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Richmond Court Nursing Home Requires improvement

Reports


Inspection carried out on 16 October 2019

During a routine inspection

About the service

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

Inspection carried out on 6 March 2017

During a routine inspection

Our inspection was unannounced. It was undertaken on 06 March 2017 by one inspector.

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.

Inspection carried out on 2 and 3 December 2014

During a routine inspection

This was an unannounced inspection that took place on 2 and 3 December 2014.

We last inspected this service on 7 October 2013. There were no breaches of legal requirements at that inspection.

Richmond Court provides nursing and personal care for a maximum of 42 people. At the time of our inspection, there were 35 people living at the home. The building was undergoing some refurbishment work to improve the environment for people living there.

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 and their families told us they were happy with the care and support they received from staff. We observed people being treated with kindness and dignity and respect.

People told us that they felt safe in the home. We noted that care plans and risk assessments were regularly updated and referrals made to appropriate health professionals where necessary. We found that staff were aware of their roles and responsibilities in respect of keeping people safe and were able to demonstrate how they kept individual people safe. However, although we found that staff had the knowledge of how to keep people safe and recognise abuse, they did not have the training to support this and two staff told us they would like to receive training in this area.

There were robust recruitment systems in place to ensure appropriate staff were employed by the home. The manager made arrangements to ensure the same agency staff were employed for consistency of care.

The Mental Capacity Act 2005 (MCA) states what must be done to ensure the rights of people who may lack mental capacity to make decisions are protected; this includes balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. Staff we spoke with were aware of MCA and DoLS and the importance of obtaining people’s consent, where possible. Mental capacity assessments had been removed from care files and it was not always clear from information held on some people’s files whether they had capacity or not.

Care plans were detailed and contained person-centred information. Staff were able to provide us with detailed information regarding the care and preferences of people living at the home and demonstrated the skills and knowledge required to meet the needs of the people living there.

Relatives of people told us they found the manager and staff approachable and that they had confidence that if they needed to raise any concerns or complaints that they would be dealt with. Staff understood their role and felt supported by the manager.

Despite refurbishment work being carried out during the inspection, the home was clean and tidy and a risk assessment had been put in place to manage the building work.

During the inspection we noted five people playing dominoes, all of whom were enjoying the interaction with each other and the member of staff facilitating the game. However, there were a number of other people who were not involved in activities and may have benefitted from some additional interaction. Staff were very busy and their roles appeared very task orientated. People told us they would enjoy more interaction with the staff group and they clearly enjoyed talking to them.

Inspection carried out on 7 October 2013

During a routine inspection

At the time of our inspection 30 people lived at Richmond Court. During our inspection we spoke with seven people who lived there, two visitors, and nine staff (which included a staff member who worked on nights at the home). People we spoke with were happy with the care provided and the staff. One person who lived there told us, “I am happy and well looked after”. Another person said, “I do like it here”. A person visiting a person who lived there said, “Oh, yes we think that they are looked after and they seem happy”. All staff we spoke with told us that they felt that the people who lived there were well looked after and were safe.

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.

Inspection carried out on 25 June 2012

During a routine inspection

There were 34 people living at the home on the day of our inspection. No one knew we would be visiting. We spoke with six people who lived at the home, six members of staff, a manager who was covering the registered manager whilst they were on leave and the registered provider.

Some of the people living at this home had dementia care needs. As people with dementia are not always able to tell us about their experiences, we used a formal way to observe people during this inspection visit to help us understand their experiences better. We call this a Short Observational Framework for Inspection (SOFI). We spent two hours in a communal area, observed a total of three people and recorded their experiences at regular intervals. This included people’s state of well being, how they interacted with staff members and other people who lived at the home and the environment.

We found that the atmosphere of the home was relaxed and friendly. Our observations showed that people were at ease with the staff. We saw that staff treated people with respect and dignity and understood how to communicate with them. People told us and we saw that choices were offered and that people’s views were sought and taken into consideration.

Staff received a range of training which included dementia care and abuse awareness training, so that they had up to date knowledge and skills in order to support the people who lived at the home and keep them safe.

Staff we spoke with were able to tell us about people’s needs so that they received care in a way that they preferred. One person living at the home told us that they were happy living there. They said "It is wonderful. They really look after me and they are so kind". Another person living at the home told us " They are so kind to me".

We saw that in-house activities were provided.People told us that they liked joining in with the activities. One person was doing a group colouring activity said " I really enjoy doing this".

We sampled the files for three new members of staff. We found that recruitment checking processes were robust and thorough which meant that unsuitable staff were less likely to be appointed and people were at less risk of harm.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

Reports under our old system of regulation (including those from before CQC was created)