Richmond Village Letcombe Regis

Richmond Village Letcombe Regis is a retirement village, the care home forms part of the main building. The care home accommodates up to 53 people in two units. The service supports older people and people living with dementia. At the time of our inspection there were 34 people using the service.

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

Systems and processes were not always effective in assessing, monitoring, and improving the quality of the service. Concerns found on inspection had not been identified or rectified.

Risks to people had not always been fully assessed or mitigating strategies completed. People were at increased risk of abuse as injuries did not always have a cause or an investigation completed.

There were not always sufficient staff deployed to meet people’s needs in a timely manner.

People and relatives had not all been asked to feedback on the service. People and relatives had not always seen or been part of their care plan and staff did not always have time to read people’s updated care plans.

People were supported by staff who had been safely recruited and who had received sufficient training.

People were supported safely with their medicines. Staff administered medicines as prescribed and had all the necessary information regarding people’s medicines.

Staff felt supported within their roles and felt they worked well as a team.

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.

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 20 February 2021)

Why we inspected

We received concerns in relation to use of equipment, management oversight and falls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond Village Letcombe Regis on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management and management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Richmond Village Letcombe Regis is a retirement village and the care home forms part of the main building. The care home accommodates up to 53 people in two units. The service supports older people with a range of needs and includes support for people living with dementia. At the time of our inspection there were 38 people using the service.

Peoples experience of using this service and what we found

Relatives told us people received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs and staff recruitment was on-going. Medicines were managed safely, and people received their medicines as prescribed.

The manager successfully created an open and transparent culture which contributed to staff work satisfaction and in turn the staff delivered good care for people. The systems in place to monitor the quality of care within the service were effective.

Rating at last inspection

The last rating for this service was Good (published 20 November 2018).

Why we inspected

We identified concerns in relation to the length of time since we last inspected the service and the absence of a registered manager. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains the same. We found no evidence during this inspection that people were at risk of harm from our concerns.

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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Richmond Village Letcombe Regis is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Richmond Village Letcombe Regis is a retirement village and the care home forms part of the main building. The care home accommodates up to 53 people in two units. The service supports older people with a range of needs and includes support for people living with dementia. At the time of our inspection there were 50 people using the service.

There was a person-centred culture that valued and respected everyone in the service. This culture was driven by the management team who were visible in the service. People were treated with dignity and respect and valued as individuals. There was a range of activities available and people enjoyed links with local schools.

There was a calm and welcoming atmosphere throughout the inspection. Staff showed kindness and compassion when supporting people. Staff were busy, however, staff ensured people's needs were met in a timely manner. The registered manager was reviewing staffing levels to ensure there were sufficient staff deployed to ensure people's needs were met.

Staff were supported and had the skills and knowledge to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were effective systems in place to manage the service.

Richmond Villages Care Home is a care home with nursing for 53 older people, which includes people living with dementia. On the day of our inspection 51 people were living 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.

People told us they felt safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they were able to recognise and report safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff who were knowledgeable about people’s needs and provided support with compassion and kindness. People received quality care that was personalised and met their needs.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed. However, accurate records of medicine stock were not always maintained and fluid thickeners were not always used safely. The registered manager also informed us about two recent medicine errors. The registered manager took immediate action to resolve these concerns.

There were not always sufficient staff to meet people’s needs. Staffing levels were generally maintained and we saw the use of agency staff had decreased. However, some people and all staff told us there were often staff shortages. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act (MCA) and all staff applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included Deprivation of Liberty Safeguards (DoLs).

The service had systems to assess the quality of the service provided. Improvements were identified and action taken which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

People had enough to eat and drink. People told us they enjoyed the food and we saw where people needed support with eating and drinking this was provided appropriately.

Staff spoke positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service. However, some staff felt communication with the provider was not effective.

People and their relatives told us the service was friendly, responsive and well managed. People knew the registered manager and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

Is the service safe?

People told us that they felt safe living at the home. One person told us 'Yes ' I'm safe enough. ' Another person said 'Yes, I do feel safe. I feel that I don't fall over.'

The service followed the local authority safeguarding procedure and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.

The home had suitable policies and procedures and training in place in relation to safeguarding, the Mental Capacity Act 2005 and accompanying Deprivation of Liberty Safeguards (DoLS). This legislation protects the human rights of adults who live in a care home or hospital and lack the capacity to consent to arrangements proposed for their care or treatment and for whom such arrangements may amount to a deprivation of liberty. DoLS are not used for people detained or liable to be detained under the Mental Health Act 1983 (as amended by the Mental Health Act 2007). Two authorisations were in place at the time of our visit. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they or their relatives had been involved in writing them and they reflected their current needs.

Is the service caring?

People were supported by kind and caring staff. A person told us 'They're very polite, very kind.' We saw that support workers explained care and encouraged independence when supporting people. People's privacy and dignity were respected by staff.

People's preferences, interests and needs had been recorded. Care and support had been provided according to people's wishes.

Is the service responsive?

People participated in a range of activities in and outside the service regularly. Most people required support while others accessed the community independently. The home had access to adapted transport, which helped to keep people involved with their local community.

People and their relatives knew how to raise concerns or make a complaint if they were unhappy. People who the service, their relatives and representatives involved with the service completed an annual satisfaction survey. Issues or concerns raised were addressed.

Is the service well-led?

There was no registered manager in place at the time of our inspection. The village manager told us that the service manager had applied to become a registered manager. The service manager showed us evidence of having submitted their application. We were told that the service manager had previously been a registered manager of another service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The service worked in collaboration with other professionals and services to ensure that people received effective care.

The service had a quality assurance system. Records we reviewed showed that identified issues were addressed. As a result the quality of the service improved.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of their roles. Suitable quality assurance processes were in place. This helped to ensure that people received a good quality service.

We found that the service protected people and delivered care safely. People told us that they always felt safe with care staff. One person told us 'Oh yes I feel safe here'. One relative we spoke with told us 'we feel he is safe here and we can pop in at any time, mum knows he is safe'.

We found people were supported by sufficient skilled and experienced staff. One relative told us 'the staff are all very good, there are enough staff and they will always help'. We observed staff interacting with people and visitors in a professional manner at all times. '. One person told us 'the staff are very good'.

Staff were supported and trained to enable them to deliver good care. One nurse told us 'we have regular handover and you can go to the manager with anything'. One care worker told us 'the manager has an open door policy you can ask for anything and she will help even if you need a pen'.

People and relatives were happy with the service they received but knew how to complain if they needed to. People told us that if they ever had any concerns they would inform the nurse or manager. One relative told us "our concern was dealt with amazingly quickly".

We observed that food was of a good quality and that people are very well supported to eat and drink sufficiently. We reviewed eight care plans which were individualised and gave staff the information they needed to be able to care for people well and keep people safe.

We spoke with five staff including a nurse, a senior care worker and care staff. Most told us that they were happy with their work and that they feel well supported and skilled to do their job. One staff member said 'I love working here'.