Richmond Residential Care Home

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

This service scored 75 (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 provider used an electronic care records system which was linked to each person’s care plan. The provider also recorded any incidents that occurred. Using this system staff and leaders were able to search through previous care records and look for any emerging themes which could allow them to improve practice and support people to improve their wellbeing.

Regular supervisions were held, with staff being asked to reflect on their practice and identify any opportunities for improvement on the way they cared for people. Staff meetings and daily handover meetings were used as opportunities to share best practice and improve outcomes.

Leaders had audit processes in place where care records and incident reports were checked over so any learning opportunities could be identified.

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 used an electronic care system where staff and visiting professionals could record care notes. People’s care records had been updated on a regular basis and leaders carried out regular audits of the recorded information.

The provider held regular meetings with the GP to discuss people’s health and wellbeing. The provider liaised with community health services such as district nurses, the falls team, physiotherapists and the dietician to ensure that people were receiving appropriate care.

One relative told us, “My relative had a couple of assessments by the social worker and the home and we went through all the information about my relative and we picked their room”.

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.

Staff and leaders were aware of safeguarding processes and when to make a referral. All staff received training on safeguarding adults and children.

The provider was knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS) legislation. This legislation protects the rights and ensures that the least restrictive practice is used when caring for people who lack the mental capacity to make particular decisions. Where appropriate the provider had applied for DOLS authorisations, and had assessed people’s mental capacity in each area of their care, recording detailed best interest decisions in areas of care where the person was found to lack capacity. Staff received training in the Mental Capacity Act and Deprivation of Liberty Safeguards in Health and Social Care, which showed that the provider was committed to ensuring that all staff had an awareness of legislation and good practice.

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.

People and their relatives were involved in discussions about risks to their health, safety and wellbeing and were supported to make informed decisions about how these were managed.

One person’s care plan regarding medication stated, “[Person] is happy for staff to administer their medication, and will then take each medication one at a time.” A further entry stated, “Staff are to remain vigilant while [Person] is taking their medication to ensure it is taken appropriately.”

This demonstrated that the provider supported the person to retain independence with their medication by providing the correct medicines and prescribed dosages for them to take themselves, while staff observed the process to reduce the risk of errors. As a result, the person was enabled to maintain as much independence as possible in managing their medication, with staff oversight ensuring their safety and effective risk management.

One relative told us “They know my relative needs encouraging. They walk everywhere and staff monitor this”. This showed that staff followed this person’s care plan by supporting the person to walk whilst monitoring their safety.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were systems in place for maintaining a safe environment and ensuring that the building was compliant with health and safety regulations. Inspections such as fire safety, gas certificates and electrical wiring tests were in date with the renewal dates identified so that the provider remained compliant.

The care home is an old building which has been extended. Whilst most of the bedrooms and bathrooms were recently decorated and pleasant, some bedrooms and bathrooms were more dated. The care home is an older building that has been extended. Most bedrooms and bathrooms showed evidence of recent redecoration; however, some bedrooms and bathrooms reflected an older decorative style and finish. Leaders advised that they always redecorate rooms prior to a new resident moving in, with residents and their family being asked to choose the colour scheme. Leaders also advised us that they were in the process of renovating the older bedrooms and bathrooms, with work being carried out on an upstairs bathroom on the day we visited.

Some of the corridors contained items of equipment. For example, some wheelchairs were stored in an open alcove near the entrance. Whilst we observed that staff were regularly monitoring people using the corridor, the inspector fed back to leaders that the environment could be made more dementia friendly by storing these items away. Following our inspection the registered manager advised us that wheelchairs and slings that had previously been in communal corridors had been stored in areas of the care home that were not accessible to people, and the provider were creating a plan for how to secure the alcove in the main corridor. This showed that the provider were responsive to the feedback given to them following our inspection.

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.

Staff retention was high, with some staff having worked for the provider for more than a decade. Staff were observed working safely with people, showing a compassionate and knowledgeable approach to meeting their needs.

Leaders told us that the majority of staff were permanent, and that when agency staff were used the provider tried to use consistent staff who had worked there before and who people using the service were familiar with.

Relatives provided mixed feedback regarding staffing levels and staff competency. One relative commented, “There are not enough staff; they struggle to cope.” In contrast, another relative said, “Some of the staff are wonderful. One of the best things is that they have regular staff, and when agency staff are used, they are familiar because the service uses the same agency staff. They play bingo and ball games.”

Although relatives' views on staffing levels varied, we reviewed staff rotas and dependency assessments, which provided assurance that the number of staff scheduled for each shift was appropriate to meet people's needs.

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 employed dedicated cleaning and housekeeping staff.

There were processes in place to manage infection control. For example, people’s laundry was organised into colour-coded linen bags, which meant that laundry which presented a higher risk of infection could be identified and prioritised for washing. Cleaning rotas were completed on a daily basis, with audits being completed on a regular basis to ensure compliance.

Cleaning chemicals and equipment were stored in a locked cupboard which required a keycode to access, preventing unauthorised access to harmful substances and items.

The provider recorded positive feedback from relatives, with one relative commenting, “Richmond always looks lovely and clean.”

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

Processes were in place for the ordering, storage and administration of medication. Mandatory training was in place for all staff who administered medication, with additional support and training being provided by qualified nursing staff.

Regular Multi-Disciplinary Team (MDT) meetings were held with each person’s GP, with any changes in their presentation being discussed with the doctor. This meant that medication could be changed and optimised on a regular basis to ensure that it was meeting each person’s needs.

Staff who administered medication were knowledgeable about people’s medicines and understood the processes in place. This meant medication was administered to people safely following agreed protocols.

Regular medication audits were carried out by staff and checked by leaders. The audits included an actions column, which meant that any issues could be reflected upon and actions taken in order to improve practice.