Richmond House

We found the following examples of good practice.

The service had updated their policies and procedures to ensure infection prevention and control (IPC) processes were robust. The premises had visible signage throughout to inform people and visitors of COVID-19 risks and IPC practices. All visitors had their temperatures checked and were required to complete a risk assessment and declaration before entering.

Care staff were managed appropriately and were zoned to specific areas. All staff had their temperatures taken twice a day and took part in regular COVID-19 testing.

Cleaning regimes and products had been changed to ensure robust processes were in place and that the products were suitable for COVID-19. Cleaning had been increased throughout the service and high touch surfaces were being cleaned more regularly.

Donning and doffing stations were situated in the service and personal protective equipment (PPE) was available throughout the building. Hand sanitiser systems had been secured onto the walls in all corridors. Staff had received training in IPC and PPE in relation to COVID-19.

Social distancing was promoted within the service by moving furniture in communal spaces. Appropriate measures were in place for people who were required to isolate. The provider had implemented a pod system to facilitate safe visits.

Richmond House is registered to provide accommodation with care and nursing support for up to 49 people. Several of the bedrooms are for use by people requiring intermediate care and support for a short period of time. The home is set within its own grounds with car parking facilities. The home is operated by HC-One Limited and is located in the Wigan area of Leigh.

People’s experience of using this service:

We carried out this comprehensive inspection on 10 and 15 April 2019. At the time of the inspection there were 47 people living at the home, with 37 people receiving nursing care and 10 people receiving intermediate care. Intermediate care services provide support for a short time to help people recover and increase independence. It can also reduce the chances of people having to go in to hospital.

The service was extremely well-led. We received positive feedback from everybody we spoke with about management and leadership within the home.

The staff team spoke highly of the leadership at the home and said they felt supported in their roles.

The home and registered manager had won a number of awards where the exceptional leadership had been recognised, particular regarding End of Life Care.

The home had been invited to be involved in a number of ‘Pilot’ initiatives in the local area.

People said they felt safe living at the home, with staff demonstrating a good understanding about how to protect people from the risk of harm.

Staff were recruited safely, with appropriate checks carried out to ensure there were no risks presented to people using the service.

Maintenance checks of the premises and the servicing of equipment was carried out throughout the year to ensure they were safe to use.

There were enough staff to care for people safely and the staff we spoke with told us they felt staffing levels were sufficient.

People received their medication safely.

Accidents and incidents were closely monitored, with regular trends analysis carried out to ensure any re-occurring themes could be identified in a timely way.

People’s mental capacity was kept under review and deprivation of liberty safeguards (DoLS) applications were submitted to the local authority as required.

Staff received the necessary training and support to help them in their roles. Staff supervisions and appraisals were carried out and gave staff the opportunity to discuss their work.

People told us they liked the food available and we saw staff supporting people at meal times, if this was something they needed help with. Where people needed modified diets due to having swallowing difficulties, these were provided.

People living at the home and visiting relatives made positive comments about the care provided at the home. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and that staff promoted their independence as required.

Complaints were handled appropriately. Compliments were also maintained about the quality of service provided.

There were a range of activities available for people to participate in, both in and out of the service.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection:

Our last inspection of Richmond House was in August 2016. The overall rating at that inspection was ‘Good’, with no regulatory breaches identified. The report was published in October 2016.

Why we inspected:

This inspection was carried out to check people who lived at Richmond House were still receiving a ‘Good’ level of care and support and to check that regulatory requirements were still being met.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for ‘Good’ rated services, however if any further information of concern 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

Richmond House is registered to provide accommodation with care and nursing support for up to 49 people. Ten of the bedrooms are for use by people requiring intermediate care and support for a short period of time. The home is set within its own grounds with car parking facilities.

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 we spoke with who lived at Richmond House told us they felt safe. Staff rotas showed that there was sufficient care staff on duty to meet the needs of people who used the service. The service took into account people's needs and their dependency level, using a dependency level tool based on information in people’s care files.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. Staff demonstrated an awareness of safeguarding and were able to describe how they would make a safeguarding referral. The home also had a whistleblowing policy in place.

We looked at six staff personnel files and found there was evidence of robust recruitment procedures, including background checks.

Medicines were managed safely within the home. All staff authorised to administer medicines had completed the necessary training as well as having their competency assessed.

The home was clean and free from any malodours. Bathrooms had been fitted with aids and adaptations, including different coloured hand rails and toilet seats, to assist people with limited mobility and to help people living with a dementia to better orientate in these rooms.

Staff were aware of precautions to take to help prevent the spread of infection. The home was adequately maintained and any equipment used was serviced and maintained appropriately to ensure it was safe to use.

There was an up to date a fire policy and procedure. There was an emergency contingency plan in place which included information of what action to take as a result of an unforeseen event.

There was an accidents/incidents record book which had been appropriately completed.

Staff received appropriate training and supervision/appraisal in line with the frequency identified in the supervision policy.

Staff were subject to a formal induction process and probationary period and had completed training in a variety of areas relative to their job role.

The service was working within the principles of the MCA and any conditions on authorisations to deprive a person of their liberty were being met. Staff were aware of how to seek consent from people before providing care or support. Relatives told us that communication with them was good.

The mealtime experience for people living at Richmond House was positive. We saw that when serving meals staff made reference to a meal list which identified what each person had chosen and who was on a specialist diet.

There were some adaptions to the environment, which included pictorial signs on the doors and contrasting coloured grab rails in the toilets/bathrooms which would assist people living with a dementia. People’s bedrooms were personalised with items of furniture and personal belongings such as ornaments and pictures. Peoples’ bedrooms had their picture on the door, which would assist people living with a dementia to find their own room.

People who used the service and their relatives told us that staff respected their privacy, promoted their independence, were kind and caring and respected their choices. Staff were aware of how to ensure people’s privacy and dignity was respected. We observed people were treated with kindness and dignity during the inspection and care staff spoke with people in a respectful manner.

People living at the home were well groomed and nicely presented. We observed staff encouraging people to become involved in activities.

Residents and relatives meetings were held monthly and the notes of previous meetings were posted on the wall for anyone to access.

Each care file had a section about advanced decisions. Where people had made an advanced decision regarding end of life care this was recorded correctly, dated and signed appropriately. The service followed the ‘North West End of Life Care Model’ which was advocated by ‘NHS North West clinical pathway group.’

We saw evidence within each care file that people and their relatives were involved in care planning. We saw evidence of person centred practice within the care files we viewed which held information that would allow staff to understand people’s individual choices and preferences.

Care plans contained a ‘remembering together’ document which included information about the person’s family, friends, work history and interests.

The home had pressure ulcer notification forms in place, which were used to document any issues with pressure ulcers. Each person had a risk assessment, care plan and the appropriate pressure relieving equipment in place.

Satisfaction surveys were sent to people who used or previously used the service. The home included people who lived at Richmond House in the interview process for new care staff, sitting-in throughout the process and drawing up and asking their own questions.

There were activities and entertainment rooms in which people could pursue hobbies, relax or socialise with friends and family.

All the relatives we spoke with confirmed they knew who to speak to if they had any concerns or wished to complain. Copies of the complaints procedure were clearly displayed throughout the home.

The staff we spoke with said there were regular team meetings where they discussed their work and received feedback on their performance.

We saw that the home had a comprehensive range of policies and procedures in place and hard copies were available in a file. There were systems in place to regularly assess and monitor the quality of the service. The home completed regular audits in a number of areas including care plans, medicines management and environmental safety.

The home had a ‘resident guide’ in place. This provided people with all the information they needed about the service including the philosophy of care, registration information, who the manager was and their background, how the home was run, what was available and how to make a complaint.

The manager operated an ‘open door’ policy and a notice was posted on their office door identifying that anyone could speak to the manager at any time or arrange a meeting if preferred.

We saw that the manager or deputy manager completed daily walk rounds of the home in order to observe and monitor specific areas of the service. Night visit checks were completed by the home manager on a regular basis.

The service appropriately submitted statutory notifications to CQC as required and had notified CQC of all significant events, which had occurred in line with their legal responsibilities.

The service worked in partnership with the local authority contracts monitoring team. A range of information was also sent each month to the health and social care information centre (HSCIC) in the form of the NHS Safety Thermometer.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

Staff members had undergone safeguarding training during their induction and received reviews of safeguarding procedures on a regular basis. A whistleblowing policy was in place at the care home and staff members we spoke with told us they would not hesitate to use it.

Accidents and incidents were logged by the manager and uploaded onto the provider`s DATIX intranet system. This system allowed prompt, thorough reporting and required the provider to review and record the action taken, so learning from incidents were disseminated. Accidents and incidents were reviewed by the quality assurance team and monthly reports were sent to the care home identifying any trends for further investigation.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. No person who used the service was subject to a DoLS at the time of our inspection.

Is the service effective?

Senior staff members had undertaken pre-admission assessments with people who used the service. The care plans we saw had been signed by the person which showed they agreed with, and were involved with creating their care plans.

People`s needs had been taken into account with signage and the layout of the care home. This helped them to move around the care home safely and freely. Richmond House had been sensitively adapted which met the needs of people with limited mobility.

Is the service caring?

We spent time in communal areas and saw staff treated people with dignity and respect. Staff members were patient and took their time to understand the needs of people who used the service.

People`s choices and preferences had been recorded and care and support was provided in accordance with their wishes. People who used the service and their families had been involved in satisfaction surveys. We saw any shortfalls had been addressed.

Is the service responsive?

We saw evidence that people who used the service were involved in activities both in the care home and within the local community. The home had its own minibus which helped people stay involved in events around the local area.

People we spoke with told us they were aware of the complaints procedure and knew what to do if they needed to complain about the service. One family member told us, "I have never had to complain but I know who to see if I needed to."

Is the service well led?

The provider had procedures in place that monitored the quality of service provided to people who used the service. We saw any shortfalls had been addressed which meant the quality of service continually improved.

We saw evidence the care home worked well with other agencies, which included GPs. The manager told us, "We have a good relationship with community health workers. We have one doctor who calls in every day." This showed the provider had a multi-disciplinary approach to providing care.

Staff told us that they received regular supervision for their role from their line manager. Supervision records viewed identified that all staff had received regular structured supervision sessions as an on-going process. The nursing staff told us that they had regular supervision sessions with the Deputy Manager and found these sessions to be most useful.

Staff members told us "there is always someone available to speak to if you have a concern", "the manager and her deputy are very approachable","this is a pleasant, friendly home in which staff work well together."

During our inspection we saw that all mandatory staff training was up to date. We also saw that some further training relevant to their roles and responsibilities had been provided, such as personalisation and restraint.

We found that the majority of records in care plans were maintained appropriately. However, we saw that some improvements needed to be made in how staff record information.