Richmond House

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

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.

The Hospital was safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff

The Hospital was safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

In the 6 months leading up to inspection, the provider reported 132 incidents. When incidents, such as episodes of aggression, occurred, staff responded promptly, documented incidents accurately, and updated care plans and risk assessments. Staff we spoke with knew what incidents to report and how to report them. Incident numbers were high due to the reporting of all incidents and near misses. The highest number of incidents reported per month included 13 incidents of self-harm in June 2025 and 10 incidents of verbal aggression in September 2025.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Managers were able to give examples of duty of candour.

Staff told us they debriefed and received support after an incident.

Lessons learnt bulletins were sent to staff monthly. Learning included ensuring patients wore appropriate footwear, following an incident where a patient tripped. Staff we spoke with were able to tell us about lessons learnt, understanding patients’ risk and triggers and how they used care plans and risk assessments to learn about how to safely manage any incidents.

We scored the service as 3. The evidence showed a good standard. The service 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.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patients’ needs could safely be met. Staff discussed admissions during meetings and detailed handovers to ensure key risks were identified and understood. Patients were given the opportunity to visit the service prior to admission to help orient them. Managers provided staff with a presentation for all new admissions to ensure staff had full knowledge of the patient prior to admission.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Patients we spoke with talked positively about the discharge process and how they were supported to integrate into their next placement. At the time of inspection, 3 out of the 5 patients had a discharge pathway in place.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate.100% of staff had received safeguarding level 3 training. Staff were able to contact safeguarding leads within the service for support and advice.

Staff we spoke with could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff worked in partnership with other agencies and took appropriate action to protect patients from abuse, neglect, or discrimination and worked collaboratively with external agencies when required, for example, the local authority safeguarding team.

Mental Capacity Act

100% of staff had had training in the Mental Capacity Act.

Staff had a good understanding of the Mental Capacity Act, in particular the 5 statutory principles.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice from within the provider regarding the Mental Capacity Act and took all practical steps to enable patients to make their own decisions.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. The ward staff participated in the provider’s restrictive interventions reduction programme. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We looked at 5 risk assessments and risk management plans during the assessment. Staff involved patients in care planning and risk assessment. We saw this evidenced in care plans by staff using the patient’s voice. Patients were fully involved in multidisciplinary team reviews by using a feedback booklet that patients completed with staff support and all patients we spoke with knew and understood their care plans.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.

Staff enabled patients to give feedback on the service they received through daily house meetings and weekly community meetings.

Staff ensured that patients could access advocacy. The service had an external advocate who visited the hospital every 2 weeks. There was an easy read poster displayed on the ward with the dates that the advocate would be attending, along with contact information should the patients wish to contact them. Patients had the opportunity to have advocacy support during their professional meetings such as Care Programme Approach meetings and Care and Treatment Reviews.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff carried out regular risk assessments of the care environment. The service had a comprehensive ligature risk assessment in place with risk mitigation clearly identified.

Staff were able to observe all parts of the ward using convex mirrors to mitigate any blind spots. The hospital fully complied with the Department of Health guidance on the elimination of mixed gender accommodation.

Clinic rooms were fully stocked with resuscitation equipment and emergency drugs, which staff checked regularly to ensure they remained ready for use.

Nurse call buttons were situated in all patients’ bedrooms, bathrooms, the quiet room and the communal lounge area, which had all been identified as areas where patients may spend time on their own. If the nurse call point was activated it showed on a panel within the nursing office and would set off the pagers which the nurse in charge and 1 other staff member would be carrying. Personal radios were available for all staff to use at times of higher acuity on the ward.

We scored the service as 3. The evidence showed a good standard. The service 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.

At the time of inspection, the service had 4 vacancies. This included 1 nurse, 1 healthcare worker, 1 speech and language therapist and 1 psychologist vacancy. The service used regular bank staff who received an induction and were familiar with the service and the patients and were actively recruiting to these positions. In the 3 months prior to inspection, staff turnover was 12% and sickness absence was 2%.

Patients we spoke with told us they had regular time with their named key worker and that they were able to have plenty of escorted leave.

There were enough staff to carry out physical interventions, for example observations, safely and staff had been trained to do so. The provider had an observations policy and procedure in place.

The service had 24 incidents of physical restraint in the year leading up to the inspection. Which was a reduction from 50 physical restraints during 2024.

There was adequate medical cover day and night and a doctor could attend quickly in an emergency. The service had a 24 hour on call rota for staff to access support when needed.

Staff had received and were up to date with appropriate mandatory training. The overall mandatory training compliance was 100%. The training was appropriate for the patient group using the service. Overall, 100% of staff had completed the Tier 1 Oliver McGowan training on Learning Disability and Autism (for a general awareness of the needs of autistic people and people with a learning disability) and 42% of staff had completed the Tier 2 training (for staff who provide direct care of autistic people and people with a learning disability). The remaining staff who had not completed tier 2 training had been booked on to a course. Nursing staff had recently completed a refresher course in epilepsy management, due to an identified need.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. All ward areas were clean, had good furnishings and were well-maintained.

Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing. Overall, 100% of staff had completed the providers infection prevention control training.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed safe and effective practices in all areas of medicines management, including storage, dispensing, administration, reconciliation, recording, and disposal. The service adhered to national guidance and best practice and evidenced how they involved patients and their families in discussions and decisions about their care and treatment wherever possible. All patients we spoke with understood what medication they were taking and how it affected them.

The service administered medicines in line with Stopping Over-medication of People with a learning disability, autism, or both (STOMP). We reviewed all prescribing, and administration records and found no concerns.

Staff reviewed the effects of medication on patients’ physical health regularly and in line with NICE guidance. Overall, 100% of eligible staff had completed training on safe handling of medicines. The service had no controlled drugs on site, and all patients were signed up with the local GP practise.

The service had an external pharmacy attend on a regular basis to carry out medicines management audits and feedback to staff with any issues raised.