Richmond House

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. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

Systems and processes in place supported the safe and effective management of accidents, incidents and complaints. The registered manager maintained good oversight and responded appropriately, and without delay, to any complaints or concerns. When required, investigations were carried out and actions implemented to mitigate risk of reoccurrence. Lessons learnt were identified, shared with staff and used to drive improvements. Feedback included, “We always give the outcome from raised concerns and updates are given, we have debriefs and can learn from them”, “Lessons learnt are documented and put into the care plan if that is needed, any refresher training can come off the back of that” and “Yes, shared within a communications book, and team meetings”.

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 provider understood the importance of accurate information sharing to ensure people’s care was joined up and safe. Systems and processes were in place to support people’s safe admission into the service and when needed, transfer out of the service. The registered manager worked effectively in partnership with other professionals and services to support people. Staff feedback included, “The [registered manager] puts information into the start of the care plan, staff read all requirements and any training that may be needed if there is a diagnosis we haven’t done training on, in a briefing or team meeting that would be shared” and “We use the care plan, read and communicate with family, management and we do get told what we need to know.” One relative told us, “They showed him pictures of the new home, they are doing their best to manage transition.”

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.

Systems and processes were in place to ensure people were safeguarded from the risk of abuse. Staff received safeguarding training and understood how to recognise and report poor care and abuse. The registered manager maintained effective oversight of concerns, ensuring these were logged and reported to partner agencies, for example, Local Authority and CQC, in a timely manner.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications or/and urgent authorisations in a timely manner.

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

Care records were detailed and accurate. They were completed in collaboration with people. Staff told us they read risk assessments and understood the risks to people’s health and how to mitigate them. Staff understood there were times when people became distressed and took steps to understand why a person was distressed and what support they needed to express their emotions. Staff spoke to and about people at times of distress in a respectful way and involved people when a person’s needs changed. One staff member told us, “We are lucky we have [Parents] that are heavily involved, they are invited to meetings, if health professionals are visiting, they are invited to come along”. Feedback from relatives included, “I was involved in care planning” and “[Name] is moving next month, I have been involved in all the discussions.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.The home was tidy, well maintained and safe. Systems were in place to ensure the required health and safety checks were completed. Staff feedback included, “We do regular fire drills and evacuations, they do a lot of checks”, “There is a maintenance sheet for the daily walk round, it gets done that day” and “The sink was blocked and they came out in an hour”.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The registered manager and staff were kind, caring, respectful and skilled, showing good knowledge and understanding of the people they supported. They were visible and responded to people’s needs without delay.Staff participated in a wide range of training relevant to their role, including learning disability training. Training compliance was high and the registered manager had good oversight of this. Staff engaged in regular supervisions and annual appraisals were in place to support them in their role and development. Staff feedback included, “Supervision every 6 weeks, and we can bring it forward if we need to” and “Extensive training schedule there is a lot of face to face, I’ve just done the [Learning disabilities and autism] training again”. One relative told us, “They deal with [Name] ok and I feel they have had enough training.”

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 provider assessed and managed the risk of infection. The provider had an infection prevention and control (IPC) policy in place and staff were trained. Processes were in place to ensure people were protected from the risk of infection. The service was clean and tidy. Relatives complimented the cleanliness of the home. Feedback included, “Home itself very clean, beautiful home spick and span” and “It is well maintained and clean, redecorated now and it is very homely”.

The provider did not always make sure that medicines and treatments were safe and met people’s needs and capacities.

Storage of some medicines was found to be insecure. Temperature control for stored medicines was not always effective. For example, although the current temperature was recorded in bedrooms there was no record of a minimum or maximum temperature, this meant medicines may have been exposed to an extreme of temperature which meant they could be unsafe or ineffective. Records relating to medicines were not always complete, or accurate. For example, a topical medicine record for 1 person did not have the correct expiry date recorded, and this medicine was recorded as being used while out of date. Body charts were not always completed for emollients to show where they had been prescribed for. This meant the topical medicine may be ineffective. Time sensitive medication had not always been administered at the scheduled time, risking safety and/or effectiveness. Although the service was carrying out audits of medicines management these had not always picked up on some of the issues found during the inspection. During and following the inspection the provider sent a report of actions taken to address the concerns we found. We did not identify any evidence of impact or harm.