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Richard House Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 March 2019

This inspection took place on 17 December 2018 and was unannounced.

Richard House offers accommodation for up to 29 people who require assistance with personal care and support. The home is a two-storey building with bedrooms and bathrooms on both floors and secure garden areas. At the time of the inspection 18 people were using the service and one person was in hospital.

At our previous inspection conducted in May 2017 the service was given an overall rating of Good and there was a breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of Well-Led to at least Good, which we received. At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance and safe care and treatment. We also made a recommendation about activities.

You can see what action we told the provider to take at the back of the full version of this report.

Richard House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 2008 and associated Regulations about how the service is run.

Accurate records to demonstrate the safe management of people’s medicines were not always present and the provider was unable to demonstrate sufficient time was being maintained between medicines. Medicines were brought from the upper floor of the building to downstairs to give to people which is potentially unsafe practice.

Records regarding PRN (when required) medicines were not always accurate.

We found gaps in some people’s medicines administration records (MAR’s). MAR charts were not always easy to read for some people. Three MAR’s we looked at were missing a picture of the person and one MAR had no name of the person on it.

Some MAR’s did not have any specialist instructions for people with swallowing difficulties and how this may affect their ability to take their medicines.

When people were identified as having dietary needs either due to swallowing difficulties or weight loss, care plans had not been updated to reflect this need and monitoring charts had not been implemented to demonstrate people’s needs were being met.

One person had been in residence at the home since September 2018, however no risk assessments had yet been undertaken.

The arrangements for assessing quality and safety required further improvements to ensure they were effective and robust in identifying concerns; audits undertaken had not identified the concerns we found during this inspection regarding the safe management of medicines and the absence of up to date records.

Activities provided to people were limited and we have made a recommendation about providing activities in relation to people’s identified preferences and choices.

Any accidents or incidents had been recorded and acted upon.

People who used the service and their relatives told us they felt safe living at Richard House and there was an appropriate safeguarding policy in place.

People told us they felt there were enough staff on duty to meet their needs and the home assessed people’s dependency levels to ensure there were sufficient staff on duty.

We observed many good interactions between staff and people who used the service; people and their relatives told us staff were kind and caring.

The register

Inspection areas

Safe

Requires improvement

Updated 15 March 2019

The service was not consistently safe.

Medicines were not consistently managed safely.

Safeguarding reporting procedures were in place; staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Staff were recruited appropriately to ensure they were safe to work with vulnerable adults.

Effective

Good

Updated 15 March 2019

The service was effective.

Care plans included a range of health and personal information, however up to date records had not always been maintained for some people who used the service.

New staff received induction and training was provided. Staff supervisions were undertaken.

Staff had knowledge of Mental Capacity Act (2005) and no-one was unlawfully deprived of their liberty.

Caring

Good

Updated 15 March 2019

The service was caring.

Staff demonstrated a caring attitude towards people and were careful to protect the privacy and dignity of people who used the service.

Records were stored confidentially and staff were aware of protecting data.

Visiting was encouraged to enable people to remain in touch with their family and friends.

Responsive

Good

Updated 15 March 2019

The service was responsive.

People told us the service was responsive to their needs.

People’s care plans contained information about their preferences and wishes.

There was a complaints procedure displayed for people to raise any concerns they may have and people knew how to make a complaint.

Well-led

Requires improvement

Updated 15 March 2019

The service was not consistently well-led.

The audits we saw had not identified the concerns we found during this inspection regarding safe care and treatment and good governance.

Policies, procedures and other relevant documents were reviewed to help ensure staff had up to date information.

All the people and staff we spoke with told us they felt supported and could approach managers when they wished.