This unannounced comprehensive inspection took place on the 26 November 2018. Richmond Court Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Richmond Court Residential Home provides care and support for up to 21 people many of whom are living with Dementia. At the time of the inspection 20 people were living at the home.

There was a registered manager in post who was present throughout our inspection. 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 risks associated with people’s care had been identified and steps put in place to reduce the risk for the person. However, we found that not all risks had been managed well. Improvements were needed in the management of infection control.

Whilst people had been offered daily choices we found improvements were needed in the application of the Mental Capacity Act 2005. Improved support was also required for people living with dementia. We have made a recommendation about accessing information and resources to support people living with dementia in their communication. We have also made a recommendation about the use of CCTV within the home

People had their privacy respected although we found some practice where supporting people in a dignified manner could be improved. Many people were supported to retain their independence.

Not all people had been supported to maintain their hobbies and interests.

Staff felt supported in their roles. There were some systems in place to seek feedback from people living at the home about the quality of the care they were receiving. Systems for monitoring the quality and safety of the service were not effective or robust and had failed to highlight the concerns raised at this inspection. We found that the provider had breached the regulation in relation to good governance. You can see what action we told the provider to take at the back of the full version of this report.

People received support from staff who were aware of the signs of abuse and whom could describe appropriate action to take should they be concerned about people. There were sufficient staff available to support people. The staff had been safely recruited.

People received their medicines safely by staff who had received training in safe medicine management. There were systems in place to ensure medicines were given safely.

People were supported by staff who had the skills and knowledge to meet their needs. Staff training had been provided around people’s individual needs. People had their healthcare needs met and were assisted to have foods and drinks they enjoyed.

People and their relatives told us they felt the staff were caring. Staff had got to know people well and we observed kind, caring interactions between staff and people.

People’s care had been reviewed to ensure it continued to meet their needs, although these reviews did not involve the person themselves.

People and their relatives felt able to raise concerns should any arise. There were systems in place to ensure any complaints received would be investigated.

Our inspection was unannounced and took place on 19 & 20 April 2016. Our last inspection of the service took place on 13 May 2014 and we found that the provider was not meeting two of the regulations associated with the Health and Social Care Act 2008. This related to there being no effective quality assurance systems in place to check the quality of the service as well as errors in the management of medications. Following the inspection we asked the provider to make improvements. The provider sent us an action plan outlining the actions they had taken to make the improvements. During this inspection we found that these improvements had been made.

Richmond Court Residential Home is registered to provide accommodation and personal care to a maximum of 21 older people who may have dementia or physical disabilities. At the time of the inspection there were 20 people living at the home.

The home had 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.

People felt safe at the home and were supported by staff who had an understanding of how to report abuse and manage risks to keep people safe.

We saw that there were effective recruitment systems in place to reduce the risk of unsuitable people being employed. Staff had appropriate training and support and we saw there were sufficient numbers of staff on duty to support people.

People were supported to take their medication by staff who had been trained and followed correct procedure when supporting people with medication.

People had their rights upheld in line with the Mental Capacity Act but staff did not have an understanding of how to support people whose liberty needed to be restricted to keep them safe.

People had choices at mealtimes and were supported to have sufficient amounts to eat and drink. Where people required input from health professionals, they were supported to access this.

People were supported by staff who were kind and treated them with dignity. People were supported to access advocacy services when needed.

People and their relatives were involved in the assessment and review of their care. People were supported by staff who had a good knowledge of people’s preferences with regard to their care.

People were told how they could make complaints. Complaints that had been made were fully investigated by the registered manager. People were given opportunity to provide feedback on their experience of the service.

The registered manager completed audits to monitor the quality of care provided. Where issues were identified, these were acted on.

We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions we had with four people who lived at the home, two members of staff who supported people, four relatives and the registered manager. We looked at five people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. People we spoke with told us they were happy with the support staff gave them. One person said, "If I am unhappy I will speak to staff".

Records showed that risk assessments were in place to identify potential risks and the action needed to reduce the risk. For example, where people needed two members of staff to support them this was identified. This meant that people confident that risks would be identified and action taken to reduce any potential risks.

We found that people's medication administration records (MAR) chart showed gaps where staff had not signed to show whether people had in fact been given their medication and if not why not. We also found that the medication process was not being checked regularly. This meant that people were at risk of unsafe administration of medicines.

People told us they felt safe living within the home. We found there was a stair gate on the main stairs used by people living in the home, but this had been risk assessed and there was a lift in the home for people to use who were unable to use the stairs, to ensure people's movement was not restricted.

An application under the Deprivation of Liberty Safeguards had been submitted by the service to the local authority. Training records showed that staff had not received training in the Deprivation of Liberty Safeguards (DoLS) or the Mental Capacity Act (MCA). Staff confirmed this, however staff we spoke with had a good understanding of the DoLS, but they had limited understanding of the MCA. The manager confirmed further training would be provided.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.

Is the service effective?

We found that staff were able to explain people support needs. Records showed that people's needs were specific to them and identified in a care plan.

We found that audits were not being carried out consistently. The audits that were being done were not always effective in identifying areas of poor quality. This meant that where people were at potential risk this was not always being identified.

People were able to access health care professionals where needed. Records showed that where health care professionals visited people this was recorded.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

People we spoke with told us that staff were, "Caring" and "Kind". One relative said, "Staff know what they are doing". Staff we spoke with were able to explain people's needs. We observed staff on the day of the inspection communicating with people in a way that promoted their independence.

Staff we spoke with had a good understanding of how to promote people's dignity and privacy. People told us they were able to go to their rooms when they wanted. On the day of our inspection we observed people in their rooms watching television or just lying on their beds. This meant that people independence, dignity and privacy was being promoted.

Where people were assessed as being safe, they were able to go out of the home as often as they wanted to go shopping or just visit friends and relatives.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.

Is the service responsive?

We found that the provider had a system in place to gather the views of people about the service they received, and take action as required. Some people and relatives we spoke with told us they had not received a survey questionnaire from the provider. We raised this with the provider, who confirmed they would take action to ensure everyone got a questionnaire.

We found that a complaints, compliment and comments process was in place. People told us even though they did not remember being given a copy of the complaints process they knew who to speak to if they had a complaint. One relative said, "I would speak to the manager". This meant that people were able to raise concerns they had about the service.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive to people's needs.

Is the service well-led?

The service was managed by a registered manager who was supportive throughout the inspection. We found that where the manager needed to act in people's best interest this was being done. This meant that people could be confident in how the service supported them.

We found that the environment in the home was not always risk free. A number of windows were not restricted to ensure people were safe. Wardrobes were not all secured to the wall, however audits were not identifying these concerns. The manager confirmed action would be taken to rectify the shortfalls in their auditing processes.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is well-led to meet people's needs.

We inspected the home in May 2013 and found that there were a number of areas where the provider was not meeting essential standards of quality and safety. We carried out this inspection to see what improvements had been made.

There were 20 people living in the home at the time of our inspection. We spoke with six people, five staff, the manager and the provider during our inspection. As some people were not able to clearly express their views we observed how people were cared for by staff.

The provider had addressed shortfalls in the management of risks to ensure people’s care was consistently delivered in a way that ensured people's safety and welfare. One person told us they had their legs elevated because they ‘swelled up”. We saw this reflected their care plan.

We found that the provider had arranged for staff to receive sufficient training in safeguarding people from harm.

The provider had addressed the gaps in staff skills and training in relation to dementia awareness, falls and managing behaviours that challenged. One staff said, “The training was good, we learned a lot and we have made a lot of changes”. A person who lived there said, “I like helping”, (when asked about the activities they did). This meant people had more opportunities to engage in activities that suited them.

There were 17 people living there on the day of our inspection. We spoke with three people, the provider, care manger, senior care, two care staff, a visiting social worker and a visiting relative.

Staff understood the importance of obtaining consent from people before they commenced care tasks. One person said, ”They always ask me before they help me if it’s ok”.

Appropriate arrangements were in place to support people who could not consent to their care and staff understood their role in protecting people.

There were gaps in the management of risks and care was not consistently delivered in a way that ensured people's safety and welfare.

We found that arrangements were in place to ensure that people were safeguarded from harm. However not all staff had received sufficient training.

There were enough staff to meet people's needs, we saw that people did not have to wait for support. However a high turnover of staff had led to gaps in skills and training, specifically in dementia awareness, falls and managing behaviours, necessary to meeting the complex needs of people.

Staff were supported in their care role. One staff told us, “The manager is always here and will show us what we need to do or tell us if we are not doing things correctly.

A visiting relative said, " I'm very pleased with the care”. A visiting social worker told us they were happy with the standards of care for their client.

There were 17 people living at the home at the time of our inspection. We spoke with three people and three staff. One person told us, "I am happy here, the staff are good”.

People had care plans in place which reflected both their care and their specific health needs. Plans detailed risks to people, and how these are met. For example we saw people are supported to eat and drink enough. We saw people who had specific health needs had the support they needed to keep healthy.

We found that people are not always protected from the risk of harm or abuse because the provider did not take appropriate steps to report allegations. There were delays in ensuring people were protected.

We found the provider had covered recent changes in the staff team, and that staffing levels were sufficient to meet the needs of the people being cared for. One person who lives there told us, "I like it here, I go out every day and when I want to, I go out with him (provider), there’s always staff around to help.”

We visited Richmond Court to check progress on the level of cleanliness in the home. When we last inspected in June 2012 we found people had been placed at risk because the provider had failed to take action to make sure they complied with the requirements of the Infection Control Code of practice. Areas of the home were dirty and people were not adequately protected from the risk of cross infection. Equipment such as hoists, beds, mattresses and commodes were dirty. Heavily stained carpets required replacement. We also saw holes in plasterwork and sink surrounds and some extractor fans were not working. Toilet brushes were stained and dirty, and 'margarine tubs' had been used for collecting urine samples. This meant people were at risk of infection.

At this inspection we found the home was clean and people were protected against the risk of infection. This was because the provider had addressed the risks to people's health by improving the standards of cleanliness in the home. The provider had replaced furnishings and ensured equipment was cleaned to an acceptable standard. We found people were cared for in a clean and hygienic environment.

We visited Richmond Court on 11 June 2012 because we were made aware of concerns in relation to the risks of inadequate nutrition and cleanliness standards.

Some of the people living at Richmond Court have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in the home and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

Some people living at the home were able to tell us about their experiences. They told us they were generally happy with the service they received and told us 'staff are lovely', ‘staff are kind and helpful’, ‘very caring, always around when I need them’, ‘no complaints I’m very happy’, ‘I like the food’.

During our inspection visit we saw that people had care plans with information about how to meet their needs. We saw risk assessments had been developed to reduce the risk of harm from falls, fragile skin and inadequate nutrition. This means people’s needs had been assessed and planned for to reduce known risks.

We saw that there were sufficient numbers of staff who understood the needs of people who have dementia.

The systems in place to protect people from the risk of infection were not effective. We saw that people used facilities and furnishings that were not clean or hygienic and could pose a risk of infection to them.

There were systems in place to monitor and audit the quality of the service and delivery of care. These had not been effective in identifying environmental shortfalls.

People living at the home that we spoke to said that the home was caring for them and meeting their needs. They told us that the staff and management were kind and helpful. People made some of the following comments:

One person said: “I am being looked after as good as can be expected. The care workers are fine and I am pleased with the care.” Another person said: “Staff are very good and kind and they are caring for me well.” One relative spoken with said: “I think mom is being cared for in the way she needs.”