Richmond Court

Richmond Court is a residential care home providing personal and nursing care to 42 people at the time of the inspection. The service can support up to 49 people. The home accommodates people with a learning disability and/or autism on the ground floor. On the first floor, nursing care is provided to people, many of whom are living with dementia.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People's experience of using this service and what we found

Right Support: Medicines were not always managed safely. Systems did not always show staff how and when to give medicines, and medicines were not always stored safely. Risks in the environment and people’s personal risks had not always been assessed so that action could be taken to reduce these. Systems in the home did not always ensure people’s dignity was promoted. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were, however, some inconsistencies in the way people’s capacity and consent were recorded and decision making was not always clearly documented. People and relatives told us they felt the service was safe. Accidents and incidents were recorded, and actions taken to reduce the chance of them happening again.

Right Care: People did not always receive care that supported their needs and aspirations, and focused on their quality of life, and followed best practice. Although there had been some recent improvements the provider had not fully acted on feedback given at the last inspection to ensure care was truly person-centred. People with a learning disability were accessing the community and taking part in more skill building activities but there was not always evidence these were planned to meet people’s long-term goals or improve their outcomes. There had been recent training around positive behavioural support, a person-centred approach to supporting people with a learning disability, and training on methods of communication people in the home used.

There were enough staff to meet people's needs. People and most relatives told us there were staff available to meet their needs quickly but there was some mixed feedback about the level of engagement on offer. The provider had appointed a new activities co-ordinator and was offering more social support. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.

Right Culture: An effective quality monitoring system was not in place. We identified shortfalls relating to the management of medicines, the assessment of risk including environmental risks and inconsistency in people’s care records, including around consent and capacity. Practices in the home did not ensure people’s dignity was always promoted. Systems had not ensured CQC was always notified of incidents in the home.

People gave positive feedback about the caring nature of the service. Staff spoke positively about the service and the management. Feedback was sought and acted on. Relatives and staff described the registered manager as approachable and responsive to any issues raised. The management team were honest and open with us during the inspection. They exhibited caring values and spoke positively about the changes and improvements which were being made. The registered manager had sought advice and support from specialists within the organisation as well as being part of wider networks on good practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 June 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider ensured suitable staffing levels were maintained. At this inspection we found the provider had acted on this recommendation and had made improvements in relation to staffing.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4, 16 and 25 February 2022 and 4 March 2022 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management, safety of the premises, assessing risk, dignity, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the last inspection we made a recommendation about staffing. At this inspection improvement had been made and the recommendation had been met.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Richmond Court is a residential care home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 49 people.

The home is divided into five areas spread across two floors. People living on the ground floor have a learning disability and/or autism. On the first-floor, nursing care is provided to people, many of whom are living with dementia.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

People’s medicines were not always safely managed. People were exposed to risk of harm due to a lack of person-centred risk assessments. People’s living environment and equipment were not always safely managed. The home was not always clean. People were not always supported by enough suitably trained staff. Visiting was not always managed in line with government guidance.

People’s needs were not always fully assessed and the support plans in place did not always promote people’s independence. The environment was not fully adapted for people living with a learning disability or dementia.

People were not always supported to have maximum choice and control of their lives. However, staff did support them in the least restrictive way possible and in line with the Mental Capacity Act 2005 (MCA). Whilst the requirements of the MCA were complied with, people were not always supported and empowered to be as independent as possible.

The service was not always well-led, and we received mixed feedback from staff about the management team. Audits did not identify the concerns we found. Care records did not always accurately reflect people’s needs.

Immediately after we fed back our concerns the provider amended existing action plans to include the issues we had identified.

People and staff were accessing regular testing for COVID-19 and the provider had ample supplies of PPE. Staff were recruited safely, with appropriate pre-employment checks in place. Accidents and incidents were recorded and monitored to identify any trends. Staff had received safeguarding training and were confident in their safeguarding responsibilities.

The staff and registered manager worked well with other professionals to ensure people’s health needs were met. The registered manager understood their responsibilities around duty of candour and worked well with other healthcare professionals. Most of the relatives we spoke with were happy with the care provided.

Right Support

The provider did not always support people to have the maximum possible choice, control and independence. For example, people living with a learning disability were not encouraged to be involved in menu planning and were not supported or encouraged to make themselves drinks or snacks. Following our initial feedback, changes were introduced to better promote choice and independence.

Staff did not always focus on people’s strengths or promote what they could do. People’s care plans did not explore ways in which staff could help people to be more involved in everyday tasks. Helping to develop these skills is important for a more fulfilling and meaningful life. Following our feedback, the provider told us all care plans were being reviewed, in line with the ‘Right support, right care, right culture’ guidance where appropriate.

Staff did not support people to achieve their aspirations and goals. Support plans for people with a learning disability contained no evidence of future planning or considerations for the longer-term aims or wishes for each person. Following our feedback, the provider told us all care plans were being reviewed in line with the relevant guidance.

Right Care

People who had individual ways of communicating, for example by using Makaton (a form of sign language), pictures and symbols could not always interact comfortably with staff and others involved in their care. This was because staff did not have the necessary skills and knowledge to understand them. Following our feedback, the provider told us communication care plans were reviewed and staff were to have Makaton training.

People could not always take part in activities and pursue interests that were tailored to them. On each of our visits we observed people spending the majority of their time sitting in communal lounges with music or television on in the background, and no meaningful activities were taking place. Following our feedback, the provider told us they were reviewing the activities available to people.

Right Culture

People did not always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People did not always receive good quality care, support and treatment because staff could not always meet their needs and wishes.

People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 30 May 2018).

Why we inspected

The inspection was prompted by an outbreak of COVID-19 at the home. Initially the inspection was a targeted inspection focusing on infection prevention and control. However, after some concerns were identified, we widened the scope of the inspection to include all five key questions.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We have made a recommendation to the provider around ensuring suitable staffing levels are maintained.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Richmond Court accommodates up to 47 people in one building. Some people were younger adults and had a learning disability and lived on the ground floor of the service whilst older adults living with dementia and mental health needs lived on the first floor. People were accommodated over two floors and in five distinct areas, two areas on the top floor and three areas on the ground floor. The service provides residential and nursing care on the first floor and residential care on the ground floor. On the day of our inspection there were 47 people using the service.

The inspection took place on 30 April 2018 and was unannounced. This meant staff did not know we were visiting.

We last inspected Richmond Court in April 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

The service had a registered manager who was on duty during the course of our visit. They had worked at the service for many years. 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.

Staff and the management team understood their responsibilities with regards to safeguarding and staff had been trained in safeguarding adults. We saw the registered manager had shared learning within the staff team from safeguarding occurrences that occurred at the service.

People’s needs were assessed before they came to live at the service. Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Health and safety checks were completed and procedures were in place to deal with emergency situations.

The home was clean, and we saw staff followed good practice in relation to wearing personal protective equipment when providing people with care and support.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way.

We found there were sufficient care staff deployed to provide people’s support in a timely manner. We saw that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. People told us their needs were attended to promptly.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking by the kitchen team who were trained in the support of people with nutritional needs.

The premises were homely and suitable for people's needs. People were involved in decisions about the decoration and the provider had taken steps to make the environment more accessible and personalised in response to changes in people's needs.

People had access to healthcare services in order to promote their physical and mental health. We saw that people were supported to have annual health checks and to attend health screening appointments.

People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times.

There were detailed, person-centred care plans in place, so that staff had information on how to support people. ‘Person-centred’ is about ensuring the person is at the centre of everything and their individual wishes, needs, and choices are taken into account.

An activities coordinator provided a range of activities within the home and support for people to access the community.

The provider had an effective complaints procedure in place. People who used the service were aware of how to make a complaint. Feedback systems were in place to obtain people’s views about the quality of the service. We saw surveys were just being undertaken to gather people's views.

There was a quality assurance system, which enabled the provider to monitor the quality of the service provided. People and staff were positive about the management of the home.

The service was working to improve links with the local community and had recently opened a café in the grounds that was open to the public and ran by people who lived at the service.

The service was last inspected in April 2014 when the provider was compliant with the regulations.

Richmond Court is part of the Willington Care Village, a group of homes owned by Bondcare Willington Limited. Richmond Court is registered to provide care for up to 49 people and includes three separate units. One unit is for individuals with dementia care and nursing needs and the other two units for people with learning disabilities which also included respite facilities. These latter two units whilst registered with CQC under the overarching service Richmond Court are also known as Binchester and Raby Court.

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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.

The registered provider carried out checks on staff before they started work in the service to see if they were suitable to work with vulnerable people.

We found the home to be clean and the registered manager had in place cleaning schedules to reduce the risks of cross infection.

Staff demonstrating to us they had a good understanding of safeguarding and what to look out for if a person was being abused.

We found people’s medicines were given to them in a safe manner and staff had been assessed to ensure they were competent to apply people’s topical medicines.

There were regular checks in place to ensure the building was safe, these included health and safety checks, fire alarm checks and fire drills. Checks were also in place for water temperatures and to ensure window restrictors were working.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. We found the service worked within the principles of the act and when required had made applications to the appropriate authority to restrict people’s liberty and keep them safe. The Deprivation of Liberty Safeguards (DoLS) provides guidance to enable care providers to do this. We found the service had followed the guidance.

Kitchen staff were aware of people’s dietary needs and their preferences. We found people were supported to eat when needed by staff and staff encouraged people during their mealtimes to eat. People’s weights had been stable with only minor fluctuations.

Staff had received training pertinent to the role. We found staff completed e-learning training and then were tested by the registered manager using a workbook. This meant the registered manager endure they were competent to carry out their roles.

Staff were viewed by relatives as very caring and supportive to the people living in the home. Relatives expressed confidence in the service.

We observed staff approaching people and treating them with dignity, respect and kindness.

Activities coordinators were employed by the service and we found people were engaged either in group or individual activities according to their preferences. People appeared to enjoy the activities.

We found there was a strong management presence in the unit. Staff and visitors to the unit made favourable comments about the manager.

The home had a range of quality audits in place to monitor the service. We found if any deficits were noted these were addressed and reported as having been carried out.

The manager had in place staff meetings where they resolved issues and gave direction and /or permission to staff to improve the service.

Surveys of the home had been conducted to monitor the service provision. The responses to the surveys were positive.

Is the service caring?

We observed people were treated with dignity and respect by the staff. People told us they liked living there. One person said, 'I was made to feel very welcome .' People's preferences and needs were recorded and their care was provided in line with their wishes.

Is the service responsive?

People participated in a range of activities to meet their needs. We found the manager had responded to suggestions for improvements by external auditors.

Is the service safe?

The registered manager set the staff rotas. People's needs were considered when making decisions about staffing numbers, qualifications, skills. The registered manager was aware of the requirements under the Deprivation of Liberty Safeguards and had appropriately used them

Is the service effective?

People's health and care needs were assessed with them, their family members and with health and social care professionals. Dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required.

Is the service well-led?

The registered manager undertook regular audits to continually improve the service. The records we looked at showed any shortfalls were addressed promptly. We found equipment was regularly serviced therefore not putting people at unnecessary risk.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We also found the provider had taken steps to make sure only suitable people were employed to work in the care home. This was because thorough background checks had been carried out.

Richmond Court was one unit and this provided care for up to 29 people with dementia type needs. Raby Cottage was the second unit which provided care for eight people with learning disabilities. Binchester Court was the third unit providing respite care for up to eight people with learning disabilities.

Most of the people in the three units found it difficult to express their experiences of living at the home. We spoke to eight people and two visitors and those able to tell us themselves or through a visitor said: 'I feel very safe here and staff always have time to listen to me'. A visitor to the service said: 'My relative has good company and has made new friends'. A visitor also told us that their relative has put weight on since living at the home. One person said: 'The food is good, I like everything'.

We observed that people were treated with dignity and respect and that they appeared comfortable and relaxed in the presence of all the staff, including the manager. There was also a smoke room for people to use whenever they wanted to.

Many of the staff had been with the provider for many years and commented that they were well supported and had training opportunities for both personal development and to help the people living in the home.

We saw the premises were on two floors. The ground floor of Richmond Court accommodated a mix of male and female residents whilst the first floor had been established as a male only facility. The new Raby Cottage was located on the ground floor and Binchester Court was on the first floor.

On the day we visited, most of the people who lived in Raby Cottage and Binchester Court were out at day care centres. Most people who lived in Richmond Court had dementia needs, so were not always able to tell us about their experiences of living at the home. We therefore spent time watching how people were supported. People appeared generally content, at ease in the home and with the staff on duty.

We spoke with three people. Those able to express an opinion told us they were happy and were well cared for. Comments included, 'It couldn't be better here' and 'It's champion. I like a smoke in the smoke room' and 'The staff are lovely; we have a laugh.'