Richmond Court Nursing Home

Richmond Court Nursing Home is a care home which provides personal care and nursing for up to 39 people, including people with dementia. At the time of our inspection there were 30 people using the service.

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

People were not always protected from the risk of harm. We found systems were not effective in assessing and monitoring risks to people through their dietary needs, the spread of infection or the safe storage of medicines. Systems were in place to safeguard people from abuse, although people didn’t always feel safe. Processes for learning lessons were effective and improvements were noted as a result.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always treated in a compassionate, respectful way. Some people experienced inconsistencies in the caring nature of staff members. The service considered people's cultural needs and wishes. People were supported to express their views and be involved in their care, although people didn't always feel this was effective.

People’s care plans did not always contain accurate information about their person-centred needs. However, staff had good knowledge of people’s likes and dislikes and people were given day to day choices. People who were cared for in bed did not always have access to meaningful activities, although a full program of group activities took place in communal areas.

Quality assurance systems were not always effective for people. This meant the action taken by the provider had not always ensured people received consistent, good quality and safe care. However, people and relatives spoke positively about the management of the service. Systems were in place to seek feedback and resolve people's complaints.

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 requires improvement (published 20 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about how people’s health and personal care needs were managed. We also received information from health professionals about shortfalls that had been identified in relation to nutrition and hydration, the monitoring of people’s health needs and the management of the service. A decision was made for us to inspect and examine those risks.

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.

Enforcement

We have identified breaches in relation to how people’s safety was managed, how people’s rights were promoted, people being treated with dignity and respect and how the service was run at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Court Nursing Home is a residential care home providing accommodation and personal care to 35 people aged 65 and over at the time of the inspection. The service can support up to 39 people with dementia and nursing need.

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

The support people received was not always responsive to their needs. At our previous inspection concerns were identified with activities not being tailored to what people wanted and we found this to still be the case at this inspection. Assessments, care plans and reviews were in place and used to ensure people were supported as they wanted. The provider had a complaints process in place which people used to share concerns they had.

The service was not always well led. Spot checks and audits were carried out to ensure the quality of the service was maintained but these were not always effective in ensuring the activities available were person centred. Questionnaires were used to gather views on the service.

The support people received was safe. There were sufficient staff to ensure any potential risks to people could be managed safely. Staff received training and knew how to keep people safe. Staff were recruited appropriately. People were administered their medicines as they were prescribed and staff were trained in infection control processes with access to personal protective equipment. Accidents and incidents were logged and trends monitored.

People were supported to have maximum choice and control of their lives. The characteristics of the Equality Act 2010 were consistently identified in how people’s needs were assessed. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People decided what they had to eat and drink and people could access healthcare as required. Staff were inducted to ensure they would know how to support people.

Staff were caring and kind in how people were supported and people’s privacy, dignity and independence was promoted.

Rating at last inspection:

The last rating for this service was Good (published 21/04/2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

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

At our previous inspection of 02 and 03 of December 2014 we found that although staff demonstrated that they had knowledge of safeguarding and mental capacity processes, records failed to show that mental capacity assessments where appropriate, were in place. At this, our most recent inspection, we found that improvements had been made.

Richmond Court Nursing Home is registered to provide nursing and personal care for a maximum of 42 people. On the day of our inspection 37 people lived at the home. People had needs that related to old age, physical disability and/or dementia.

A manager was registered with us. 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 provider had policies in place and had received training on procedures they should follow to ensure that any risk of harm and/or abuse was prevented. Risk assessments had been undertaken to maintain the safety of the people who used the service. The staff had been trained to manage medicines safely. Medicines were given to people as they had been prescribed. Staffing levels were to be reviewed by the provider to ensure that people’s needs could be met and that they would be safe.

The staff had received the training they required to give them the knowledge they needed to support the people in their care. The providers understood that people must receive care in line with their best interests and would not unlawfully restrict any person. People were encouraged to make decisions about their care. If they were unable to, their relatives were involved in how their care was planned and delivered. In the main staff were available to support people with their nutritional and hydration needs. The general mealtime experience was to be re-considered by the provider

People and their relatives told us that staff were kind and caring. People’s privacy, dignity and independence was promoted and maintained.

Activity provision did not cater for people’s individual needs. Complaints systems were in place for people and their relatives to raise their concerns or complaints if they had the need to. People’s needs were known by staff and were reviewed regularly.

The provider had a management structure that staff understood. Staff were guided and worked as a team to meet people’s needs. Methods to audit the service in terms of quality and safety were used.

We found that people were treated with politeness and that their privacy and dignity was maintained. We saw good interactions between people who lived there and staff. We observed that people were at ease in the company of staff. We saw that people's needs had been assessed by a range of health professionals including specialist doctors, specialist nurses, the dietician, and the speech and language therapist. This meant that staff had taken action so that people's health and care needs would be monitored and met.

People had been provided with varied food and drink options to prevent malnutrition and dehydration.

We saw that the premises were adequately maintained and were reasonably safe.

We determined that staffing levels were adequate to ensure that people's needs were met and that they were safe.

We saw that complaints processes were in place for people or their relatives to use if they were not happy with the service provided.