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We are carrying out checks at Richmond. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 1 December 2017

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 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, one of whom was in hospital.

Richmond was inspected 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. Following our inspection the provider sent us an action plan telling us how they would make improvements. This inspection 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. We acknowledge the management structure had changed following the last inspection and there had been difficulty in staff recruitment.

There was no 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. A manager had been appointed and was in the process of submitting their application for registration. Since our inspection we have received this application and it is currently being processed.

There have been a number of changes to the management of the home in the past two years. In recent months CQC have received a number of concerns about the service and where appropriate, these have been sent to the local safeguarding team for investigation. During our inspection we received concerns from two whistle blowers (WB). Immediately following our inspection a third WB contacted us. Concerns included poor record keeping, a lack of availability of some prescribed creams and poor care. We looked at some of the concerns raised and asked the provider to carry out an investigation. We found some of the concerns were substantiated. However, a number of concerns were historical and actions had already been taken to address these areas.

The management team confirmed staff turnover had been high and in a number of cases disciplinary actions had been taken. This had led to low staff morale. The management team had responded robustly to this and to the impact this had on the running of the home and the care and support people received. Feedback from staff, visitors and people confirmed significant improvements had been made in relation to the running of the home.

Whilst we found improvements had been made we also found there were areas where improvements were needed. For example in relation to the management of medicines prescribed on an ‘as required basis,’ in relation to monitoring of mattress settings to ensure people’s skin integrity, and in consideration of risks when caring for people whose behaviour can challenge.

There were particular times of the day when calls bells were busy and this had an impact on people and staff. Whilst there were systems to monitor this, they needed to be implemented more frequently to ensure people’s needs were met safely and if necessary to revise staff levels. Systems for monitoring staff levels also needed to take account the overall impact of a high use of agency staff and a high number of falls.

Despite the above concerns we found staff understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The manager and staff had completed training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed some restrictions were required to keep people safe for example, doors were locked and, where assessed as appropriate bed rails and mat sensors were used for people’s safety. Where this was the case referrals had been made to the local authority for authorisations.

People had access to healthcare professionals when they needed it. This included GP’s, dentists, community nurses, and opticians.

People were asked for their permission before staff assisted them with care or support. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities. Staff spoke positively about the changes made to the running of the home and the way the home was managed.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received positive feedback from relatives and visiting professionals about the care provided.

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 this report.

Inspection areas

Safe

Requires improvement

Updated 1 December 2017

The service was not consistently safe.

The management of medicines prescribed on an as required basis were not always safe.

Staff understood the procedures to safeguard people from abuse.

Recruitment procedures ensured only suitable people worked at the home.

Effective

Good

Updated 1 December 2017

The service was good.

There was a training and supervision programme to ensure staff maintained current knowledge and skills.

The manager and staff had a good understanding of mental Capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were given choice about what they wanted to eat and drink and received food they enjoyed.

People were supported to have access to healthcare services and maintain good health.

Caring

Good

Updated 1 December 2017

The service was good.

People were treated with respect and dignity.

Staff knew people well and treated them with kindness and warmth.

Staff adapted their approach to meet people’s individual needs and to ensure care was provided in a way that met their particular needs and wishes.

Responsive

Good

Updated 1 December 2017

The service was good.

People received support that was responsive to their needs because staff knew them well.

People were supported to take part in activities of their choice.

People’s support plans contained guidance to ensure staff knew how to support people.

Well-led

Requires improvement

Updated 1 December 2017

The service was not consistently well led.

Systems to assess safe staff levels needed to be monitored more regularly.

There were systems for monitoring and improving the service.

The manager was approachable and supportive and encouraged staff to develop in their roles.