About the service: Richmond Residential Home 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. Richmond Residential Home is registered to provide accommodation for up to 20 people who require support due to mental health needs. At the time of our inspection, there were 15 people living in the home.

People’s experience of using this service: Risks to people within the home had not always been managed safely. Not all equipment had been maintained to ensure it was safe and risks identified within the environment had not been addressed. Since the inspection, the registered manager evidenced that some of the required improvements had been made.

The systems in place to monitor the quality and safety of the service were not always effective as they did not identify all the issues that we found on inspection and action had not always been taken in a timely manner to address the issues found. Notifications regarding incidents and events that had occurred within the home, were not always submitted to CQC as required.

People told us they felt safe living in the home; that they received their medicines when they needed them and that the home was always clean and tidy.

Staff had been recruited safely and had a good awareness of safeguarding procedures. They knew how to raise any concerns they had and we found that appropriate referrals had been made to the local safeguarding team.

There were enough staff available to support people both in the home and in the community. Staff were supported in their role through supervisions and regular training.

People’s dietary needs were known and met by staff, including their individual preferences. When there were concerns regarding people’s intake, this was monitored by staff and timely actions taken, such as referrals to the dietician.

People’s consent to their care and treatment was sought and recorded in line with the principles of the Mental Capacity Act 2005.

People told us staff were kind and caring and always treated them with compassion. Staff knew people well and they used this knowledge to ensure people had detailed, accurate and person-centred plans of care in place.

Staff supported people in ways that protected their privacy and dignity and encouraged their independence.

A range of activities was available based on people’s interests and hobbies. A minibus was also available that enabled people to go out on trips as a group.

The registered manager was described as approachable and staff told us their door was always open if they needed to discuss anything.

Rating at last inspection: Good (last report published September 2016)

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We carried out this comprehensive inspection on 25 and 30 August 2016. Richmond Residential Home is a care home registered to accommodate up to 20 people who do not require nursing care. The people who use the service require 24 hour support due to mental illness.

The service had a registered 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.

We previously inspected the service on 23 June 2015 when we found breaches of three regulations of the Health and Social Care Act 2014 and that overall the home required improvement.

When we visited, there were 18 people living at the home. The manager told us that two bedrooms that were previously used as double rooms were now for single occupancy and unlikely to be shared in the future. Most people had lived at the home for a considerable length of time but two people had gone to live there during 2015, one of whom had since left the home. Another person we met was having a temporary stay at the time of the inspection. The home accommodated both males and females and people’s ages ranged from 40 to 80 years.

People we spoke with said they felt safe and well cared for and information about safeguarding was available. We found that since our last inspection, all staff had received training about how to recognise abuse and their responsibility for reporting any concerns.

There were enough staff to meet the needs of the people living at the home. Safe recruitment practices had been followed when a new staff member of staff was employed and they had completed a full induction process. The staff team had made good progress towards completing a comprehensive programme of training and had received regular supervision from the manager.

Regular health and safety checks were carried out and improvements to the environment had continued to ensure that people had a comfortable environment to live and work in.

People’s health was monitored and people had access to medical professionals as needed. Medicines were stored securely.

People’s individuality was respected and staff encouraged and supported people to participate in the social activities they enjoyed. Some progress had been made in supporting people to develop independent living skills.

The manager had made significant improvements to working practices and to the standard of record keeping in all areas.

We carried out this comprehensive inspection on 23 June 2015. Richmond Residential Home is a care home registered to accommodate up to 20 people who do not require nursing care. The people who use the service require 24 hour support due to mental illness. The service had a registered 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.

When we visited, there were 19 people living at the home and one person had been admitted to hospital. Most people had lived at the home for a considerable length of time but two people had gone to live there during 2015. The home accommodated both males and females and people’s ages ranged from 40 to 80 years.

People we spoke with said they felt safe and well cared for and information about safeguarding was available. However, we found that not all staff had received training about how to recognise abuse and their responsibility for reporting any concerns.

There were enough staff to meet the needs of the people living at the home, however not all staff had received the training and support required to carry out their work. Safe recruitment practices had been followed when new staff were employed.

Regular health and safety checks were carried out and improvements to the environment had continued to ensure that people had a comfortable environment to live and work in.

People’s health was monitored and people had access to medical professionals as needed. Medicines were stored securely and new procedures had been introduced for the administration of medication.

People’s individuality was respected and staff encouraged and supported people to participate in the social activities they enjoyed. There were no plans in place to support people to develop independent living skills.

The manager had made improvements to working practices and people told us they were listened to. Some auditing tools were in use but there was scope for further development of quality assurance processes.

The specialist professional advisor commented “By and large, Richmond provides a ‘homely’ environment where people feel safe, cared for and looked after.” The expert by experience wrote “I felt the home was reasonably well maintained and had a nice atmosphere around the residents and staff.”

During this inspection we found breaches of Regulations 11, 13 and 18. You can see what action we have asked the provider to take at the back of this report.

The name of the registered manager on page 2 of the report refers to the previous manager of the service who is no longer in this post.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were protected against the risks of unsafe premises because regular safety checks were carried out and an up to date fire detection system was in place.

People were protected against unsuitable staff because appropriate checks were carried out before people started working at the home.

Is the service effective?

People experienced care, treatment and support that met their needs and protected their rights. Monitoring systems were in place to ensure that people received the medical and personal care that they required.

Is the service caring?

People were encouraged and supported to take part in social and recreational activities of their choosing. People told us: “I have lived here for 17 years, it’s a smashing place.” and “We get well looked after.”

Is the service responsive?

We saw evidence that people who lived at the home were consulted about issues that were important to them, for example what they would like to eat and where they would like to go, and satisfaction questionnaires had been completed in 2013.

Is the service well led?

The provider took an active part in the day to day running of the home. He was present in the home most days and spoke with people who lived there and staff who worked there. A new manager was appointed in March 2014. She had previous experience working as a team leader and was working well with the provider and the administrator to improve the quality of life of the people who lived at the home.

People we spoke with said that they liked the meals they had at the home. One person told us “The staff look after you well, couldn’t be better.” and another said “The support is very good, staff are always on hand, and the manager is very approachable.” The manager told us that since the beginning of this year everyone had been seen by their GP and had a full health check. People had been supported to use local health facilities including podiatry, dentist and optician. The manager had also referred all of the people living at the home to mental health services for a reassessment of their support. People's prescribed medicines were managed safely.

We observed that the home was clean and free of unpleasant odours. People we spoke with considered that the cleaning staff were very good. We looked around the building and found that many bedrooms were in need of redecoration and had shabby, damaged furniture. The provider told us that he intended to refurbish one bedroom per month, with the agreement of the occupant. People we spoke with did not raise any complaints about their bedrooms.

Systems to regularly assess and monitor the quality of service that people received had been introduced. Record keeping had improved to protect people from the risks of unsafe or inappropriate care and treatment.

People we spoke with at the home had no complaints. Most had lived there for a long time and considered it their home. People told us about friendships they had made with other people who lived at the home. We observed shows of affection between people living at the home, and people choosing where they wished to spend their time and who with. People we spoke with considered that they were ‘well looked after’ at the home.

Since our last visit to the home in June 2012, everyone had been visited by their GP and had a full health check. Everyone who lived at the home had been referred to mental health services for a reassessment of their support. People had been supported to use local health facilities including chiropody, dentist and optician.

Policies and procedures relating to safeguarding had been reviewed and rewritten in line with current guidance and staff had received training about safeguarding and about dignity in care.

The manager had been working closely with the local authority to update policies and procedures and to develop quality assurance processes, however this was not yet completed.

New staff files had been set up and training records were kept. There were no care plans or risk assessments in place for the people living at the home.