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Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 December 2018

We inspected Richmond on the 8 and 9 November 2018. This was an unannounced inspection.

Richmond is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Richmond is located in Bexhill-on-Sea and provides accommodation and personal care for up to 58 older people requiring support with a dementia type illness and who are at risk of falls and live with long term healthcare needs such as Parkinson's. The home is set out over two floors. There is lift access between the ground floor and upper level. At the time of our inspection there were 49 people living at the home.

Following our inspection in March 2017 a number of breaches were identified and the service was rated requires improvement with the well led domain rated as inadequate. We served a number of Requirement Notices in relation to meeting people’s preferences, providing support in line with the Mental Capacity Act, unsafe medicine procedures, not reporting possible abuse effectively, inadequate systems for assessing and monitoring the service and insufficient staff levels. The provider sent us an action plan that told us how they would address these. We inspected again in September 2017 to check the provider had made improvements and to confirm legal requirements had been met. We found improvements had been made in several areas but in relation to the management of ‘as required’ medicines and the overall assessment of staff levels there were still shortfalls that needed to be addressed to fully meet the regulations.

This inspection found that whilst improvements seen in September 2017 had not deteriorated, there had not been the necessary improvements to change overall the rating to Good.

This is the third consecutive time the service had been rated as Requires Improvement.

Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed. For example, a deterioration in health and nutritional needs.

Not all care plans had been reviewed and updated to ensure they reflected people’s current needs and associated risks. For example, when a person’s skin integrity changed and the equipment used to manage the risks to their skin, such as pressure reliving mattresses.

We have made a recommendation about the management of some medicines and in how staff administered medicines.

There was a registered manager in post. 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 associated Regulations about how the service is run.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.

Most care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, swallowing problems and risk of choking, and moving and handling. The care plans also highlighted health risks such as diabetes and leg ulcers. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff to ensure there was a sufficient number with the right skills when people moved into the home.

Inspection areas

Safe

Requires improvement

Updated 13 December 2018

Richmond remains Require Improvement.

People's safety was put at risk because some people’s care plans and risk assessments were not up to date and had not reflected important changes to people’s health and well-being.

There were systems to make sure risks were assessed and measures put in place where possible to reduce or eliminate risks. However, staff were not following their organisational medicine administration policy and there were some areas of ‘as required’ medicines that needed to be improved. Medicines were stored safely.

There were sufficient staff to meet people’s individual needs. Comprehensive staff recruitment procedures were followed

Staff had received training on safeguarding adults and were confident they could recognise abuse and knew how to report it. Visitors were confident their loved ones were safe and supported by the staff.

Effective

Good

Updated 13 December 2018

Richmond remained Good.

People were supported to maintain good health and were supported to access health professionals.

Staff received regular training, supervisions and an annual appraisal.

People were supported to eat and drink to maintain their health and well-being.

People's rights were protected by staff who had received training and had knowledge of the Mental Capacity Act 2005.

Caring

Good

Updated 13 December 2018

Richmond remains Good.

People were supported by staff who were kind, caring and supported their independence.

People were involved in decisions about their care and the home.

People's privacy and dignity was respected and maintained.

Responsive

Good

Updated 13 December 2018

Richmond remains Good.

People’s preferences and choices were respected and support was planned and delivered with these in mind.

Group and individual activities were decided by people living in the home and regularly reviewed by them.

A complaints procedure was in place. People and visitors knew how to raise a concern or make a complaint but also said they had no reason to.

Well-led

Requires improvement

Updated 13 December 2018

Richmond was not consistently well led.

Quality assurance systems needed to be further developed and embedded into everyday practice to ensure people received consistent good care.

The registered manager, staff and provider encouraged people, their relatives and friends to be involved in developing the service.

The service worked in partnership with other relevant organisations.