We inspected the service on 8 and 11 May 2018. The inspection was unannounced. Richmand house 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. Richmand House is registered to provide care for 12 people, on the day of our inspection 11 people were using the service.On the day of our inspection 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. Richmand House was inspected in 2015 and rated as Good. At this inspection we found a number of concerns relating to safe care and treatment, person centred care and lack of governance. This led to a number of breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and at this inspection the service was rated as Requires Improvement.
The registered manager worked to keep people safe from abuse by responding to and investigating any concerns. They put in measures to protect people, however they had not recognised the need to ensure local authority safeguarding teams were aware of their actions and had not reported these and other significant events to the CQC as part of their statutory responsibilities.
People were not always protected from risks to their personal safety, as the registered manager had not undertaken assessments of individual and environmental risks to ensure this. People’s needs had not been assessed using nationally recognised tools to guide staff to make robust assessments of their needs.
People were supported by appropriately trained staff and the registered manager had ensured there were always adequate numbers of staff on duty to care for people. Staff received training and support to safely administer medicines and most aspects of the management of medicines were safe. However, the lack of protocols for ‘as required’ medicines meant staff did not have the information to assist them make appropriate decisions on when to give these medicines. This put people at risk of not receiving safe and appropriate care.
People were protected from the risks of infection as the registered manager had effective processes in place to ensure cross infection risks were reduced. The registered manager ensured staff learned from incidents to reduce the risk of reoccurrences.
The majority of people’s nutritional needs were well managed by staff, but there had not been a referral to the speech and language therapy (SALT) team for one person. This put them at risk of receiving an inappropriate diet for their needs. However, in all other respects people’s health needs were well managed by staff and people were supported to maintain a healthy lifestyle.
The environment people lived in allowed them to move freely around the premises and personalise their own living space.
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 were supported by staff who treated them with care and respect and supported them to maintain their privacy, dignity and independence. People’s views about their care were considered and they had choices in relation to how they spend their time. The registered manager supported the use of an advocate to ensure people had the support to voice their views and opinions. People’s cultural needs were met.
The information about people’s individualised care needs was not always up to date or actually recorded in their care plans to support staff to give person centred care to people. There were some initiatives in place to assist people to access information about their care in ways that met their needs.
People were supported to access a range of social activities both within the home and in the community. The registered manager involved people in a number of community based activities to prevent social isolation. People were aware of the company’s complaints procedure and felt able to voice any complaints or concerns they had to the registered manager. However, people and relatives told us they had no complaints about the service as the registered manager dealt with concerns quickly and to their satisfaction.
People were supported to achieve a pain free and dignified death and when appropriate the registered manager had discussed end of life wishes with people or their relatives.
The service lacked an effective auditing process to highlight any issues with the quality of the service provided to people. This had resulted in a number of issues relating to people’s care. This had meant there was a lack of oversight in areas such as care planning, risk assessments both individual and environmental, and falls. The registered manager had also not informed us of significant events at the service as part of their statutory responsibilities.
There was a registered manager in post at the time of our visit. People and staff told us they were visible, supportive and approachable. Both people and staff at the service felt their opinions and views were listened to by the registered manager.
The service is in breach of three health and social care act regulations as they failed to provide safe care and treatment for people and there was a lack of robust audits to give the registered manager a clear oversight of the quality of the service people received. There was also a breach of the CQC registration regulations as the registered manager had failed to notify us of significant events at the service. You can see what action we told the provider to take at the back of the full version of the report.