Richmond Village Coventry

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question Good. At this inspection the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had a culture that supported ongoing learning to ensure care was safe and focussed on the people in the service. People felt confident in being able to raise concerns and said the provider and management team were proactive in listening, responding to and then learning from any concerns. One person told us, “If I had a concern they would speak to me, and it would be okay.” Staff described a supportive approach and a no blame culture.

The manager reviewed accidents and incidents regularly and lessons were learnt to improve and embed good practice. Every morning there was a meeting with heads of departments where any concerns, accidents, incidents or issues within the home were shared and discussed. This ensured any concerns or recording issues could be quickly addressed and timely actions implemented. For example, where there had been a delay in a call bell being responded to, this had been identified and resulted in a review of staff break times. One staff member told us, "We have a report in the morning, and if anything has changed in anyone's care, then it is relayed then. If anything changes during the day, the nurses will come and talk to you and then it will come on the phone (Handheld electronic device)."

The provider ensured staff completed regular training to support their learning so they could provide safe care. This included training linked to people’s needs. Nurses had access to training to further develop and enhance their clinical skills. Staff supervision meetings and further training were used to support learning when staff practice fell below expected standards. One staff member told us, “I would always own up (to a mistake). There is no blame and it is usually a training thing. We should always help our staff to do things competently and confidently."

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager told us relatives were involved in decision making during the pre-assessment of people’s needs where this was appropriate. This helped to ensure a safe transition of their family member to the service.

The provider worked with people and healthcare professionals to maintain safe transitions and systems of care. This helped to ensure continuity of care and support. For example, when a person was admitted to hospital, the provider printed key and essential information about the person from their electronic care planning system. This information was then sent with the person to the hospital so other healthcare professionals had access to this and understood the support they needed to manage risks such as eating, drinking and moving around safely. The documentation also included information about any recent visits by other healthcare professionals, the person’s medication and their recorded wishes for future care.

Staff understood the importance of relatives being informed about any hospital admissions of their family member, so they were involved in this process. One relative told us, “We get good communication from the home if he needs to go to hospital for appointments.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the home and felt at ease to raise any concerns with staff if needed. One person told us, “I feel safe here, everybody is friendly.” A relative told us how they were kept informed if there were any concerns, they told us, “They found a bruise on her arm and contacted us immediately.”

Staff aimed to ensure people experienced a safe environment and completed safeguarding training to help them identify any potential abuse. Staff were confident to report any concerns that people were at risk of abuse, neglect or discrimination. One staff member told us, “I would report it (a concern) to [registered manager] immediately. I am fully on to whistleblowing and speaking up to safeguard our residents." Overall, staff knew how to escalate their concerns externally if they felt action had not been taken to keep people safe. One staff member commented, “I would go to safeguarding (Local Authority) if I thought I wasn’t listened to. I would definitely report it and go to CQC as well. You have to safeguard these people to make sure they are comfortable in their surroundings." However, 1 staff member was not aware of the full range of external organisations they could report safeguarding concerns to.

The provider had a safeguarding policy to guide staff on how to manage any safeguarding concerns. The registered manager ensured any safeguarding concerns were recorded and reviewed for any immediate actions. Where appropriate safeguarding referrals were made to us and the local authority safeguarding.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs which was safe, supportive and enabled people to do the things which mattered to them.

Any risks associated with people’s care were identified when they were assessed prior to using the service. Risk assessments were developed and care plans devised to support staff in managing any risks. People’s care plans reflected their views, wishes and preferences to ensure risks were managed safely. The only exception was in relation to 1 person who had an allergy to latex but did not have a specific risk assessment or care plan in relation to this. This meant there was a potential risk staff may not always provide them with safe and consistent care.

Where people had health conditions, risk assessments showed how these health conditions should be managed. For example, 1 person had skin damage and needed to be repositioned regularly, but they found this uncomfortable. There was a risk if they did not reposition frequently, this could impact on the healing of their skin. Staff had worked with the person to support their comfort and preferences by modifying their pressure relieving equipment, this helped to ensure the risk of further skin damage was reduced. Care plans for people with diabetes and catheter care contained clear instructions to support safe systems of working.

The provider did not always have clear records to demonstrate they detected and controlled potential risks in the care environment. They aimed to make sure equipment, facilities and technology supported the delivery of safe care.

The provider had arrangements in place for regular cleaning, maintenance and checks of equipment that people used to ensure they lived in a safe environment. However, we found the ferrules (rubber feet) on 1 walking frame were worn to the metal which meant there was an increased potential risk of the person falling. We also noted in two washroom areas the floor covering was coming away from the floor surface and needed attention. These issues were raised with the registered manager on the day. The ferrules on the walking frame were replaced during our inspection visit.

A fire risk assessment had been completed for the service which showed numerous actions were required. Dates were detailed when each of the actions were to be completed by and each action had been risk assessed as either low, medium or high. We were assured systems were in place to manage all risks with some being managed by external contractors where this was deemed necessary. The provider told us there had been an increase in staffing levels and they were utilising an external “Waking Watch” provider to patrol the grounds and home on a daily basis to identify any potential fire safety risks.

The environment was maintained to ensure communal areas provided comfortable and welcoming areas for people. There were large spaces with seating for people to use with drink stations close by. We saw people accessed the garden areas which were well maintained. There was clear signage around the home with many doors to people’s rooms containing photos or items of interest to them to help them locate or recognise their room.

There were several maintenance staff employed at the home who worked daily to ensure the home was safe and suitable for people. Health and safety checks completed included legionella (water), gas and electricity. A maintenance person told us how they reviewed actions from the checks made and these were prioritised to make sure people were not placed at risk. Equipment checks included bath hoists, walking aids and specialist mattresses.

Where staff or people identified maintenance issues, these were recorded on a maintenance log so that action could be scheduled for them to be addressed. One person told us, “Once the bathroom light wasn’t working and they came and put it right.”

Due to Richmond Village being a large complex with several buildings, it was not always clear from maintenance records what had been actioned in regards to the care home or what actions were in progress. We discussed this with the village manager and registered manager, and they stated they would review the records to ensure this was clearer.

The provider aimed to make sure there were enough qualified, skilled and experienced staff that met their individual needs. Staff usually received effective support, supervision and development.

Staff were observed to be visible and available to people during our inspection visit. However, there were mixed views from people in relation to their being sufficient numbers of staff available. Some people told us there were delays in their call bells being responded to when they needed support. Comments included, “When I press the buzzer, they do sometimes take a long time to come” and “The other day I pressed my buzzer 4 times then gave up” and “There is always enough staff around to look after me.” People and relatives spoke positively of the staff, 1 relative told us, “They do deliver good care.”

Overall, staff felt staffing levels were adequate but acknowledged it could be demanding at busier times of the day and in particular if there was unplanned absence due to sickness. One staff member told us, “Staff are massively busy. When you have agency who don’t know the building, it becomes harder on the carers who work here full time." Another staff member commented, “If staff don't turn up, it is very, very busy."

There were ancillary staff to maintain a clean environment and kitchen staff prepared people’s meals and drinks. This allowed clinical and care staff to focus on providing people with safe care.

Systems were in place to ensure staff were recruited safely. This included, obtaining references and Disclosure and Barring Service (DBS) checks. The DBS checks help employers make safer recruitment decisions and prevents unsuitable people from working with vulnerable people. However, it was not always clear that appropriate checks had been completed for agency staff. For example, it was not clear that the DBS checks were enhanced or that they had completed all of the required training. The registered manager told us this would be reviewed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and tidy with no unpleasant odours. Staff had completed training, so they understood how to reduce the risk of infection spreading. They told us they had access to the PPE and equipment they needed to support people safely.

A member of housekeeping staff confirmed they were told about any infections in the home so they could take action to mitigate the risks of them spreading. At the time of our visit nobody in the home had any infections that required enhanced cleaning.

The provider completed observations of staff and the home to check cleaning was effective and staff followed good infection control practice.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us they received their medicines as required. One person told us, “They never forget my medication, if I am in pain they are on it.” Records showed people received their medicines as prescribed and we saw staff administering medicines using safe practice. However, 1 person told us, “I may drop my medication in bed and forget to take it. if that happens, I would inform them, and I won’t take it.” This suggested staff may not always be observing people taking their medicines in accordance with good practice.

Medicines were stored safely in locked trolleys and cabinets. Medicines were only administered by nurses or suitably trained senior care staff.

Staff ensured they contacted health professionals for any support needed with medicines. For example, staff had identified 1 person may need to have their medicines administered covertly (disguised in food or drink). The GP had been consulted and had provided the necessary authorisation should this be needed. Staff were aware of risks associated with some paraffin-based creams and appropriate risk assessments were in place in relation to these. Each person had a ‘body map’ showing where creams were to be applied.

Where people had been prescribed pain relief medication to be administered PRN (as required) the appropriate protocols were in place to make sure people did not receive too much medication in any one time period. Staff also monitored people’s pain to ensure the medicine was effective.

Staff had access to policies and procedures in relation to medicine management if required and regular auditing of medicines took place. This helped to ensure medicines were being managed in accordance with good practice guidelines.