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Richmond Care Requires improvement


Inspection carried out on 9 April 2019

During a routine inspection

About the service: Richmond Care is a 'care home' that provides both residential and nursing care. The service can provide care for up to 19 people. There were 18 people with enduring mental health needs and other complex needs living at the home, although two people were in hospital at the time of this inspection.

People’s experience of using this service:

Medicines were not being managed safely. A recent medicine audit had not picked up the errors we found.

The number of staff available during the day and at night was sufficient to ensure people’s needs were met in a timely way at the time of the inspection, due to additional resources in the home. We were not confident that normal staffing levels would meet people’s needs, especially with people’s increasing dependencies.

The home was clean. Audits in this area were fit for purpose and any identified failings were rectified.

Environmental health and safety checks had been carried out but had not identified some of the issues we identified. The system for reporting and addressing repairs required to the home needed to be formalised.

Risks to people’s health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were mitigated as much as possible.

The management and staff understood their obligations under the Mental Health Act 1983 and worked within these legislative frameworks.

Care plans reflected that care was being delivered within the framework of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been applied for when necessary.

People told us they felt safe and well cared for at the home. Staff knew people well and had developed close, caring relationships. Staff were aware of their responsibilities to safeguard people.

Recruitment practices were safe and staff received the training they required for their roles.

People and their relatives were involved in making decisions about their care.

People who were independent were able to access the community and engage in meaningful leisure and social activity. There were less opportunities for people who required support from staff to do this.

Audits of the service were in place and were undertaken, although these were not always used effectively to monitor and improve the quality and safety of the home.

The manager was using available resources such as the local registered manager network and meeting with relevant health professionals for advice and guidance.

We identified two breaches of the regulations and we made three recommendations. These included introducing a formal process to determine staffing levels, improving the way required repairs were reported and dealt with and engaging people more in meaningful social activities.

The home met the characteristics of a rating of “Good” for two key questions and “Requires Improvement” for three key questions. Our overall rating for the home after this inspection was “Requires Improvement”.

Rating at last inspection: At the last inspection in October 2016 the home was rated Good (report published 31 October 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Please see the ‘action we have told the provider to take’ section at the end of the report.

Follow up: We have asked the provider to complete an action plan detailing how they will make improvements to ensure the regulations are met. We will work with our partner agencies, including the local authority, to review the progress made by the provider. We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 10 October 2016

During a routine inspection

This was an unannounced inspection carried out on the 10 October 2016. At the last inspection in June 2013 we found the provider met the regulations we looked at.

Richmond Care is a nursing home with 20 beds that provides care and support for people with enduring mental health problems and/or substance misuse issues. The accommodation is situated over three floors and includes a number of communal areas and a large garden.

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 and associated Regulations about how the service is run.

People told us they felt safe and the service was caring. There were systems in place to manage risk and protect people from abuse. Staff were aware of their responsibilities and knew what actions they needed to take to ensure people were protected.

Overall there were sufficient numbers of appropriately trained staff on duty to care for people. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Medicines were safely administered by staff who had received appropriate training, including an annual check of their competence.

Equipment, such as hoists, bathing aids and pressure relieving mattresses were available in the home and these helped promote people's safety and comfort. There were new procedures in place to ensure standards of cleanliness were monitored and maintained.

Our inspection of the building showed it was a safe environment in which to care for vulnerable people with the exception of some damaged floor coverings and a broken window restrictor.

Staff were appropriately trained and skilled and demonstrated a good understanding of their roles and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

Staff understood the importance of encouraging people to make choices, where they were able to, and always sought consent before undertaking any care. There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. Staff were trained in the principles of the MCA and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

Most people we spoke with were happy with the quality and choice of food provided at the home.

People were supported to maintain good health and where needed specialist healthcare professionals, such as dieticians, were involved with their care.

People who used the service were very positive about the care they received. People told us the staff were caring and their dignity and privacy were respected.

Care plans were person centred and were reviewed regularly by the trained nurses. Staff cared safely for people with a variety of complex health problems.

Records showed people were involved in range of activities. However, some people told us they were sometimes bored at the service.

There were systems in place to ensure complaints and concerns were fully investigated.

Quality assurance processes such as audits were in place to ensure that the service delivered high quality care that met people's needs.

Inspection carried out on 8 May 2013

During a routine inspection

People who used the service told us they generally felt respected by staff. One person said: �We are one big happy family� [The manager] is a belter�. However people told us they did not always feel as fully involved in the decisions made about their care as they could be. We spoke with the relative of a person who used the service and they told us they were happy with the care and support their relative received. Comments included: �Everything is running along smoothly� and �We�re very pleased�everything is fine�.

We found that the provider had systems in place to obtain and review the consent of people who used the service. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Care plans and risk assessments were in place for each person to ensure people experienced care, treatment and support that met their needs and protected their rights.

People who used the service, staff and visitors were protected against the risks of unsafe premises. People were protected from the risks of unsafe or unsuitable equipment because relevant checks were performed to ensure that equipment was safe to use.

There were enough qualified, skilled and experienced staff to meet people�s needs. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. The provider had systems in place to regularly assess and monitor the quality of service that people received.

Inspection carried out on 22 May 2012

During an inspection looking at part of the service

People using the service were happy with the care they were receiving. People said they thought there was plenty to do at the home. People told us about some recent activities that had taken place, including games and going out for a meal. People said they got the medicines they needed. People were happy with the staff working at the home. No one raised any concerns about their care.

Inspection carried out on 31 October 2011 and 10 January 2012

During an inspection looking at part of the service

People using the service gave us positive feedback about the standard of their care. People were happy with the amount of information they were given and said they felt involved. Everyone we spoke to said they were happy with the care they were receiving at the home. People said they felt safe and were complimentary about the staff. People told us that the provider sought feedback from them.

Inspection carried out on 7 July 2011

During a routine inspection

Most of the people we spoke to gave positive feedback about their care. People said they felt well cared for and staff listened to them. One person commented that the home was the best place they had been and another said "it is like a hotel". Some people were not aware of what their care plans said and one person said they did not think they had any care plans. People were generally positive about the activities available and said they did not get bored. One person said there was not enough to do and staff did not have time to do activities with people. Most people said they liked the food but one person said they did not think there was enough choice and the quality of the food was not good. Everyone was happy about the amount of information they were given about their medicines and said they received their medicines when they needed them. Everyone we spoke to said they received the support they needed with their physical healthcare. People said they got on well with the staff and they felt well supported by people working at the home. Some people were aware of how to make a complaint but some people were not. One person said they had concerns but no action had been taken by the provider to address these.

Reports under our old system of regulation (including those from before CQC was created)