About the service: Richardson Court is a care home that provides personal care for up to nine people with a learning disability. At the time of the inspection nine people lived at the service. The service was split between a main house which six people lived in and a cottage within the grounds of the main house which three people lived in. The main house was split over two floors, all bedrooms are single occupancy, one with ensuite facilities and other people have a private hand wash basin. The cottage was split over two floors, and had three bedrooms. People living in either the Court or Cottage had access to communal bathrooms, lounge, dining room, kitchen and garden. People’s participation within the local community was encouraged and enabled. This forms part of the values that underpin the Registering the Right Support best practice guidance.

People’s experience of using this service:

Although auditing processes were in place to analyse risk and the delivery of care, audits had failed to identify the issues we found during our visit. The provider had failed to effectively monitor and act upon identified shortfalls.

The provider had not responded in a timely way to maintenance issues around the service which impacted on people and staff.

Some parts of the service were cold due to maintenance issues. This did not demonstrate a caring approach to people’s needs.

People were not always supported safely around eating meals and staff did not have clear guidance to follow to help people manage behaviours which could challenge.

Some records were confusing and contradictory which meant staff could not rely on documentation to guide their practice.

The registered providers had not always followed up on risk and their processes for monitoring this were not robust.

There were enough staff to support people with their needs.

People were communicated and supported in a person-centred way which considered communication adaptive needs.

Peoples medicine was managed safely.

Staff were supported and trained to carry out their roles.

People had access to health care professionals as required.

Staff worked together and with other healthcare professionals to ensure people received joined up care and support.

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. The service was compliant with the Mental Capacity Act 2005.

People were treated with respect and compassion. Staff spoke to people with kindness and in a patient way.

People received personalised care that promoted their independence.

People and their relatives could make complaints to improve the quality of care.

The service had a registered manager who promoted an open and fair culture.

More information is in the detailed findings below.

Rating at last inspection: Requires improvement (report published February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We found that the service continued to meet the characteristics of Requires Improvement. The overall rating is now Requires Improvement. This is the fourth time the service has been rated Requires Improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 13 and 23 November 2017. The inspection was announced.

This service 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.

Richardson Court is registered to provide accommodation and personal care for up to nine people with a learning disability. The accommodation was split between a main house which six people could live in and a Cottage within the grounds of the main house which three people could live in. At the time of our inspection there were five people living in the main house, Richardson Court and there were three people living in Richardson Cottage. The main house Richardson Court was split over two floors, all bedrooms are single occupancy, one with ensuite facilities and other people have a private hand wash basin. Richardson Cottage was on one level and had three bedrooms. People living in either service had access to communal bathrooms, lounge, dining room, kitchen and a garden.

At our last inspection, in September 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the management of risk to individuals' safety within the main house, tins of paint had been left in a person’s bedroom and the service was using electric heaters without the potential risks to people being assessed. This inspection took place to check that the registered provider had made improvements to meet the regulation. We found that improvements had been made and the breach had been met.

There was a registered manager based at the service who was supported by a recently appointed deputy manager. 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 were not always effectively deployed to ensure people were enabled to increase their independence and receive a personalised service. There were enough staff to keep people safe and observations showed people were comfortable with staff and peers. Safe recruitment procedures were in place to ensure staff were suitable to work with vulnerable people. People were kept safe by staff who understood safeguarding procedures and knew the action to take in the event of any concern.

Staff did not always feel supported in their role by the registered manager. We have made a recommendation about this.

Staff were given the training they needed to meet people’s needs including any specialist needs. Staff had access to and followed a range of policies and procedures to enable them to fulfil their role.

Risk assessments were individual to people’s needs and minimised the risk to people, staff and others. Appropriate checks of the environment were made to the environment to keep people safe. Procedures were in place to promote people’s safety in the event of an emergency. People who displayed behaviour that could challenge themselves or others did not always have access to the support they required. We have made a recommendation about this.

People’s needs had been assessed and recorded prior to moving into the service. People’s support plans were person centred and contained information and guidance for staff to meet people’s needs. People were enabled to use different forms of communication to make their wishes known. Staff knew people well and understood how people communicated their needs and preferences. People were not always supported to take part in activities to meet their needs and interests. We have made a recommendation about this.

People were supported to maintain their nutrition and hydration with the support and guidan

This inspection took place on the 27 and 29 September 2016 and was unannounced. Richardson Court provides accommodation and support for up to six people who may have a learning disability or autistic spectrum disorder. Some people display behaviour which may challenge others. At the time of the inspection six people were living at the service.

Richardson Court was last inspected on 19 August 2015 where two breaches of our regulations were identified, an overall rating of requires improvement was given at that inspection. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

Each person had a single room; some rooms had en-suite facilities. People had access to shared bathrooms, kitchen, laundry room, dining room, and a large communal lounge. There was a well maintained, secure garden and outside area that people could access freely. There was off street parking within the grounds.

The service did not have 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 manager had de-registered with the Commission in February 2016; the provider had appointed a manager to manage the service in March 2016. They had submitted an application to register with the Care Quality Commission (CQC) at the time of our inspection. The manager was present throughout the inspection.

Risks to people were not always managed safely, this put people at potential risk of harm. Paint had been left in a person’s bedroom and portable, electric fires used in peoples rooms were unguarded and had not been risk assessed.

Regular supervisions had not been established for all staff, the manager had not checked the competency of a staff member who worked alone.

There were enough staff to meet people’s immediate needs, agency staff and the manager covered any gaps in the rota. The provider was in the process of recruiting more staff.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment.

The manager had good oversight of monitoring people’s support needs. People had behavioural guidelines in their care plans to help staff manage incidents. When incidents occurred the manager and staff discussed how things could change to improve outcomes for people.

Staff had a good understanding of how to keep people safe. Contact names and numbers of who to contact within the service and outside of the service were available should concerns about people’s safety need to be raised.

There were safe processes for storing, administering and returning medicines. Medicines were administered by trained staff. Regular audits were conducted on medicines to check errors had not occurred.

Staff had appropriate training and experience to support people with their individual needs and demonstrated a clear understanding of the people who lived there.

New staff underwent an induction which prepared them for their role and did not work unsupervised until assessed as competent to do so. Safe and robust recruitment process were in place to ensure people were supported by appropriately checked staff.

The service was good at responding to people who needed help to manage their health needs. People were supported to access outside health professionals.

The manager had a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). People were offered advocacy services and the service had taken the appropriate steps to meet the requirements of the legislation.

People had choice around their food and drink and could choose alternative meal options when they wished. People with individual dietary requirements were cater

This inspection took place on 19 August 2015 and was unannounced. The previous inspection was carried out in December 2013 and there were no concerns. Richardson Court is registered to provide accommodation and personal care for up to six people who have a learning disability or autistic spectrum disorder. Some people display behaviour which may challenge others.

At the time of the inspection six people were living at the home each having their own bedroom either on the ground or first floor, and some rooms had en-suite facilities. People had access to a large communal lounge, dining area, kitchen, laundry room and shared bathrooms. There is a well maintained, secure garden and outside area with chickens in a run and a polly tunnel for growing vegetables. There is off street parking within the grounds. People could move freely between the inside and outside areas of the home.

The service is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

Apart from one radiator, all other radiators around the service were unguarded posing a risk to the people who live there. The house was generally clean; however we found shortfalls in the maintenance of the equipment and refurbishment of the premises. This resulted in areas of the home being impossible to clean adequately by staff and safe infection control practices could not be met. Although systems for reporting maintenance concerns were in place follow up action had not been taken for prolonged periods of time. Some people had been left with broken equipment in their personal rooms and in communal areas.

Although quality assurance monitoring was in place to improve the outcomes people living at the service received, action was not always being taken to improve the areas identified as needing improvement. The views of people outside of the service such as relatives had been sought, however questionnaires were not clearly dated and action plans to improve on the comments made were not evident. The provider had failed to respond to areas of improvement that they had internally flagged as being in need to improve. This meant people would not benefit from receiving better care and support and be able to live in and environment which is safe and comfortable.

Staff told us they felt confident that they could speak to the management of the service if they required support and guidance. There were safe systems in place for the recruitment of new staff. New staff underwent a full induction and were asked to sign up to complete their level two or level three health and social care diploma at the start of their employment. Existing staff supported new recruits who shadowed them on shifts. Further training was offered to staff covering specialised areas such as autism awareness and Makaton. Staff were supported to carry out their duties effectively and were offered further support through one to one supervision, team meetings and could request further training in areas they felt they needed more knowledge and confidence in.

People had personalised care plans, risk assessments and guidance in place to help staff to support them in an individual way. We saw that staff members actively encouraged people to be fully involved and feel included in their environment. Where people required space to manage their behaviours this was respected and staff approached people in a kind a caring manner. Staff spoke about the people who lived at the home in a respectful way which demonstrated they cared about the people’s welfare. We observed throughout our inspection people interacting positively with staff smiling and wishing to be involved in conversations.

People were offered a full time table of activities and were able to participate in educational and social activities of their choice. People were supported to pursue individual interests and hobbies such as horse riding or athletics club. Staff communicated with people in a way which showed understanding and knowledge of the person, communication aids were used around the home to help people to express themselves.

People were supported to make their own decisions and choices and these were respected by staff. Staff were aware of the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLs). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. We found that the registered manager had made DOLs applications for some people which had been granted, and was waiting for the remainder to be returned. The registered manager had notified the Care Quality Commission (CQC) of the applications which had been granted which is a statutory requirement.

People were encourage to eat and drink enough and were offered choices around their meals and hydration needs. We observed people being supported to have drinks on their request and be encouraged to choose what food they would like. Some people went out for a fish and chip lunch on the day of the inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

When we arrived at the service four of the six people were on their way out Christmas shopping. We saw that staff were aware of the complex communication needs and were involving people in the decision making, demonstrated by two of the people choosing not to go out.

We saw that people received care that met their individual needs. There was an effective system in place to manage people’s medicines and money. We saw that there was also an effective system to manage consent, working with people, their families, social services and the relevant professionals.

We saw that the spacious environment allowed people to have plenty of room to choose interaction or personal time.

We saw that staffing levels and skill mix were appropriate to need. The home manager told us that there was a monthly allocation of hours assessed against need. One person’s care allocation was being re-assessed six weekly to ensure adequate 1:1 time. The person had recently been assessed by the Occupational therapy team, who had agreed the need for more 1:1 time. This should ensure an increase in the care hours.

We saw a clean and well maintained home with systems in place to monitor quality and safety of the service.

At the time of inspection six people were living at the service. We used different methods to help us understand the experiences of people because they had complex needs which meant they were not able to tell us their experiences. We spoke with a relative and they told us their relative was “happy there” and staff encouraged their relative to participate in activities, “The staff are quite good, they are better than they were and they care for people well”. A healthcare professional told us that since the new manager came into post there had been “lots of engagement” from the service and another professional told us that staff implemented the guidance they provided.

We saw that people were involved in making day to day decisions. The environment promoted people’s independence and people were supported to cook, clean and do their own washing.

We saw that people received care that met their individual needs and it was reviewed regularly. We saw that people were protected from the risk of abuse because staff knew how to recognise potential abuse and what action to take. However, we noted an example where a staff member had not followed the procedure. There was an effective system in place to manage people’s medication and money.

Staff were supported in their role by undertaking training, attending regular supervision and staff meetings.

There were systems in place to regularly monitor service delivery and the health and safety of the service.

People who use services had special communication needs and expressed themselves

using single words, sounds, signs and pointing to objects. They indicated that staff treated

them with respect and that they were supported to be as independent as possible.