Richmond Court

Updated 23 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and a specialist nurse advisor. An Expert by Experience made telephone calls to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. We gave 24 hours’ notice of the second day of the inspection. This was because we wanted to give the provider or registered manager opportunity to be in the home to support the inspection. Inspection activity started on 12 June 2023 and ended on 3 July 2023. We visited the location’s service on 12 and 27 June 2023. We continued to speak with professionals and receive information from the provider until 3 July 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people. Some people who used the service had difficulty communicating, however, we spent time observing people's daily experiences of the care and support provided. The Expert by Experience spoke with 11 relatives about their experience of the care given.

We gathered feedback from 16 members of staff including the registered manager, regional manager, deputy manager, activity coordinators, maintenance person, nurse, senior care staff and care staff. We reviewed a range of records. This included 7 people's care records and 17 medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 23 August 2023

About the service

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.