Archived: Richmond Court Residential Home

We found the following examples of good practice:

The provider was following best practice guidelines in ensuring visitors to the home did not introduce or spread COVID-19. Due to recent confirmed cases visitors were not allowed to enter the home. Communication with families was held regularly through telephone and video calls. All families had been notified of the outbreak and were sent regular updates by the provider.

Staff were adhering to Personal Protective Equipment (PPE) guidelines and extra PPE locations had been set up on each corridor. Where social distancing could not be maintained, staff took extra precautions through the use of PPE and handwashing to minimise the spread of infection.

The provider had ensured that all staff had received a personal COVID-19 risk assessment and conversations about their wellbeing were held regularly.

Staff had completed the appropriate infection control training and regular competency assessments of infection control guidelines were completed including handwashing techniques and the donning and doffing of PPE.

Richmond Court Residential Home is a care home providing personal care to people aged 65 and over. At the time of the inspection 20 people were living at the service. The service can support up to 21 people. The accommodation is provided in one adapted building with bedrooms on the ground and first floor and communal areas on the ground floor with access to a small garden.

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

Staff had received training in safeguarding and knew how to recognise and report potential abuse. There were enough staff on duty to meet people’s needs and staff had been recruited safely. People told us they received their medicines as prescribed. Accidents and incidents were recorded and followed through with appropriate action to minimise the risk of re-occurrence.

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, although some further work was required to ensure all capacity assessments clearly showed which decision was being assessed. Staff were trained to meet people's needs and acted promptly to refer people to healthcare professionals when required. People received support to eat and drink meals of their choosing and specialist dietary needs were met. Some work had been completed on the environment to adapt it for people living with dementia.

People were supported by kind and caring staff who respected their privacy and dignity and supported their independence.

People were supported by staff who knew about their needs and routines and ensured these were met and respected. There were activities in place for people to take part in. People and relatives felt confident to raise concerns and felt they would be listened to. End of life wishes were discussed and recorded.

The management team had worked hard to improve the care since the last inspection and audits to ensure the quality and safety of the service were robust. People and relatives were involved in decisions about the service. Staff were happy with the way the service was led and felt the management team were visible and approachable. There was good partnership working with other organisations.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 February 2019) and there was a breach of regulation 17, good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

There was a registered manager in post who was present throughout our inspection. 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.

The risks associated with people’s care had been identified and steps put in place to reduce the risk for the person. However, we found that not all risks had been managed well. Improvements were needed in the management of infection control.

Whilst people had been offered daily choices we found improvements were needed in the application of the Mental Capacity Act 2005. Improved support was also required for people living with dementia. We have made a recommendation about accessing information and resources to support people living with dementia in their communication. We have also made a recommendation about the use of CCTV within the home

People had their privacy respected although we found some practice where supporting people in a dignified manner could be improved. Many people were supported to retain their independence.

Not all people had been supported to maintain their hobbies and interests.

Staff felt supported in their roles. There were some systems in place to seek feedback from people living at the home about the quality of the care they were receiving. Systems for monitoring the quality and safety of the service were not effective or robust and had failed to highlight the concerns raised at this inspection. We found that the provider had breached the regulation in relation to good governance. You can see what action we told the provider to take at the back of the full version of this report.

People received support from staff who were aware of the signs of abuse and whom could describe appropriate action to take should they be concerned about people. There were sufficient staff available to support people. The staff had been safely recruited.

People received their medicines safely by staff who had received training in safe medicine management. There were systems in place to ensure medicines were given safely.

People were supported by staff who had the skills and knowledge to meet their needs. Staff training had been provided around people’s individual needs. People had their healthcare needs met and were assisted to have foods and drinks they enjoyed.

People and their relatives told us they felt the staff were caring. Staff had got to know people well and we observed kind, caring interactions between staff and people.

People’s care had been reviewed to ensure it continued to meet their needs, although these reviews did not involve the person themselves.

People and their relatives felt able to raise concerns should any arise. There were systems in place to ensure any complaints received would be investigated.

Richmond Court Residential Home is registered to provide accommodation and personal care to a maximum of 21 older people who may have dementia or physical disabilities. At the time of the inspection there were 20 people living at the home.

The home had 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 felt safe at the home and were supported by staff who had an understanding of how to report abuse and manage risks to keep people safe.

We saw that there were effective recruitment systems in place to reduce the risk of unsuitable people being employed. Staff had appropriate training and support and we saw there were sufficient numbers of staff on duty to support people.

People were supported to take their medication by staff who had been trained and followed correct procedure when supporting people with medication.

People had their rights upheld in line with the Mental Capacity Act but staff did not have an understanding of how to support people whose liberty needed to be restricted to keep them safe.

People had choices at mealtimes and were supported to have sufficient amounts to eat and drink. Where people required input from health professionals, they were supported to access this.

People were supported by staff who were kind and treated them with dignity. People were supported to access advocacy services when needed.

People and their relatives were involved in the assessment and review of their care. People were supported by staff who had a good knowledge of people’s preferences with regard to their care.

People were told how they could make complaints. Complaints that had been made were fully investigated by the registered manager. People were given opportunity to provide feedback on their experience of the service.

The registered manager completed audits to monitor the quality of care provided. Where issues were identified, these were acted on.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions we had with four people who lived at the home, two members of staff who supported people, four relatives and the registered manager. We looked at five people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. People we spoke with told us they were happy with the support staff gave them. One person said, "If I am unhappy I will speak to staff".

Records showed that risk assessments were in place to identify potential risks and the action needed to reduce the risk. For example, where people needed two members of staff to support them this was identified. This meant that people confident that risks would be identified and action taken to reduce any potential risks.

We found that people's medication administration records (MAR) chart showed gaps where staff had not signed to show whether people had in fact been given their medication and if not why not. We also found that the medication process was not being checked regularly. This meant that people were at risk of unsafe administration of medicines.

People told us they felt safe living within the home. We found there was a stair gate on the main stairs used by people living in the home, but this had been risk assessed and there was a lift in the home for people to use who were unable to use the stairs, to ensure people's movement was not restricted.

An application under the Deprivation of Liberty Safeguards had been submitted by the service to the local authority. Training records showed that staff had not received training in the Deprivation of Liberty Safeguards (DoLS) or the Mental Capacity Act (MCA). Staff confirmed this, however staff we spoke with had a good understanding of the DoLS, but they had limited understanding of the MCA. The manager confirmed further training would be provided.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.

Is the service effective?

We found that staff were able to explain people support needs. Records showed that people's needs were specific to them and identified in a care plan.

We found that audits were not being carried out consistently. The audits that were being done were not always effective in identifying areas of poor quality. This meant that where people were at potential risk this was not always being identified.

People were able to access health care professionals where needed. Records showed that where health care professionals visited people this was recorded.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

People we spoke with told us that staff were, "Caring" and "Kind". One relative said, "Staff know what they are doing". Staff we spoke with were able to explain people's needs. We observed staff on the day of the inspection communicating with people in a way that promoted their independence.

Staff we spoke with had a good understanding of how to promote people's dignity and privacy. People told us they were able to go to their rooms when they wanted. On the day of our inspection we observed people in their rooms watching television or just lying on their beds. This meant that people independence, dignity and privacy was being promoted.

Where people were assessed as being safe, they were able to go out of the home as often as they wanted to go shopping or just visit friends and relatives.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.

Is the service responsive?

We found that the provider had a system in place to gather the views of people about the service they received, and take action as required. Some people and relatives we spoke with told us they had not received a survey questionnaire from the provider. We raised this with the provider, who confirmed they would take action to ensure everyone got a questionnaire.

We found that a complaints, compliment and comments process was in place. People told us even though they did not remember being given a copy of the complaints process they knew who to speak to if they had a complaint. One relative said, "I would speak to the manager". This meant that people were able to raise concerns they had about the service.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive to people's needs.

Is the service well-led?

The service was managed by a registered manager who was supportive throughout the inspection. We found that where the manager needed to act in people's best interest this was being done. This meant that people could be confident in how the service supported them.

We found that the environment in the home was not always risk free. A number of windows were not restricted to ensure people were safe. Wardrobes were not all secured to the wall, however audits were not identifying these concerns. The manager confirmed action would be taken to rectify the shortfalls in their auditing processes.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is well-led to meet people's needs.

There were 20 people living in the home at the time of our inspection. We spoke with six people, five staff, the manager and the provider during our inspection. As some people were not able to clearly express their views we observed how people were cared for by staff.

The provider had addressed shortfalls in the management of risks to ensure people's care was consistently delivered in a way that ensured people's safety and welfare. One person told us they had their legs elevated because they 'swelled up'. We saw this reflected their care plan.

We found that the provider had arranged for staff to receive sufficient training in safeguarding people from harm.

The provider had addressed the gaps in staff skills and training in relation to dementia awareness, falls and managing behaviours that challenged. One staff said, 'The training was good, we learned a lot and we have made a lot of changes'. A person who lived there said, 'I like helping', (when asked about the activities they did). This meant people had more opportunities to engage in activities that suited them.

Staff understood the importance of obtaining consent from people before they commenced care tasks. One person said, 'They always ask me before they help me if it's ok'.

Appropriate arrangements were in place to support people who could not consent to their care and staff understood their role in protecting people.

There were gaps in the management of risks and care was not consistently delivered in a way that ensured people's safety and welfare.

We found that arrangements were in place to ensure that people were safeguarded from harm. However not all staff had received sufficient training.

There were enough staff to meet people's needs, we saw that people did not have to wait for support. However a high turnover of staff had led to gaps in skills and training, specifically in dementia awareness, falls and managing behaviours, necessary to meeting the complex needs of people.

Staff were supported in their care role. One staff told us, 'The manager is always here and will show us what we need to do or tell us if we are not doing things correctly.

A visiting relative said, " I'm very pleased with the care'. A visiting social worker told us they were happy with the standards of care for their client.

At this inspection we found the home was clean and people were protected against the risk of infection. This was because the provider had addressed the risks to people's health by improving the standards of cleanliness in the home. The provider had replaced furnishings and ensured equipment was cleaned to an acceptable standard. We found people were cared for in a clean and hygienic environment.

People had care plans in place which reflected both their care and their specific health needs. Plans detailed risks to people, and how these are met. For example we saw people are supported to eat and drink enough. We saw people who had specific health needs had the support they needed to keep healthy.

We found that people are not always protected from the risk of harm or abuse because the provider did not take appropriate steps to report allegations. There were delays in ensuring people were protected.

We found the provider had covered recent changes in the staff team, and that staffing levels were sufficient to meet the needs of the people being cared for. One person who lives there told us, "I like it here, I go out every day and when I want to, I go out with him (provider), there's always staff around to help.'