Richard House 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

Staff protected people from abuse and improper treatment. Staff were trained in safeguarding they recognised and identify allegations of abuse, made referrals in line with the providers and local authority’s policy and procedures. Risks to people's health and safety were assessed and mitigated. People were kept safe from the risk of infections or contracting an infection from others. The registered manager had recognised that some staff had required additional training in medicine management.

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.

Most people’s families told us that the service always investigated incidents and informed them of the outcomes, 1 family member said that investigations outcomes were slow under the former manager but that this had improved.

Not all staff felt they received feedback from managers around lessons learnt. The registered manager told us that following an incident or accident there were lessons learnt plans that were shared with staff. They said this would also be discussed with staff at senior and carers meetings. As an organisation the registered manager said that they meet with other managers where they share learning across the organisation.

The provider has a comprehensive system of audits to monitor quality at service level, this included monitoring of and learning from incidents, accidents as well as feedback received about the service, with an improvement plan. Team meetings outlined areas of improvement. Additionally, the service had a monthly lesson learnt summary. Outlining any areas of concern, what good looks like and what improvements could be made.

People and their relatives we spoke with did not express an opinion on how people were supported around safe systems, pathways and transitions.

Staff told us they were given information on how to support people who were new to the service and that care plans were frequently updated when needs changed. The registered manager informed us that they always complete a face to face assessment of the person’s needs. They ask the person and their family for a full history prior to admission.

As part of the assessment process, we spoke to commissioners from the local authority they told us that the service worked well with the local G.P surgery and the community nurse team to support safe systems and transitions for people at the service.

The organisation has a thorough process for admissions and transitions. The organisation had thorough process in place for admissions and transitions. However, this had recently been reviewed to include information regarding conviction disclosures after concerns had been raised by staff in the home following a lack of information in this area on admission.

Most people and their families told us that they felt safe at the service. However, one person said that they had concerns about visitors knowing the codes to enter the building.

Staff told us they would give people time to talk and recognise if there were any changes in their behaviour that they felt might need to be reported due to safeguarding concerns. The registered manager told us that safeguarding was everyone’s business and that the staff will come to them if they have a concern and that they [the registered manager] will raise a notification with the local authority safeguarding team

During our onsite visit we did not observe anything of concern relating to safeguarding.

All staff at Richard House had received safeguarding training. We found all safeguarding’s were reported in line with the providers policies to the local authority safeguarding procedures. All reported safeguarding’s were analysed and where needed changes were made to the persons concerned care plans.

Most people’s families said that they had conversations with the service regarding risk, one family member said that they were aware that the registered manager who was new was trying to get in contact with all families to have such conversations. However, 2 family members who we spoke with said that they had not had any conversations about risk management with the service.

The registered manager said that they involve people and their families in their risk assessments. They discussed how there is a balance between choice, managing risk and a person’s best interest.

We observed people being supported to manage risk. One person had 1.1 support in place to support them with a known risk.

The service ensured people and their families were involved in the management of risk. The service had a resident of the day where all aspects of the persons care would be reviewed with them and or their family.

People and their families told us that the environment was safe and that they felt safe and secure at the service. However, there was 1 person at the service who was concerned about visitors having the codes to the main door. The person had said they felt unauthorised people would be able to access the service.

Staff told us there were weekly fire drills at the service. They told us that all equipment is frequently checked to ensure it is safe to use and that they do checks each time they use a piece of equipment to make sure it is safe before carrying out any tasks. The registered manager told us that the codes for the door and the access to the lift were frequently changed.

We observed the environment to be well maintained. We saw maintenance staff making repairs where needed. We observed the receptionist letting people into the service and checking their identification. We did observe visitors being given codes to the lift so that they could visit their loved ones upstairs. We did not witness the code to the main door being given out to anyone and were assured that no unauthorised people would be able to access the service. Staff were observed to use equipment safely.

The provider had effective systems and processes in place to ensure a safe environment. The registered manager was responsible for a daily walk round of the service. All people living at the service had a personal emergency evacuation plan (PEEPs) in place. The service had monthly and quarterly audits in place to ensure they maintained a safe environment. Staff were up to date with their moving and handling training. However, some staff were not up to date with their fire safety training. This had been recognised by the provider who was putting in steps to improve staff training compliance.

People and their families gave us mixed feedback around staff available to give support at key times. Some people and their families said that staffing had improved whereas others felt that there were often less staff available at weekends. People and families expressed that there were not always staff in communal areas of the home which had been an issue on the dementia floor when there had been an altercation between two people who live there. Some families said they did not feel there were always enough staff to meet people’s emotional needs as well as their physical care needs. People at the service said that they felt staff were competent in their roles.

Staff told us that staffing levels had been an issue in the past but that this had improved. The registered manager told us that there were no staff vacancies at the time of the assessment. They said that they were looking at the skills of their staff to recognise skills and potential, promoting and supporting carers to become team leaders. They said that there are occasions where staff sickness is a problem. We were told that when needed the registered manager and the care manager will work supporting people. We were also told that the Chief executive and the Director of Quality and Operations had worked supporting people to allow for staff to be freed up to attend training.

We observed people to be supported in a timely manner. Most staff appeared to be competent in their roles. We saw staff in communal areas throughout the day. Managers were frequently present across the service helping staff and supporting people where needed.

Most staff had completed their mandatory training. However, several staff needed to complete their basic life support practical training. Staff rotas showed that staffing levels varied with some shifts having 1 senior carer on shift and others had 2. There was no pattern to this. For example, a shift that had less staff on was not necessarily at a weekend. However, when shifts were short in the week managers were able to support. We could not be assured that this was happening at weekends. Whilst there were shifts with different staffing levels, this did not appear to affect peoples care. We reviewed staff recruitment processes and found that all staff had been recruited safely.

Most people and their families told us the service was kept clean, free from odours and well maintained, 1 family member said that there had been improvements made to the cleanliness of the service. One person at the service said, “The cleaner does a wonderful job.”

Staff told us that they had received training and knew how to maintain a safe environment using infection prevention control (IPC) measures. They told us that the training the use of protective equipment (PPE) and hand hygiene. The registered manager said that they had been working with staff to improve the culture around IPC, they do spot checks to ensure staff are adhering to policies around IPC.

We observed the service to be clean and well maintained. We observed staff to be following IPC principals. We observed occasions where staff were not wearing the correct PPE. The registered manager was quick to tell them to get an apron

The service had an effective audit process in place to monitor the cleanliness of the home. Where issues were identified, action was taken to ensure the safety of the service. Staff meetings reminded staff of the importance of using PPE when delivering personal care.

People told us they were supported to take their prescribed medicine and that they were able to ask for pain relief when necessary.

Staff told us they received training and shadowing shifts relating to medicine management. They said that their competencies to administer medicine was assessed prior to carrying out these duties. They were able to explain that all information needed in relation to administering medicine was available to them on the electronic medicines chart, including allergies and any protocols for as and when (PRN) medicines. We observed medicines being administered during out visit to the service, we found that people were not always told what their medicines were. When asked the senior carer did not know why each medicine had been prescribed.

All Care Team leaders were either in the process of completing their medicine training or had completed. The service has monthly medicine audits as well as weekly spontaneous checks. The registered manager had recognised, following audits that improvements needed to be made to the management of medicines at the service. They had notice that there had been several medicine errors, including where people at the service had missed or refused their medicines. Staff had not always documented if a person had refused their medicines or the reasons why they had refused. Investigations took place and an action plan was created. Staff received supervisions relating to medicines administration. Where necessary staff were no longer allowed to administer medicines as part of their role.