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Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 June 2018

This comprehensive inspection was carried out on 13 and 20 February, and 6 March 2018. The first day of the inspection was unannounced and we informed the provider of our intention to return on the second and third days. We also gathered additional information for this inspection from the registered manager and the director of care during a visit to the provider’s head office on 4 April 2018. The inspection date was brought forward as we had been informed by the provider that a serious medicine error had occurred in December 2017. At our previous comprehensive inspection on 3 and 8 May 2017 we had rated the service as Requires Improvement. Safe and well-led were rated as Requires Improvement and effective, caring and responsive were rated as Good.

Richford Gate is a ‘care home’. People living in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service comprises two adjoining first floor flats, each with four single occupancy bedrooms. Each flat has its own lounge, kitchen, bathroom and separate toilet. At the time of the inspection the premises were at full occupancy. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post, who has managed the service for several years. A registered manager is a person who has registered with the CQC 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. The registered manager was on annual leave on the first two days of the inspection and was present on the third day.

At the previous inspection we had been informed by the registered manager that there had been seven separate medicine errors since October 2016. We had noted that measures had been taken by the registered manager and provider to fully investigate why these errors had occurred, and staff had received additional medicines training and other appropriate support and guidance from the registered manager, the area manager and the provider’s medicines trainer. During the previous inspection we had discovered two concerns that needed to be addressed in regards to how staff completed medicine administration record (MAR) charts and how they checked expiry dates for prescribed medicines. We had issued a breach of regulations in relation to the management of medicines. Following the inspection, the provider had sent us an action plan which outlined how they proposed to address this breach of regulations. At this inspection we found that the provider had achieved improvements with the management of medicines, however we found further issues that the service had not identified and addressed.

At the previous inspection we had found that the provider had failed to notify us about a safeguarding concern which had resulted in the police attending the service. This had meant the CQC could not effectively monitor events at the service in order to ensure people’s safety. We had issued a breach of regulations in regards to the provider not informing us about significant incidences at the service, in accordance with the Health and Social Care Act 2008. Following the inspection, the provider sent us an action plan which outlined how they proposed to address this breach of regulations. At this inspection we found that the provider had appropriately notified us of any notifiable events, in accordance with legislation.

People who used the serv

Inspection areas

Safe

Requires improvement

Updated 6 June 2018

The service was not always safe.

Improvements had been achieved with the management of medicines. However, a serious medicine error that occurred since the previous inspection and some of our observations during this inspection showed that these improvements were not yet fully engrained.

People who used the service were supported by staff who understood how to protect them from abuse and harm. Risks to people were assessed and plans were developed to manage these.

The service deployed sufficient numbers of safely recruited staff.

The premises were clean and hygienic and people were supported by staff who understood how to protect them from the risk of cross infection. However we found unnecessary clutter, which placed people at risk.

Effective

Good

Updated 6 June 2018

The service was effective.

Staff received the training and support they needed to provide effective care and support.

People who used the service were supported to make meaningful decisions, wherever possible. If people did not have the capacity to make a specific decision, the provider made sure that their legal rights were upheld.

Systems were in place to support people to meet their health care needs, and attend local health promotion events if they wished to learn about ways to promote their health and wellbeing.

People were involved with choosing and preparing their meals and snacks, and their dietary needs and preferences were respected by staff.

Caring

Good

Updated 6 June 2018

The service was caring.

Staff interacted with people in a friendly, kind and supportive way.

People’s individual interests, preferences, needs and wishes were respected by staff. People were supported to speak with staff about issues that were important to them during individual sessions.

Systems were in place to enable people to participate in the day to day running of the service. Staff supported people to receive their care and support in a dignified manner.

Responsive

Good

Updated 6 June 2018

The service was responsive.

People’s needs were assessed, monitored and reviewed. This ensured that any changes to their needs could be promptly identified and responded to.

Staff supported people to access a range of activities to enable them to pursue their interests, and develop skills, confidence and increased independence.

People and relatives received a thorough response to any concerns or complaints about the quality of the service.

Well-led

Requires improvement

Updated 6 June 2018

The service was not always well-led. The provider did not consistently demonstrate that suitably robust system were in place to assess, monitor and improve the quality of the service.

Systems were in place to appropriately inform the Care Quality Commission about any notifiable events.

People and relatives were happy with the management style of the registered manager.