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Inspection carried out on 4 December 2018

During a routine inspection

We inspected Richmond Village on 4 December 2018. This inspection was unannounced.

Richmond Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 63 people in an adapted building. At the time of the inspection there were 43 people living at the service.

There was no registered manager in place. 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. A clinical lead had been recruited and was managing the service. A new manager had been appointed and scheduled to in January 2019.

People told us they were safe living at Richmond Village. There were enough staff to meet people’s needs. Staff demonstrated they understood how to keep people safe and we saw that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed.

People had their needs assessed prior to living at Richmond Village to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team.

People living at Richmond Village were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights. The provider had processes in place to maintain confidentiality.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. Staff had a good understanding of the MCA and applied its principles in their work. We saw people were supported without breaching their rights.

People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. People had access to a wide range of meaningful activities.

People, their relatives and staff told us they felt inconsistences in leadership had affected how Richmond was run. However, they also commented on recent positive changes. We also found staff supervision records were not always up to date. The village manager and clinical lead promoted a positive, transparent and open culture. Staff told us they worked well as a team. The provider had effective quality assurance systems in place which were used to drive improvement. The management team had a plan to further develop and improve the home. The home had established links with the local communities which allowed people to maintain their relationships.

Inspection carried out on 5 December 2017

During a routine inspection

The inspection took place on 5 December and was unannounced.

Richmond Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Richmond village accommodates 63 people across two separate units, each of which has separate adapted facilities. One of the units Mulberry, specialises in providing care to people living with dementia. The other unit, Willow, is a nursing unit. On the day of our inspection, there were 34 people living in the home.

We were welcomed by the registered manager, village manager and staff who were happy to see us and keen to show their caring nature and share the positive changes they had made in the previous months.

Before the inspection, the provider contacted us and shared some concerns they had identified through their internal quality assurance systems. These concerns included poor medicines management, poor staffing levels, poor leadership, lack of audits, lack of staff induction and training, no comprehensive assessments and reviews as well as un-investigated complaints. The provider told us they had implemented a rescue plan which included not taking new people into the home until concerns were addressed.

We found the provider had made significant improvements to ensure people’s safety. However, they were still working through their action plans and there were still some areas to improve. Where people required covert medicines, a pharmacist’s guidance had not been sought. People’s care plans gave details of support required, however, they were not always person centred or up to date. The provider had already identified these concerns and was working through the action plan.

People told us they felt safe living at Richmond Village. Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicine as prescribed.

Richmond Village continuously recruited staff to ensure people’s needs were met. The home had staff vacancies which were covered by regular agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team were doing all they could to ensure safe staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had their needs assessed prior to living at Richmond Village to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

People living at Richmond Village were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The home provided information including in accessible format to help people understand the care and support that was available to them. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.

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