Archived: Richmond

Updated 25 December 2020

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This was a targeted inspection looking at the infection control and prevention measures the provider has in place. As part of CQC’s response to the coronavirus pandemic we are conducting a review of infection control and prevention measures in care homes.

This inspection took place on 07 December 2020 and was unannounced.

Updated 25 December 2020

About the service:

Richmond is located in Bexhill-on-Sea and provides accommodation and personal care for up to 58 older people who live with dementia, and live with long term healthcare needs such as Parkinson's. The home is set out over two floors, Richmond and Heatherbank. Heatherbank was on the ground floor and supported people who lived specifically with dementia and who had additional health problems such as decreased mobility. Richmond supported people with health needs and general frailty. There is lift access between the ground floor and upper level. At the time of our inspection there were 36 people living at the home.

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

At the last comprehensive inspection in November 2018, we told the provider they needed to improve the oversight and governance of the service and to ensure people received safe care and treatment. The manager and provider had made significant improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including their medicines. However, there were some areas of documentation that needed to be further developed to ensure people received safe and consistent care. There were also improvements needed to ensure people consistently received care that met their individual needs. Activities reflected people’s preferences and interests. However, the activity programme has been impacted on by staff sickness. One person told us, “I enjoy the activities, but they are in a bit of a doldrums now.” There were plans to allocate care staff to cover the programme so that people received the social interaction they needed and wished for. At the time of the inspection, it was clear that there was some instability within the staff teams, we received mixed feedback about the management of the service and staff feeling unsupported. The atmosphere of the home was subdued, and if not managed had the potential to impact on the people who lived there.

People received safe care and support from staff who had been appropriately recruited, trained to recognise signs of abuse or risk, and understood what to do to safely support people. People said, “I do feel safe, I am happy here, I like the food and I don’t need more,” and “I like it here genuinely, I’m very safe, I feel this is my home.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. Medicines were given safely to people by competent and knowledgeable staff, who had received appropriate training. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were reviewed following falls or changes in a person's health condition. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs. Agency staff used, received an induction to the service and worked alongside regular staff.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training and this had ensured all staff received the training and updates needed to provide safe consistent care. A plan of supervision to support staff was available and this also included competency sessions on training received. One staff member said, “Supervision is every couple of months, but we are encouraged to speak up if we need support.” People’s nutritional and health needs were consistently met with involvement from health and social care professionals.

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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. People were relaxed and comfortable in the company of staff and were treated with respect. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

People were encouraged to go out and meet family and friends. Technology was used to keep families in contact by skype and email. Staff knew people’s communication needs well and staff communicated with people in an effective way.

Care delivery was based on people's preferences and wishes. People were involved in their care planning as much as they could be. One person said, “I am very involved in my care plan because I know what I want.” End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. One visitor said, “I speak to the manager if I have any concerns.” The provider and manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service to deliver sustainable good 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 requires improvement (published 13 December 2018)

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

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.