, cannot do enough for me."

Is the service responsive?

In the recent questionnaire most people who used the service said they would not know who to complain to. As a result of this an action plan was instigated to ensure the complaints procedure was available to people. We saw the home had a complaint procedure in place and a copy of this was available by the main entrance along with a comments box.

Is the service well led?

The provider carried out a monthly workplace inspection which checked for example, hazardous substances, cleanliness and infection control and emergency procedures. The principal service manager also carried out an unannounced visit, where they spoke with people who used the service and their relatives. They looked at the standard of the building and premises along with several other checks.

Staff we spoke with told us learning from incidents took place. One member of care staff we spoke with said, "If we need to make any changes to the way we do things the manager tells us or we are given a notice we have to read."

We saw people being attended to promptly. There were enough staff to ensure people's needs were safely met. We observed lunch and saw the meal to be an enjoyable and social occasion. Staff were able to assist people where required and at the end of lunch people did not have long to wait to be assisted to leave the dining room.

People who used the service told us how happy they were with the service they had received. One person said, "They've all been very, very good." and "I'm looking forward to going home, but I'll miss everyone here." Another person said, "They couldn't do more for you."

The care plans we looked at were regularly reviewed and showed what people were able to do when they first arrived and their progress was tracked throughout their stay. A member of staff told us, "You get a massive sense of achievement when people go home and are more able."

The home was clean and free from unpleasant smells. We checked bedding and mattresses and saw these were clean and undamaged. We looked in lavatories, bathrooms and showers and saw they were clean.

We spoke with four members of staff, one care worker said, 'People have to wait longer, the people who are here at the moment are quite demanding.' and 'If people are sat waiting I tell them I'll get to you as soon as I can.' They also said, 'We used to be able to sit with people, but not now.' We spoke to people who used the service and one person said, 'Staff are very pleasant, very good, I think there are enough staff.' and 'They are so kind, I've no complaints.'

We looked at complaints documentation, such as letters of complaint, details of investigations and the responses to the complainant from the provider.

People who used the service were satisfied with the care they received. Individuals told us 'Staff are good,' and 'We are well looked after.' Another person said 'It is like a four star hotel' and 'We have lots of fun.'

People we spoke with were aware of safeguarding procedures and systems on how to raise a concern were in place. People were satisfied that staff or the manager would take action to solve their problems.

Our observations of the service showed that staff spoke with and interacted with people who used the service in a patient and pleasant manner.

People who used the service said the care and treatment was discussed with them although one person told us 'At times I do not always feel involved with my care.'

Staff told us there were systems and processes, policies and procedures in place. Report writing in the multiagency care records reflected the changes in care and treatment that people received.

We found that staff were supported and monitored in their working practice and had training and appraisal programmes in place.