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Inspection carried out on 20 November 2019

During a routine inspection

About the service

Richmond Mews provides accommodation and personal care for up to 44 adults with a learning disability. At the time of the inspection there were 41 people living at the home across 8 separate flats and 1 bungalow.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The service was a large home, bigger than most domestic style properties. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People were cared for by trained and skilled staff who knew people well. People were treated with kindness and were able to live their lives as they wished because they were given opportunities to express their wishes and feelings, likes and dislikes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. The environment was free from risks and hazards. People were encouraged to take positive risks to achieve personal growth and independence.

Staff worked well together to meet people’s needs and provide support in a relaxed and homely environment. People had access to healthcare as they needed it and received on-going health care support as part of their assessed needs.

People were involved in leading their own care participating in reviews of their care needs. Meetings were held on a regular basis to enable people to feedback about the day-to-day running of the home.

The home was well-led by a management team who were committed to providing high-quality care.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 24 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 12 April 2017

During a routine inspection

This inspection took place on 12 April 2017 and was unannounced.

Richmond Mews provides accommodation and personal care for up to 44 adults with a learning disability or other complex needs. The accommodation is in eight separate flats and one bungalow. At the time of this inspection 43 people lived at the home.

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

During our previous inspection undertaken on 19 October 2015, we identified concerns in relation to staffing levels, medication and quality audits. During this inspection we found that the required action had been taken to correct these concerns.

People were kept safe living in the home because the registered manager and staff understood their responsibilities to identify and report potential harm and abuse. The registered manager consistently reviewed accidents and incidents to reduce the possibility of people being harmed.

Risks to people's health and wellbeing were known by staff and well managed. The registered manager and staff maintained close links with external health care professionals to promote people's health.

There were systems in place so that the requirements of the Mental Capacity Act 2005 (MCA) were implemented when required. People's consent was sought where appropriate. Where people lacked the capacity to consent to decisions, legal requirements were met.

There were sufficient numbers of staff available to meet people's needs. The registered manager monitored staffing levels alongside people's individual needs to reduce risks to people's wellbeing. The registered manager made all the appropriate checks on new staff's suitability to work at the home. People's medicines were managed, stored and administered by staff who had received the training to promote safe practices.

People were supported to eat and drink enough by staff who understood the importance of assisting people to maintain a balanced diet. People were offered meals which were suitable for their individual nutritional needs and met their preferences to keep people healthy and well.

People were supported by staff who knew them well and who they described as kind and caring. Staff knew about people's individual preferences for care. Staff respected people's dignity and privacy and responded to people's likes and dislikes to support people in following their own interests.

People and their relatives knew how to raise any concerns and who they should report any concerns to. Staff were able to support people if they wished to complain. The registered manager actively sought feedback and responded to people's complaints. They took action to improve the service as a result of complaints and feedback from people, relatives, staff and healthcare professionals.

The registered manager was aware of their responsibilities and had developed systems to monitor the quality of the service people received. There was evidence of learning from incidents and changes were put in place to improve the service people received. The registered manager was

continually looking at how they could provide better care for people. In doing so they valued people's views about the services provided and used these to drive through improvements and further develop services people received.

Inspection carried out on 19 October 2015

During a routine inspection

We inspected this service on 19 October 2015. This was an unannounced inspection. Our last inspection took place in July 2013 and at that time we found the home was meeting the regulations that we checked them against.

Richmond Mews is registered to provide accommodation and personal care for up to 48 people. People who use the service have a learning disability. At the time of our inspection 43 people were using the service.

The service had a registered manager. 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.

Improvements were needed to ensure there were enough staff available to consistently support people to receive their agreed care. The registered manager and provider were aware of staffing shortfalls and were taking action to address this.

Risks to people’s safety and wellbeing were assessed and planned for. However, improvements were needed to ensure people’s risk plans were reviewed and updated promptly following safety incidents.

Effective systems were not in place to enable the registered manager and provider to consistently assess, monitor and improve the quality of care. This had meant the registered manager was not aware of some of the areas for improvement that we had identified.

Staff knew how to recognise and report abuse and we saw that concerns about people’s care and safety were reported and investigated appropriately.

People were supported to eat and drink and people’s health and wellbeing was monitored to ensure people stayed as well as they could be. Advice from health care professionals was sought promptly.

Staff had completed training that enabled them to meet people’s needs effectively and the development needs of the staff were monitored by the senior staff and registered manager.

Staff sought people’s consent before they provided care and support. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People were encouraged to make choices about their care and the staff respected the choices people made. Staff treated people with kindness and compassion and people’s dignity and privacy was promoted.

People were involved in the assessment and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them. Staff were able to meet people’s care preferences because they understood people’s likes, dislikes, communication styles and behaviours.

There was a positive and homely atmosphere at the service and people were relaxed around the staff and registered manager. People knew how to complain about their care if needed and the registered manager responded appropriately to complaints.

The registered manager and provider had a regular presence at the service and staff told us they were supported by the senior staff and registered manager.

Inspection carried out on 2 July 2013

During a routine inspection

Richmond Mews is registered to provide accommodation for up to 48 people. However as a result of changes made to improve facilities for some people who have complex needs, the home can actually only accommodate 43 people. The provider had not formally reported these changes at the time of our inspection.

We saw that people were treated with respect by the staff that cared for them. One person said, "It�s nice here I like the staff�. A member of staff told us, �We are here to support people not take over their lives�.

The nutritional needs of people who used the service were catered for. Systems were in place to monitor the weight and wellbeing of vulnerable people.

Drugs and medicines were stored securely, administered correctly and audited.

Records were kept securely and updated regularly. Audits and surveys were conducted which enabled the management team to monitor, analyse and respond to issues and people�s needs.

Inspection carried out on 12 December 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people who used the service as part of our planned schedule of inspections. The inspection was unannounced which meant the provider and the staff did not know we were going to visit.

At the time of the inspection Richmond Mews was providing accommodation and support for up to 43 people. During this inspection we visited three of the units, met with five people who used the service, and spoke to the staff that supported them. People we spoke with confirmed that they knew who their key staff were. Where people were not able to tell us about their lives at Richmond Mews, we observed the support they received.

We saw that people were included in making decisions and their consent to care and treatment was sought and recorded. Where people's capacity to consent was limited. Best interest decisions were made on their behalf, with their relatives or advocates and other professionals.

We saw the care records included all information about how people needed to be supported and how all risks had been assessed. We saw that records were usually updated regularly.

We confirmed that staff understood their responsibilities to recognise and protect people from the risk of potential abuse. Essential training was provided and staff confirmed that they felt supported.

There was evidence provided during this inspection that the service was monitored and audited to ensure that quality standards were maintained.

Inspection carried out on 2, 3 February 2011

During a routine inspection

We saw records of meetings with users of the service and evidence of reviews of care. People told us they were happy with the support they receive and confirmed that they knew who their key staff were.

The people spoken to during this visit were able to provide limited verbal feedback. We talked to two people about their care plans and what they felt the service did well.

We observed two other people interacting positively with their support workers and confirmed from their records and from discussion with key staff that care plans and risk assessments are personalised.

We observed people using the service being involved in shopping for their food, and making decisions about the meals they have. In one example where a member of staff was helping one person to prepare lunch we observed how they encouraged an individual to show them what he wanted to eat. We saw that people have access to the kitchen areas within the boundaries of risk assessment and safe practice. We talked to two people about the food choices available to them, they confirmed that they are able to choose what they have to eat and can be involved in food preparation if they choose to do so.

The people we talked to and observed during our visit have lived at Richmond Mews for a number of years. We saw that records showed how the service co-operated and consulted with other agencies throughout any pre admission assessment.

We saw in health action plans that people are supported to attend health appointments and the service engages regularly with community health teams.

We also saw that other professionals are invited to reviews of care.

We spoke to two social workers, who confirmed that the service is good at raising alert if it suspects an incident of abuse and co-operates fully in any enquiries. They also confirmed that the service actively responds where areas for improvement are identified.

People using the service told us that they like living at Richmond Mews. We observed that people using the service had freedom to move around their environment subject to risk assessment. We were invited to see three people's bedrooms and noted that they were personalised, comfortably furnished, well equipped and maintained.

We spoke to two people about their home and were told that they liked it. We saw that since our last visit a lot of work to redecorate and refurbish the service has taken place, improving the environment for those living there.

We saw that people using the service have the opportunity to comment on the quality of the service they receive at meetings and on an annual basis they and their relatives and supporters are asked to comment in a questionnaire.

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