We inspected the service on 16 August and 12 September 2018. The inspection was unannounced. The service under the name Richmand House provides two regulated activities from this location. Richmand House 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. Richmand House is registered to provide care for 12 people, and on the day of our inspection 12 people were using the service. Richmand House is also a domiciliary care agency. It provides personal care to 10 people living in their own homes. It provides a service to older adults.

We previously inspected the service in May 2018 when we only inspected against the regulated activity Accommodation and nursing or personal care. At that inspection we found the provider to be in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one of the Care Quality Commission (Registration) Regulations 2009 We asked the provider to send us an action plan to show how they would address our concerns. We received the actions plan and at this inspection we found the provider had addressed our concerns and was no longer in breach of these regulations.

On the day of our inspection there was a registered manager in post. 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.

People who used the services were protected from harm as the provider had processes in place to ensure their safety. Staff supporting people were aware of their responsibilities in relation to protecting people from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

The risks to people’s safety were clearly identified with measures in place to reduce these risks. The environment and essential equipment were well maintained.

People were supported by well-trained and competent staff in sufficient numbers to keep them safe. Their medicines were managed safely and people were protected from the risk of infection through good hygiene practices and staff knowledge of reducing the risks of cross infection.

People’s needs were assessed using effective evidenced based assessment tools. These were then used to provide clear guidance for staff to assist them gain a good understanding of an individual’s needs and offer the most effective support to people. Staff were supported with appropriate training for their roles.

People were supported to maintain a healthy diet, with staff showing good knowledge of people’s nutritional and health needs. They received support to manage their health needs through well-developed links with local health professionals. The environment people lived in was a safe environment which met their needs.

Staff sought consent from people before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People using the service, and relatives were treated with kindness and care by staff who supported people with respect and dignity, and developed positive relationships with people in their care.

People could maintain relationships with people who were imp

We inspected the service on 8 and 11 May 2018. The inspection was unannounced. Richmand house 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. Richmand House is registered to provide care for 12 people, on the day of our inspection 11 people were using the service.

On the day of our inspection there was a registered manager in post. 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. Richmand House was inspected in 2015 and rated as Good. At this inspection we found a number of concerns relating to safe care and treatment, person centred care and lack of governance. This led to a number of breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and at this inspection the service was rated as Requires Improvement.

The registered manager worked to keep people safe from abuse by responding to and investigating any concerns. They put in measures to protect people, however they had not recognised the need to ensure local authority safeguarding teams were aware of their actions and had not reported these and other significant events to the CQC as part of their statutory responsibilities.

People were not always protected from risks to their personal safety, as the registered manager had not undertaken assessments of individual and environmental risks to ensure this. People’s needs had not been assessed using nationally recognised tools to guide staff to make robust assessments of their needs.

People were supported by appropriately trained staff and the registered manager had ensured there were always adequate numbers of staff on duty to care for people. Staff received training and support to safely administer medicines and most aspects of the management of medicines were safe. However, the lack of protocols for ‘as required’ medicines meant staff did not have the information to assist them make appropriate decisions on when to give these medicines. This put people at risk of not receiving safe and appropriate care.

People were protected from the risks of infection as the registered manager had effective processes in place to ensure cross infection risks were reduced. The registered manager ensured staff learned from incidents to reduce the risk of reoccurrences.

The majority of people’s nutritional needs were well managed by staff, but there had not been a referral to the speech and language therapy (SALT) team for one person. This put them at risk of receiving an inappropriate diet for their needs. However, in all other respects people’s health needs were well managed by staff and people were supported to maintain a healthy lifestyle.

The environment people lived in allowed them to move freely around the premises and personalise their own living space.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who treated them with care and respect and supported them to maintain their privacy, dignity and independence. People’s views about their care were considered and they had choices in relation to how they spend their time. The registered manager supported the use of an advocate to ensure people had the support to voice their views and opinions. People’s cultural needs were met.

The information about people’s individualised care needs was not always up to date or actually recorded in their care plans to support staff to give

As some people were not able to speak with us we spent some time observing the care and support they received from staff. We found staff were attentive to people’s needs and there was evidence of good relationships being maintained.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We spoke with three relatives of people using the service and all of them told us they were very happy with the care and support that their relatives’ received. One relative told us they were involved in care planning and they had annual reviews of the care provided. They also said, “The staff are very good, they do all they can in regards to minimising falls and making my relative safe.” Another relative said, “My relative is settled and they have made progress since their admission.”

We spoke with five people using the service. One person said, “It’s quite nice, I would like more entertainment. If I want any help they would help. The staff are polite and I’m quite happy with what the staff do.” Another person said, “Everyone is very happy, very good.”

We found the environment was well maintained and had a homely feel and each person’s room was individualised.

We saw that staff received appropriate training and supervision to support them in their job role and development. People using the service and their relatives spoke positively about the staff.

We found people were supported to make a complaint if they felt this was necessary. We asked people about if they felt able to make a complaint if they were unhappy and if staff would listen to them. One person said, “The staff treat us okay, I think the staff would listen.”

We visited the location to carry out a planned review. We spoke with one relative, four people using the service and two members of staff.

People living at Richmand House told us they were happy and settled living there and that they felt involved in their care. Everyone told us the staff cared for them well and they supported them in a way they preferred.

One relative also confirmed they were involved in their relative’s care and that they could express their views.

Everyone we spoke with told us their needs were met and staff supported them as needed. One person said, “I am very happy here, the staff are very accommodating. I am not aware of any care plans but they look after me in a way I prefer. Another person said, “The staff care for me as needed, they are very kind.”

One relative said, “The staff care for my [relative] in a way they prefer, and they care for them well and their needs are met.”

Everyone we spoke with said they felt safe living at the home and they could tell staff if they were unhappy in anyway. One person said, “The staff are respectful, if I was unhappy I could say.” Another person said, “The staff are not unkind, I could say if I was unhappy.”

Everyone told us that they were enough staff to support them as needed.

Two people told us they attended the meetings that were held so they could have a say about how the service was run and managed.

We carried out an unannounced inspection of the service on 10 and 12 November 2015. Richmand House Residential House is registered as a care home without nursing to accommodate up to 12 older people living with or without dementia. At the time of the inspection there were 12 people using the service. Richmand House is also registered for personal care and provides domicillary care services. At the time of the inspection there were two people in the community receiving this support.

On the day of our inspection there was a 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.

People told us they felt safe. Relatives said their relations were safe. People were supported by an appropriate number of staff and they were recruited through safe recruitment practises. Staff turnover was low. Staff had attended safeguarding adults training, could identify different types of abuse and knew the procedure for reporting concerns. Safe medicines practices were followed.

People were supported by members of staff who had the knowledge and skills required to meet their needs. People confirmed that they had consented to the care they received. They told us that care workers checked with them that they were happy with support being provided. Staff received regular support and supervision from their manager to carry out their role effectively

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. An application for DoLS was required for one person as the home has not followed the DoLS process. Assessments of people’s capacity were generally in place.

People received sufficient to eat and drink and were happy with the food they received. People’s day to day health needs were met by the staff and external professionals.

People told us the staff were very caring towards them. Relatives agreed. Staff valued people as individuals and took time to get to know people and what was important to them. They spoke kindly of people who used the service and showed compassion when supporting people. People who used the service and staff interacted with each other well. People’s privacy was respected, their dignity was maintained and their independence encouraged.

People had the opportunity to take part in a variety of activities. People were involved in planning their care and their care plans were written in a person-centred way. Staff knew people’s likes and dislikes and what interested them. People were able to see their friends and relatives when they wanted to. People and relatives felt comfortable to approach the registered and home care manager with any issues..

People using the service and their relatives knew how to make a complaint. They told us they had not made a complaint but were confident the registered and home care manager would address any concerns if they had any.

People using the service and their relatives said that the home and domicilary care service was well-led and provided a good service The registered and home care manager had developed positive working relationships with people who use the service, the staff and relatives. People, staff members and relatives spoke positively about the registered and home care manager. The registered and home care manager encouraged open communication with people who use the service, those that matter to them and staff.