Richard House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People were supported to make choices about their own life supported by staff who knew them well. Staff had a good understanding of people’s individual risks, knew how to mitigate these risks and ensured people were involved.

There were appropriate processes and policies in place to support a learning culture. The registered manager and staff felt strongly about making improvements to ensure people received good and safe care. For example, following a number of medicines errors identified whilst administering medicines to people, one staff member was designated to administer medicines to people, instead of different staff for different medicines round throughout the day to ensure there was a consistency. This led to the number of medicines errors reducing.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s safety and continuity of their care was a priority for the provider. Staff collaborated well with people, their relatives, and stakeholders to ensure they received the support they needed. One relative told us, “My loved one had complex needs regarding their diet. They had both GP and dietician involved in their care. Staff here work as a team.”

People and their relatives told us, they could speak and raise concerns, and they had confidence these would be acted upon.

People had relevant risk assessments in place, and staff had a good understanding of these. Some of the risk assessments in people’s care plans were more detailed than others. The registered manager was in the process of updating people’s care plans including their risk assessments.

Relatives told us, they participated in their loved one’s care, and their input was sought after. There was evidence of regular care reviews and meetings taking place. However not all the relatives and people saw their completed care plans.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People consistently told us they felt safe. One person told us, “I feel safe and comfortable here.”

Staff had a good understanding of how to keep people safe and protect them from avoidable harm and abuse. One staff member told us, “If I saw any markings on the person, I would tell the registered manager but if nothing was being done about it, I would always go higher up.”

Staff received safeguarding training.

There were systems, processes and policies in place to make sure people were protected from abuse and avoidable harm. The provider reported safeguarding concerns to the local authority in line with local guidance.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

The provider ensured people and their loved ones engaged in conversations about any risks and how to keep themselves safe. There was evidence of regular service reviews taking place enabling both people and their loved ones to discuss aspects of their care and the way they wished to be supported.

Staff had a good understanding of people’s risks and knew how to support people in a positive and person-centred way. For example, one person who used a wheelchair at times chose to slide down on to the floor. Staff told us how they tried to support this person by explaining to them the risks of doing so and how they provided reassurance and emotional support when the person got distressed.

Risk assessment was put in place in consultation with each person to ensure risk was minimised considering their wishes and preferences.

People, their relatives and staff were encouraged to speak up and raise concerns. One person told us, “If I had any concerns I would go the manager.”

Some of the risk assessments were more detailed than the others. The provider was in the process of updating people’s care plans including their risk assessments.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Facilities and equipment were not always maintained in a way that consistently supported safe care.

During the assessment we identified some areas within the environment which required the provider’s attention. We saw some of the radiator covers were not fixed to the wall and some of the doors to high-risk rooms were not locked, such as the door leading to the cellar or sluice room. Additionally, we asked the provider to review their current arrangements regarding window restrictors.

Following our feedback the registered manager took prompt action to ensure window restrictors were installed, and high rooms were locked appropriately. The provider shared with us an internal improvement plan which included actions related to the environment, such as relaying new carpet on the staircase leading to the staff room.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

We received positive feedback from people regarding staff. People told us, staff were kind and treated them with empathy. There was consistency within staff teams which meant people and staff had an opportunity to get to know each other and build a good rapport. One relative told us, “My loved one, loves their staff. They[staff] made my loved one feel at home.” One professional told us, “When I visit, I always see the same, regular faces.” During the last assessment of the service the provider did not follow safe recruitment practices.

However, at this assessment improvements had been made.

The provider obtained references prior to staff commencing their employment and staff had a right to work in the UK. Criminal checks for staff were completed and these were reviewed periodically. Gaps in the employment of staff were identified and followed up. Probation reviews were completed for staff to ensure their suitability for the role.

It was not always obvious how risks to staff health were identified and following our feedback, the registered manager reviewed the current procedure to ensure this was more transparent. Staff received regular supervisions. However, we saw no evidence of appraisals taking place. We told the provider about this, and regular appraisals for staff were to be included in the provider’s action plan. Staff meetings were held, and staff were encouraged to provide regular feedback and engage in a conversation. One staff member told us, “There is always somebody you can go and talk to. You can talk to the manager as well.”

Staff were provided with training, and the overall training compliance was overseen by the registered manager. Training included a mixture of face-to-face sessions such as moving and handling and online training. Staff told us, they had access to training to ensure their skills were up to date and there were opportunities to further their careers. One staff member told us, “We do moving and handling training face to face as well as medicines training. I have now completed level 2 qualifications in Health and Social Care and would like to do level 3.”

Staff completed induction. People and their relatives did not raise any concerns with us regarding staff lacking skills and knowledge. One relative told us, “Yes, I do think staff have skills and knowledge to support my loved one.” Some people commented, at times there were communication difficulties between staff and people where staffs first language was not English.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were appropriate policies and procedures in place to support infection and control prevention within the home.

Staff completed infection control training and had good understanding of infection prevention and control principles. Staff had access to Personal Protective Equipment (PPE) such as apron and gloves. During our assessment we observed staff using it effectively. The provider addressed any concerns regarding infection control and shared good practice with staff. We saw evidence the provider worked with stakeholders and partners such as the local infection control and prevention team.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At the time of this assessment improvements had been made.

There were policies and procedures in place to support how medicines were administered. People’s care plans contained information regarding the support they required with their medicines. However, some of the care plans were more detailed than the others. The provider was in the process of updating care plans to ensure these were detailed including information about peoples’ medicines.

People received their medicines on time and when they needed them. For example, we saw one person asking for paracetamol as they were in pain and a staff member responded promptly to their request. Staff received medicines training, and their competencies were regularly checked. The provider had good oversight of medicines errors, and we saw evidence where action was taken, and lessons were learnt when concerns were identified. For example, staff completed additional checks when pharmacy errors were identified to ensure people’s medicines were correct and given safely. Staff had a good understanding of people’s medicines and how to administer people’s medicines in a safe way. For example, one staff member explained in detail what they did to ensure medicines errors were spotted promptly and what action needed to be taken. When people required support with their PRN medicines (PRN medicines are medicines not required on a regular basis, such as paracetamol) there was guidance in place which informed staff of when and how to administer these medicines.

Some guidance was more detailed than others. People’s medicines were not always stored safely. We saw people’s creams and ointments were stored outside locked cabinets. We also saw some people’s medicine cabinets were left unlocked. We told the provider about this, and they took prompt action by ensuring all people’s medicines were locked away and staff were reminded of the correct procedures for storing medicines safely. The stock count of people’s medicines was conducted in a safe way and staff had a good understanding of how to identify any discrepancies. However, the procedure regarding this was only communicated verbally between staff. Following our feedback the provider wrote this procedure down to ensure this was a part of their contingency planning. People and their relatives did not raise any concerns regarding how their medicines were managed and administered.