Archived: Richmond Lodge

About the service

Richmond Lodge is residential care home providing personal care for up to 5 people with a learning disability. Accommodation is provided over two floors. A communal lounge, conservatory and dining kitchen are based on the ground floor. At the time of the inspection 4 people were living at the service.

People’s experience of using this service and what we found

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff did not deliver care and support in line with people’s needs and strengths. People’s interests, abilities and strengths were not promoted to ensure they lived fulfilled lives. Lessons were not learnt to reduce the risk of repeated incidents.

Right Care

Staff did not always understand how to protect people from poor care, neglect and abuse. Staff completed safeguarding training but did not always recognise incidents as abuse. Individual risks were not always accurately assessed or managed well, and this placed people at risk of harm.

Right Culture

Support plans showed people had been involved in creating these however the provider failed to effectively monitor records to ensure care was delivered in line with their needs and wishes. The culture did not empower or support people to live fulfilled meaningful lives. Governance systems remained ineffective as they did not identify areas for improvement and when they did not enough action had been taken to improve the quality and safety of care.

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 inadequate (published 05 October 2022). 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.

Why we inspected

We carried out an unannounced focused inspection of this service on 16 and 22 August 2022. 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, person centred care, need for consent and 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, effective, and well-led which contain those requirements.

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.

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 inadequate.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to providing safe care, medicines management, infection control, safeguarding, consent to care, person-centred care and management of the service at this inspection.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Richmond Lodge is residential care home providing personal care for up to five people with a learning disability. At the time of the inspection five people were living at the service. Accommodation is provided over two floors, accessed by stairs. A communal lounge and dining area are based on the ground floor.

People’s experience of using this service and what we found

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the providers own systems in the service did not always support this practice.

The provider did not make reasonable adjustments for people so they could be fully in discussions about how they were supported. Staff did not always support people to pursue their interests and to achieve their aspirations and goals, because they were not identified. People were not always engaged to take part in daily tasks and activities meaningful to them.

The provider did not always learn from incidents and how they might be avoided or reduced in the future. People’s risk assessments were not detailed and did not provide guidance to staff on how to meet peoples' support need and reduce the risks.

People were supported to access specialist health and social care support in the community when this was required.

Right Care:

The provider did not accurately or fully assess risks people might face. People’s support plans were not detailed and did not reflect their range of needs and did not always promote their wellbeing and enjoyment of life.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe during the day. However, there was only one night staff and there was a potential risk of people not having their needs met. We made a recommendation to the provider to review their dependency tool and staffing levels.

Staff knew how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

The provider had not evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. People and those important to them, told us they were not always involved in planning their care.

The provider’s own governance systems and processes were not robust enough to identify areas where improvements were required.

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

Rating at last inspection

The last rating for this service was good (published 19 December 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to initial inquiries to determine whether to commence a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

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.

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 changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond Lodge on our website at www.cqc.org.uk

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to providing safe care, person centred care, consent to care and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Richmond Lodge is registered to provide personal care for up to five people with a learning disability. At the time of the inspection four people were living at the service. Accommodation is provided over two floors, accessed by stairs. A communal lounge and dining area are based on the ground floor.

People’s experience of using this service and what we found

People told us they liked living at Richmond Lodge and they liked all the staff. People told us they felt safe.

People’s support plans contained guidance for staff about how to provide support to people safely and to minimise risks to people. Staff were trained in their responsibilities for safeguarding adults and knew what action to take if they witnessed or suspected any abuse.

Systems were in place to make sure people received their medicines as prescribed. Staff supported people to maintain their health by making appropriate referrals to community health professionals and acting on any advice they were given.

There were enough staff provided to meet people’s needs. We observed staff were with the people they supported throughout the day.

The provider had recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Staff were provided with regular training, supervisions and appraisals, which supported them to conduct their roles effectively.

People were supported to have maximum 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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were happy with the food provided. They told us they had choice and helped shop for food. Staff were aware of people’s dietary requirements and preferences.

The provider had a complaints procedure in place. Information about how to complain was provided to people. People living at the service said they could talk to the registered manager and staff if they had a complaint or any worries.

The registered manager understood the regulatory requirements and monitored the quality and safety of the service on a regular basis. Staff told us they were proud to work at the service.

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

Rating at last inspection: The last rating for this service was good (published 12 May 2017).

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

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

People were safe and continued to receive safe care. The risks to people’s safety were regularly reviewed and processes were in place to protect people from avoidable harm. Sufficient numbers of staff were in place to keep people safe and safe recruitment procedures ensured people were protected from the risks of unsuitable staff. People’s medicines were managed safely and people received their prescribed medicines when needed.

People’s right to make their own decisions about their care and support needs, where able, was respected by staff. Where decisions were made for people, they were made in line with the principles of the Mental Capacity Act 2005 (MCA). People were encouraged to eat and drink healthily. Staff were well trained and felt supported to carry out their role effectively. People’s day to day health needs were monitored and referrals to external professionals were made where needed and in a timely manner.

People were treated with kindness, dignity and respect by the staff. People had developed positive relationships with staff which contributed to a positive atmosphere within the home. People’s support records were person centred and focused on what was important to them. Support was provided for people in line with their personal preferences. People were provided with an ‘easy read’ complaints process that supported people living with a learning disability. Effective systems were in place to manage any complaints that the provider may receive.

The service was well-led. The current registered manager split their time between two services, but this did not impact on the quality of the service provided. People, relatives, staff and professionals commented positively about the registered manager. There was a calm, open and friendly atmosphere at the home which resulted in a high quality of service for people. Effective auditing processes were in place, with regular input from representatives of the provider.

This helped us to answer the questions below.

Is the service safe?

The environment was clean and hygienic and appropriate steps were in place to reduce the risk of cross infection. Environmental risk assessments had been completed and actions taken to reduce the risk where possible. Regular checks were made of key factors such as legionella prevention.

The Home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards to protect the rights of people using the service. It was clear from talking with staff that they had an in-depth understanding of mental capacity issues and capacity assessments for the people who used the service were sometimes complex. Steps were taken to maximise people's participation in decision making and a multi-disciplinary approach was taken to ensure best interest decisions were made.

Individual risk assessments had been carried out and care was planned in response to these. This meant care and support was planned in a way that was intended to ensure people's safety and welfare.

Is the service effective?

Full assessments of each person's care and support needs were undertaken. Care plans were reviewed regularly and updated as necessary to ensure the support provided was appropriate to each person's individual needs.

We saw there was involvement from a range of professionals in each person's care, ensuring care was effective and specialist input obtained where necessary.

There was a structured approach to training and appraisal of staff to ensure staff were supported to function effectively in their job roles.

Is the service caring?

The staff knew the people who used the service well and had positive relationships with them. They were attentive to people's needs and gave them encouragement and support. Staff were able to recognise non verbal cues to indicate people's wishes.

People's preferences, interests, and diverse needs were recorded and care and support was provided in accordance with their wishes.

People were encouraged to participate in activities they enjoyed thus promoting their well-being. People were able to choose whether or not to participate in activities and if a person indicated they would prefer to do something else this was listened to and acted on.

Is the service responsive?

We saw the service responded to the needs of individual people and tailored the service to take account of their changing needs and skills.

A number of methods were used to obtain feedback from people who used the service and we saw examples of improvements which had been implemented as a result of this feedback.

People told us they had not had any need to complain but they knew how to make a complaint if necessary and who to contact if they were not satisfied with the response. However, they told us they were confident their concerns would be dealt with by the staff and manager.

Is the service well led?

Policies and guidelines were in place to ensure safe services were delivered. These included policies covering health and safety, the Mental Capacity Act, whistle blowing and Adult Safeguarding.

Quality review systems were in place to assess the quality of the service and identify the need for improvement. Staff told us the results of audits and reviews were shared with them and discussions took place about actions being taken to improve. This meant that information gained from audits was used to improve the service.

There was a planned approach to education and training and staff had received the training they required to deliver safe and effective care. Staff received regular supervision and appraisal. They told us they felt well supported by the manager and encouraged to undertake further development.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us told us they were asked for their consent. The person also told us, 'I do the things I want to.'

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. A person told us, 'They have never run out of my medication.'

We found there were sufficient staff to meet people's needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, 'There are always enough staff around.'