The Richmond

We found the following examples of good practice.

The home had systems in place to support relatives to visit their family members, minimising the risk of infection. Relatives and friends were encouraged to keep in contact with their loved ones via telephone and video calls. They were also able to visit in person, by appointment, meeting in a dedicated room with a separate entrance. The registered manager told us they would also adapt the garden to facilitate outdoor visits in warmer weather.

The registered manager and staff had considered how to prevent social isolation during the pandemic. They had put in place additional activities to ensure peoples well-being.

We observed signage around the home to guide staff on the use of protective personal equipment (PPE) and appropriate handwashing technique. The premises were clean and hygienic. Frequent touch points, such as handrails and door knobs were regularly cleaned. Staff supported people to keep apart as much as possible to try and maintain safe social distancing. For example, by moving chairs in communal areas further apart.

All people living and working at The Richmond had been offered a vaccine and were regularly tested for COVID-19 in line with government guidance.

Risk assessments were in place to consider and reduce any impact to people who used the service and staff who may be disproportionately at risk of COVID-19. These included Black, Asian and Minority Ethnic groups (BAME), people with learning disabilities and people with dementia.

This comprehensive inspection was unannounced on the first day, which meant those associated with the home did not know we were coming. It took place on 31 July and 1 August 2018.

At the last inspection in June 2017 the service was rated overall as requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘The Richmond’ on our website at www.cqc.org.uk.

At this inspection we found the service had improved to good.

The service had a relatively new registered manager, who had been registered with the Care Quality Commission since May 2018. 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.

Improvements had been made to the guidance to help staff give medicines safely. Medicines were well managed and records showed people received their medicines as prescribed. The registered provider continued to make sure people were protected from the risk of abuse. Staff we spoke with knew the importance of reporting any incidents. Assessments identified risks to people and management plans were in place to reduce the risks. We received positive feedback from people who used the service and their relatives. The standards of cleanliness and maintenance in the home were good and there were sufficient staff to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. We also found improvements had been made to the information available in people’s records in relation to this. This helped to protect people who may not have the capacity to make decisions for themselves. Staff were aware of people’s nutritional needs and they supported people to have a healthy diet, based on their choices with a good variety of food and drink. People told us they enjoyed the meals. People’s physical health was monitored including people’s health conditions and symptoms, so that appropriate referrals to health professionals could be made. There was an extensive programme of redecoration and refurbishment and good progress had been made with this, including new floor coverings in several areas. Staff received training and support to ensure that they could fulfil their role. Staff we spoke with told us they felt supported by their managers.

There was a strong, person centred and caring culture in the care and support team. (Person centred means that care is tailored to meet the needs and aspirations of each person, as an individual.) The vision of the service was shared by the management team and staff. The service had a friendly atmosphere. Staff approached people in a kind and caring way and encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt staff knew them well, and their likes and dislikes.

People told us there were activities and entertainment they could be involved in. We observed the activity co-ordinators undertaking group activities and one to one activities with people. People were well supported in decisions regarding their end of life wishes. The complaints process was clear and people’s comments and complaints were taken seriously, investigated and responded to in a timely way. People we spoke with did not have any complaints to tell us about and indicated they were happy living at the home.

Systems were in place which assessed and monitored the quality of the service, including obtaining feedback from people who used the service and outside agencies and these views were acted upon. The registered manager placed a lot of emphasis on listening to and involving people, those close to them, the staff and other professionals and on using opportunities for learning and improvement. People and their relatives praised the registered manager very highly and were happy with how the service was being run.

Further information is in the detailed findings of this report.

The service had a registered manager who had been registered with the Care Quality Commission since February 2016. 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 Richmond is registered to provide nursing and residential care for up to 50 people who may be living with dementia, or have mental health problems. It is a purpose built care home situated in Sprotborough, on the outskirts of Doncaster. The home is on two floors. At the time of our inspection 47 people were living at the home.

We found medication was administered safely and key staff had received training and had their competencies checked periodically. However, we found improvements were needed in the protocols for some medicines.

For the most part the requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. However, there was a need to improve some information available in people’s records regarding this. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

We received feedback from some staff and visitors that people were not put at risk, but that the time care staff had to spend with each person was limited. Our observations during the inspection supported this.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals.

Some carpets and furniture needed replacing. The registered provider told us they had identified this and confirmed improvements were due to be completed within the next month.

Risk assessments identified risks associated with people’s care and had been devised to help minimise and monitor the risks, without placing undue restrictions on people, although some assessments and care plans were not as person centred as others.

People’s physical health was monitored including people’s health conditions and symptoms, so that appropriate referrals to health professionals could be made.

People told us there were activities and entertainment they could be involved in. We observed the activity co-ordinators undertaking group activities and one to one activities with people.

Overall, we found the service had a friendly atmosphere and felt homely. Staff approached people in a kind and caring way and encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt staff knew them well, and their likes and dislikes.

Formal staff supervision’s took place. However, as no policy was available about supervision we were unable to check if this was in line with the frequency set by the provider. Staff we spoke with told us they had recently received supervision and they told us that they felt supported by their managers.

The complaints process was clear and people’s comments and complaints were taken seriously, investigated and responded to in a timely way. People we spoke with did not have any complaints to tell us about and indicated they were happy living at the home.

There were systems in place to monitor and improve the quality of the service provided. However, we found that audits were not always effective. The provider’s senior management team were aware of this and improvements were being introduced. Following the first day of our inspection, the registered manager acted swiftly to make improvements in the areas we identified.