Richmond Village Witney

Richmond Village Witney is a purpose-built residential care home providing personal and nursing care to up to 63 people within a village. The service accommodates people across 2 separate wings each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. At the time of the inspection there were 46 people living at the home.

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

Prior to the inspection, we had received concerns in relation of staffing, environment, nutritional support, records and management of the home. We found, inconsistency in leadership had impacted on staff support, morale and management of the home. The service had gone through several managers since our last inspection in 2018. There was a manager who had been in post for 5 months who knew the service as they had managed the other part of the village.

People’s care plans were not always complete or up to date. Staff records of supervisions and support had not been completed in line with the provider’s policy. However, staff told us they felt supported by the new manager and said they were approachable and available. The provider’s quality assurance systems had identified these shortfalls and the team was working through an improvement plan.

On the day of the inspection we saw there were enough staff on the dementia unit. However, staff deployment could be improved on the nursing unit. The village manager told us they were one staff member short due to an unplanned absence. However, staff told us they often struggled to meet people’s needs especially during busy periods.

People living at Richmond Village told us they felt safe living in the home. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Medicines were managed safely, and people received their medicines as prescribed. Staff had the necessary skills to carry out their roles. The environment was clean, and staff followed strict cleaning schedules.

People had a positive dining experience which offered a variety of food choices available at times that suited people’s preferences. We saw people were supported with nutrition and staff had oversight of people on special diets.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home.

Rating at last inspection and update

The last rating for this service was good (Published 8 January 2019)

Why we inspected

We received concerns in relation to staffing, environment, records and management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 requires improvement based on the findings of this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified a breach in relation to record keeping and inconsistency in leadership 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.

Richmond Village 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.

The care home accommodates up to 63 people in an adapted building. At the time of the inspection there were 43 people living at the service.

There was no registered manager in place. 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. A clinical lead had been recruited and was managing the service. A new manager had been appointed and scheduled to in January 2019.

People told us they were safe living at Richmond Village. There were enough staff to meet people’s needs. Staff demonstrated they understood how to keep people safe and we saw that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed.

People had their needs assessed prior to living at Richmond Village to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team.

People living at Richmond Village were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights. The provider had processes in place to maintain confidentiality.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. Staff had a good understanding of the MCA and applied its principles in their work. We saw people were supported without breaching their rights.

People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. People had access to a wide range of meaningful activities.

People, their relatives and staff told us they felt inconsistences in leadership had affected how Richmond was run. However, they also commented on recent positive changes. We also found staff supervision records were not always up to date. The village manager and clinical lead promoted a positive, transparent and open culture. Staff told us they worked well as a team. The provider had effective quality assurance systems in place which were used to drive improvement. The management team had a plan to further develop and improve the home. The home had established links with the local communities which allowed people to maintain their relationships.

Richmond Village 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 village accommodates 63 people across two separate units, each of which has separate adapted facilities. One of the units Mulberry, specialises in providing care to people living with dementia. The other unit, Willow, is a nursing unit. On the day of our inspection, there were 34 people living in the home.

We were welcomed by the registered manager, village manager and staff who were happy to see us and keen to show their caring nature and share the positive changes they had made in the previous months.

Before the inspection, the provider contacted us and shared some concerns they had identified through their internal quality assurance systems. These concerns included poor medicines management, poor staffing levels, poor leadership, lack of audits, lack of staff induction and training, no comprehensive assessments and reviews as well as un-investigated complaints. The provider told us they had implemented a rescue plan which included not taking new people into the home until concerns were addressed.

We found the provider had made significant improvements to ensure people’s safety. However, they were still working through their action plans and there were still some areas to improve. Where people required covert medicines, a pharmacist’s guidance had not been sought. People’s care plans gave details of support required, however, they were not always person centred or up to date. The provider had already identified these concerns and was working through the action plan.

People told us they felt safe living at Richmond Village. Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicine as prescribed.

Richmond Village continuously recruited staff to ensure people’s needs were met. The home had staff vacancies which were covered by regular agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team were doing all they could to ensure safe staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had their needs assessed prior to living at Richmond Village to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

People living at Richmond Village were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The home provided information including in accessible format to help people understand the care and support that was available to them. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

People, their relatives and staff told us they felt Richmond Village was well run. The registered manager and management team promoted a positive, transparent and open culture. Staff told us they worked well as a team and felt valued. The provider had effective quality assurance systems in place which were used to drive improvement. The registered manager had a clear plan to develop and further improve the home. The home had established links with the local communities which allowed people to maintain their relationships.