This comprehensive inspection was carried out on 13 and 20 February, and 6 March 2018. The first day of the inspection was unannounced and we informed the provider of our intention to return on the second and third days. We also gathered additional information for this inspection from the registered manager and the director of care during a visit to the provider’s head office on 4 April 2018. The inspection date was brought forward as we had been informed by the provider that a serious medicine error had occurred in December 2017. At our previous comprehensive inspection on 3 and 8 May 2017 we had rated the service as Requires Improvement. Safe and well-led were rated as Requires Improvement and effective, caring and responsive were rated as Good.

Richford Gate is a ‘care home’. People living in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service comprises two adjoining first floor flats, each with four single occupancy bedrooms. Each flat has its own lounge, kitchen, bathroom and separate toilet. At the time of the inspection the premises were at full occupancy. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post, who has managed the service for several years. A registered manager is a person who has registered with the CQC 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 registered manager was on annual leave on the first two days of the inspection and was present on the third day.

At the previous inspection we had been informed by the registered manager that there had been seven separate medicine errors since October 2016. We had noted that measures had been taken by the registered manager and provider to fully investigate why these errors had occurred, and staff had received additional medicines training and other appropriate support and guidance from the registered manager, the area manager and the provider’s medicines trainer. During the previous inspection we had discovered two concerns that needed to be addressed in regards to how staff completed medicine administration record (MAR) charts and how they checked expiry dates for prescribed medicines. We had issued a breach of regulations in relation to the management of medicines. Following the inspection, the provider had sent us an action plan which outlined how they proposed to address this breach of regulations. At this inspection we found that the provider had achieved improvements with the management of medicines, however we found further issues that the service had not identified and addressed.

At the previous inspection we had found that the provider had failed to notify us about a safeguarding concern which had resulted in the police attending the service. This had meant the CQC could not effectively monitor events at the service in order to ensure people’s safety. We had issued a breach of regulations in regards to the provider not informing us about significant incidences at the service, in accordance with the Health and Social Care Act 2008. Following the inspection, the provider sent us an action plan which outlined how they proposed to address this breach of regulations. At this inspection we found that the provider had appropriately notified us of any notifiable events, in accordance with legislation.

People who used the serv

This inspection was conducted on 3 and 8 May 2017. The first day of the inspection was unannounced and we advised the registered manager of our intention to return on the second day. At our previous inspection on 26 December 2014 and 2 January 2015 we found the provider was meeting all the required Regulations and the service was rated as Good.

Richford Gate is an eight bedded care home for adults with a learning disability. The service comprises two adjoining first floor flats, each with four single occupancy bedrooms. Each flat has its own lounge, kitchen, bathroom and separate toilet.

There was a registered manager in post, who has managed the service for several years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the previous inspection we had found that medicines were stored, administered and disposed of safely. We had noted that staff had completed mandatory and refresher medicines training and understood their duties in regards to the safe management of medicines. At this inspection we were informed by the registered manager that there had been seven separate medicine errors since April 2016. Measures had been taken by the registered manager and provider to fully investigate why these errors had occurred, and staff had received additional medicines training and other appropriate support and guidance from the registered manager, the area manager and the provider’s medicines trainer. During the inspection we discovered two issues that needed to be addressed when we looked at how staff completed medicine administration record (MAR) charts and how they checked expiry dates for prescribed medicines. These findings demonstrated that further actions by the provider were required to ensure people using the service were suitably protected from the risks associated with unsafe medicines management.

At the previous inspection we had noted that the provider had promptly reported safeguarding concerns to the CQC and produced clear information about the actions they had taken to protect people. At this inspection we found that staff had received safeguarding training and understood how to identify and protect people from different types of abuse, however the provider had failed to notify us about a safeguarding concern which had resulted in the police attending the service, which meant the CQC could not effectively monitor events at the service in order to ensure people’s safety.

The risk assessments within the three care plans we looked at demonstrated people were supported to be as independent as possible whilst taking into account their safety and wellbeing. The staffing rotas showed there were sufficient staff rostered each day to enable people to access community resources with staff support, if required. We observed on the first day of the inspection that seven people were out in the wider community at their chosen social and educational activities. The provider adhered to robust recruitment practices to ensure that people were supported by staff with suitable knowledge and experience.

The provider had implemented a programme of training, supervision and annual appraisals in order to support staff to carry out their roles and responsibilities. The staff we spoke with demonstrated an appropriate understanding of systems to protect people who could not make decisions, as they had received guidance and training in relation to the legal requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain a healthy and balanced diet, and to participate with food preparation tasks where possible. We observed people making cups of tea and sandwiches, either independe

People at Richford Gate were cared for in a safe environment and their needs were assessed very well. The assessment records were detailed and people's preferences were included in their care plans. People's independence was promoted and they were encouraged to contribute to their care. The staff monitored people's health and welfare, monitoring their physical well-being and activities. People told us they were happy and safe at Richford Gate. One person said: "The staff are good here, they are nice."

There was a good system for people to raise their concerns, especially at the residents' meetings. People were encouraged and supported in raising their concerns and they felt that their concerns were listened to and acted upon. The complaints procedure was in an easy-read format.

There were arrangements for the ordering, dispensing, storage and administration of medicines; staff had been trained and were competent in administering medicines.

The provider supported the staff in their professional development and provided them with ongoing supervision, support and training. One member of staff told us: "It's a good team here. We are passionate about what we do here".

People told us they were happy living at Richford Gate. Comments included "living here is brilliant, staff are really good” and “staff are really good to me and we go out all the time to places I like to go". We were told by three people that if they were unhappy with anything they would talk to the management team and the provider.

People told us that they were happy with the service being provided by staff at Richford Gate. They told us they liked the food and that staff were very helpful and friendly. We saw positive interactions between people who use the services and the staff and it was evident that staff know and understand the needs of the people who use the service.

We were told that if for any reason people were not happy about anything in their home, they would report it to staff.

This inspection took place on 29 December 2014 and 2 January 2015. The first day of the inspection was unannounced and we told the registered manager we were returning on the second day. At our previous inspection on 12 December 2013 we found the provider was meeting regulations in relation to the outcomes we inspected.

Richford Gate is an eight bedded care home for adults with a learning disability. The service comprises two adjoining first floor flats, each with four single occupancy bedrooms. Each flat has its own lounge, kitchen, bathroom and separate toilet.

There was a registered manager in post, who has managed the service for three years. 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.

There were policies and procedures in place to protect people from harm or abuse. Records showed that staff had attended relevant safeguarding training and they were able to tell us the actions they would take to protect people. The four care plans we looked at contained risk assessments, which provided guidance about how to support people with varying wishes and needs, including how to support people to safely use a cooker and to travel with confidence on public transport. We found that there was enough staff available to support people with their personal care and social interests at home, and to go out for activities. Medicines were stored, administered and disposed of safely. Staff undertook appropriate medicines training and could describe their duties in regard to the safe management of medicines.

Staff had regular supervision and training, including training about how to meet the needs of people with a learning disability. This meant that people were supported by staff with suitable knowledge and skills to meet their needs. People were offered choices about their food and drinks, and encouraged and supported to make their own snacks, light meals and beverages in accordance with their individual wishes and abilities. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. We found that staff had received applicable training and could explain how they protected people’s rights.

We saw that people had positive and friendly relationships with staff, who demonstrated their understanding and knowledge of people’s needs and wishes. Staff knew about people’s hobbies, college courses, relationships with family and friends, and favourite local cafes, markets and leisure facilities. People were spoken with and treated by staff in a caring and respectful manner, and their privacy was maintained. For example, people were asked by staff if they were happy to have a chat with us and show us their bedrooms.

People using the service told us they were happy with their care and we received complimentary remarks from their families. Care plans reflected people’s needs and interests and were up to date. People were involved in planning and reviewing their goals, and relatives told us they were consulted about their family member’s care and support. People accessed community medical and healthcare facilities and the local practice nurse was involved in the care planning to meet healthcare needs.

People’s relatives told us they were pleased with how the service was managed and they described the registered manager as being "caring", "friendly but professional" and "always approachable". We observed the registered manager interacting well with people who used the service and staff. There were systems in place for the ongoing monitoring of the quality and effectiveness of the service, in order to use this information to make improvements.