This inspection took on 3 December 2018 and was unannounced. Richmond Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Richmond Court provides nursing and care for up to 64 people. There were 55 people living at the service at the time of our inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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 remained safe using the service. Staff understood how to protect people from the risk of abuse or harm. Risks were assessed, monitored and managed to ensure people remained safe. Processes were in place to keep people safe in the event of an emergency such as a fire. People were protected by safe recruitment procedures and sufficient numbers of staff were available to meet people’s health and care needs. People received their medicines as prescribed. Staff understood their responsibilities in relation to hygiene and infection control.

People continued to receive effective care. Staff had the skills and knowledge required to support people safely. People were supported to have choice and control of their lives. People were supported to eat nutritionally balanced meals. People had access to healthcare professionals when needed, to maintain their health and wellbeing. Staff promoted people’s independence.

People continued to receive a service that was caring. People were supported by staff who were kind, caring and compassionate. People’s rights to privacy and dignity were respected by staff.

People continued to receive a service that was responsive to their individual needs. Care records were personalised and contained details about people’s preferences and routines. People were supported to pursue hobbies and activities that interested them and processes were in place to respond to any issues or complaints.

The service was well-led, the registered manager understood their role and responsibilities and staff felt supported and listened to. People and staff were encouraged to give feedback, and their views were acted on to enhance the quality of service provided to people. The provider worked in conjunction with other agencies to provide people with effective care. The provider completed regular checks to monitor the quality of the care people received.

Further information is in the detailed findings below.

This unannounced inspection took place on 12 April 2016. At our last inspection in July 2013 we found the provider was meeting the requirements of the regulations we inspected.

Richmond Hall is a nursing home providing accommodation and personal care for up to 64 older people. At the time of our inspection 47 people were living at the home.

The home had 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 told us they felt safe in the home. Staff we spoke with were aware of their responsibilities to report any concerns of potential abuse or harm. The provider had safe processes in place to recruit staff and carried out appropriate pre-employment checks.

Risks to people’s health and welfare were assessed and appropriate equipment was available for staff to use. People received their medicines at the correct time and as prescribed. People were supported to make their own decisions about their care and support needs. Staff obtained consent from people before they provided care or support.

People were offered a choice of what they would like to eat and drink. People had been involved in planning their care and felt involved in their care and treatment. People had access to other healthcare professionals to ensure that their health needs were met.

People told us staff were kind, polite and caring. Staff understood people’s choices and respected their dignity and privacy when providing care and support. People were encouraged to be as independent as possible.

People were supported to maintain relationships and relatives said they were made to feel welcome when they visited the home. People told us they felt comfortable raising concerns with the registered manager or staff members. The provider had a system in place to respond to people’s complaints and concerns.

The registered manager was approachable and visible within the home and people knew them well. The quality audits systems in place did not always identify some of the areas shortcomings identified from the inspection. More robust monitoring systems could improve the quality of care provided to people.

During our inspection we spoke with the registered manager and three staff members.

During the inspection our expert-by-experience spoke with ten people who lived at the home. We also spoke with three relatives who were visiting the home.

People we spoke with told us that they were happy with the standard of care provided and were involved in giving feedback to the service.

One person living at the home told us: "The staff are wonderful, they treat me like their own mother, and they are very kind to me. If I was sick they would get the doctor to come and see me".

We found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff told us they were supported to deliver care safely and to an appropriate standard.

One member of staff told us: “I had a great induction to the home when I started here. I have done training in moving and handling and fire safety”.

We saw that the provider had an effective complaints system available. We saw that comments and complaints people made were responded to appropriately.

One person who lived at the home told us: “I would complain if things were not right, I’d speak to the manager but I do feel safe here, staff look after me very well”.

We also looked at Outcome 21: records. The home was found to be non-compliant at the last inspection in September 2012. We found that the records we looked at were accurate and fit for purpose.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drinks available in the home. This inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector who was joined by a practising professional who was a social care professional based in a hospital, an Expert by Experience; this is a person who has experience of using services and who can provide a view of that perspective. There were 58 people in the home at the time of our visit. No one knew that we were going to visit the home.

We spoke with 13 people who lived in the home about their experience of living there, three staff and the manager of the home. We also spoke with four relatives who were visiting people. To help us understand people's experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

People’s privacy and dignity was maintained. We saw that people were spoken to politely and were given the support they needed to eat their meal and meet their personal care needs. People we spoke with told us their needs were met in a dignified way.

Most of the people we spoke with told us they could make choices in relation to daily living. We saw people choosing what to do, what to eat and where to sit.

Some people lived in the home on a long term basis and some stayed for short periods of time before they moved back to their own homes or to other long term placements. People on the lower and ground floors were generally content with the care and support they received. Some people on the first floor told us they did not feel part of the home and felt they missed out on the activities that were available on the other floors.

We saw that people’s special dietary needs were met. Two people we spoke with told us they enjoyed their food. We saw that people received food and drinks throughout the day. This meant people’s nutritional and hydration needs were met.

All but one person we spoke with told us they had no concerns about the care and support they received and would raise any concerns they had with their relatives or one of the staff. One person said they were, “happy with everything and were well cared for.” Another person said, “the care on offer is good.”

We saw that there were sufficient numbers of staff available to assist people with their meal and support needs. Staff were aware of people’s needs but we saw that care records did not always give staff up to date information about how to meet people’s needs. This could mean that people were put at risk of not having their needs met appropriately.

We saw staff respect people’s privacy and dignity throughout our visit. Staff talked to people in a way that respected them as a person so helping to ensure their well being. We saw that people were offered choices about what they wanted to do and what they wanted to eat and drink.

People told us: “It's a lovely home, the staff are good.”

“I’m here temporary but I would like to make this my permanent home.”

"I was very poorly when I came here but I am a lot better now."

“Sometimes people are left for a while before being taken to the toilet but if I need a bed pan in the night, staff always come."

“Staff accompany me to hospital appointments if my family can’t go with me.”

Relatives said “It's very good here, the staff seem good and the food is ok.”

“It's brilliant here, much better than when my relative was in hospital.”

Records sampled included the information that staff would need to know how to support people to meet their needs. Other professionals are involved in people’s care where needed and staff follow their advice to ensure the person’s well being.

We saw that staff interacted well with people and ensured their safety and well being.

One person told us: "There is nothing for me to do.” We saw that some people were engaged in activities but other people spent time asleep or with not much to do. A programme of varied activities is organised and several people told us they took part in these. One person said: "A keyboard player comes in and plays the music we like. The food is quite nice and we get a variety. It’s not like being at home but I make the best of it.” Other people said they did not enjoy the activities provided. One relative said, "My relative is well looked after but there is not much going on here – everyone seems to be asleep.” However another relative said, “My relative is really different since they have been here. The activity worker has brought abilities out of her that I didn't know she had. She has gained weight and can walk on her own with a frame."

Staff knew how to safeguard people from harm and how to report appropriately any abuse or bad practice.

Staff would benefit from more knowledge about legislation that ensures that people who do not have the mental capacity to make decisions about their welfare and safety are kept safe from harm.

Staff told us that they have the training they need to support the people living there and are well supported in their role.

One person told us: "Any concerns I have raised have been dealt with and I am happy with this."

We saw that the views of the people living there, their relatives and staff are listened to. Where needed improvements are made to the home as a result of this.

Staff told us that the managers listen to them and they are supportive and approachable. They said and we observed throughout the day that the home is well run in the best interests of the people living there.