About the service:

Richmond Heights is a care home that provides accommodation for people who require personal or nursing care. The home can accommodate up to 51 people. At the time of this inspection there were 47 people using the service.

People’s experience of using this service:

• People told us they felt safe at Richmond Heights. They knew who to report any concerns to and were happy with the support they received from staff. People’s care records contained guidance for staff about how to support people safely and minimise risks to people. Staff were trained in their responsibilities for safeguarding adults and knew what action to take if they witnessed or suspected any abuse;

• The service had systems in place to ensure people received their medicines as prescribed. Staff supported people to maintain their health by making appropriate referrals to community health professionals and acting on any advice they were given;

• There were enough staff on shift to keep people safe and we observed staff usually responded to people in a timely manner throughout the day. Staff told us they thought there were enough staff to meet people’s needs. We have made a recommendation about the deployment of staff during mealtimes as we observed some people had to wait for support during lunchtime;

• People told us staff were kind and caring. We observed staff knew people well. People’s likes, dislikes and social histories were recorded in their care records. This helped staff get to know people well and care for them in a personalised way;

• Staff were competent, knowledgeable and skilled. They received regular training, supervisions and appraisals which supported them to conduct their roles effectively;

• 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 happy with the food provided at Richmond Heights. The service catered for people's special dietary requirements and staff monitored food and fluid intake levels of people who were assessed to be at risk;

• A range of activities were provided for people living at Richmond Heights, such as ‘chairobics’, quizzes, games and external entertainers such as singers. We received mixed feedback about the activity schedule. Some people said there was plenty to do. Other people and some relatives said there was not much to do so they watched a lot of TV. We have made a recommendation about the involvement of care staff with the activity provision in the service;

• The provider had recently purchased a mini-bus so people could be supported to access the local community. People had recently been supported to visit a local country park and the pub for lunch. They had provided staff with positive feedback about these experiences;

• The provider had an effective complaints procedure in place. Information about how to complain was displayed in the entrance to the home. People and their relatives knew how to complain if they needed to;

• The provider and registered manager understood the regulatory requirements and monitored the quality and safety of the service on a regular basis;

• Staff provided positive feedback about how the home was run by the registered manager. Staff told us they enjoyed their jobs, their morale was positive and they told us the staff team worked very well together;

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (published 17 August 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor this service. We plan to complete a further inspection in line with our re-inspection schedule for those services rated good.

This inspection took place on 19 July 2016. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. The service was last inspected on 4 February 2014 and was meeting the requirements of the regulations we checked at this time.

Richmond Heights is in a residential area of Sheffield and provides accommodation for 55 people who require nursing and/or personal care. Accommodation is provided over two floors, accessed by a lift. All bedrooms are single with en-suite toilets. There are lounge and dining areas on each floor of the home. The service has a garden and a car park. At the time of the inspection there were 49 people living at the service.

There was a registered manager. 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 was a calm and friendly atmosphere in the service. The service was clean and had a pleasant aroma. Our observations during the inspection told us people’s needs were being met in a timely manner by staff. We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

People told us they felt safe and were treated with dignity and respect. Staff had undertaken safeguarding training which was regularly refreshed so they understood their role and responsibility to keep people safe from harm.

The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

People had personalised their rooms and they reflected their personalities and interests. We saw the signage in the service to help people navigate around the building could be improved. People living with dementia may need such signs every time they move around a building.

People spoken with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Relatives spoken with also made positive comments about the care their family members had received and about the staff working at the service.

People had a person centred care plan in place. People’s records were updated on a daily basis. Individual risk assessments were completed for people so that identifiable risks were managed effectively. People and/or their representatives were included in the completion of these and they were reviewed regularly and in response to changes. There was evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food and said their preferences and dietary needs were being met.

Staff told us that there was a good team working at the service and that they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, likes and dislikes.

Staff received training and ongoing support to enable them to support people appropriately.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities. There was a range of activities available which included: boules, quizzes, card games, basketball and do remember cards. We looked at the service’s newsletter dated July 2016. It gave details of the events the service was holding in July. For example, a barbecue, an outing to the armed forces

At the last inspection in July 2013 we found the service was non compliant in two outcomes. The service was asked to send us a report saying what action they were going to take to achieve compliance. We carried out this inspection to check whether the service had completed these actions. We found the service had completed an action plan and achieved compliance.

People spoken with were satisfied with the quality of care they had received and made positive comments about the staff. Their comments included: “they [the staff} always ask me how I am feeling”, “the staff are lovely” and “I can talk to any of them but the most important thing is they listen”.

Relatives spoken with were satisfied with the quality of care their family member had received. Their comments included: “we think it is pretty good and the staff are very good” and “they [the staff] treat her very well, they maintain her dignity and her personal care is good”

We reviewed five people’s care plans. We found action had been taken by the service to ensure that a risk assessment and care plan for all areas of identified need in the person’s pre-assessment and reviews were in place. This showed that people had been protected against the risks of receiving inappropriate or unsafe care as care had been planned to meet people's needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with three people and they told us that they were treated with respect. They also told us that their opinions were sought so that they were involved in decisions and that they had choice.

People we spoke were satisfied with the quality of care that they had received and that staff responded in a reasonable time when they used their buzzer to call for assistance. One person commented: “when I ring the buzzer you may have to wait a little bit but they always come”.

We spoke with one relative and two advocates who were very satisfied with the quality of care their family member or person they represented had received. Their comments included: “all the staff are wonderful”; “I am very satisfied with the quality of care” and “very good care”.

We found that although the service had carried out an assessment of the needs of people using the service, we saw that the service had not planned or delivered the care to meet some people’s individual needs. The service was non compliant in this outcome area.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The service was non compliant in this outcome area.

We saw the service had a procedure in place to deal with complaints. All the people we spoke with told us that they felt “safe” and that if they had any concerns that they would speak to a relative or staff.

People we spoke with were satisfied with the care they had received. One person commented: "I like the staff and I get on with them." We spoke with three relatives and they told us that they were satisfied with the quality of personal care their relative had received. Their comments included: "The staff seem to care." "Staff lovely, smashing." One relative told us that their relative needed more activities.

We found that the standard of the care plans had improved and that people’s care and treatment was planned and that staff had accessed training from the Sheffield care home support team.

We saw that improvements had been made on how people were assisted to eat at meal times. We found the environment in one of the dining rooms to be more calm and conducive to people eating.

We found that staff monitored people’s wellbeing and recorded it in their charts. We saw that some people had access to their call buzzers but we found examples where this was not the case.

We found that there were clear procedures in place for the administration of medication. We found that people had received medicines at the times they needed them and in a safe way.

The home was undergoing a major refurbishment at the time of our inspection. This had resulted in people having to temporarily move in order for their rooms to be re-decorated. The lounge on the ground floor and the dining room on the second floor were also out of action due to the refurbishment. Whilst it was evident that major works were taking place, areas subject to refurbishment were screened off with hardboard in order to reduce the level of noise and dust for people who used the service. We also noted that a specific care plan in relation to how to minimise the possible impact of dust had been completed for people with a history of chest problems. Our observations on the day of our inspection showed us that the home and staff had worked hard to minimise risk and disruption for people who used the service.

We spoke with people who used the service and their relatives about how Richmond Heights respected and involved them in their care. One person told us, “it’s very comfortable here, the staff are nice and very helpful, they see the little things and always ask if there’s anything else you need.”

We spoke with people about how staff respected their dignity and privacy and involved them in choices about their care. One person told us, “carers always cover me up when they’re washing me and close the curtains, they’re good like that.” The same person also told us that staff always ask them what they would like to wear each day. Another person told us that they often requested drinks and snacks and that these requests were always met.

We received mixed reports about activities on offer within the home. One person told us about their participation in the Sheffield Care Home Olympics and their enjoyment of this. Two of the five people we spoke with told us of that they enjoyed visits to the home by a singer. However, some people were unaware of the other activities within the home. One person told us, “they haven't got any activities. I get bored.” They also stated, “I’d be happier if I could get out of this room.” One relative said that whilst their family member enjoyed the regular bingo sessions they, “get bored and fed-up” due to the lack of activities within the home. Another relative told us that their family member sometimes took part in art, baking and bingo sessions at Richmond Heights.

Relatives were aware of the recent relatives meeting organised by the newly appointed manager of the home and appreciated the fact that the manager had arranged this meeting in order to introduce herself to them. They also felt that their views were welcomed and listened to.

We spoke with people and their relatives about the care, treatment and support they received at Richmond Heights. One person who used the service told us that they had, “improved dramatically.” They attributed their improved health and level of independence to the care they received at Richmond Heights and said, “I’d recommend it to anyone.” Each relative told us that they were confident in the way in which their relative was cared for, and that they were informed straight away of any issues about their relative’s care.

We received mixed views about the food within the home. Some people told us that they enjoyed the food whilst others felt there to be a lack of variety. Two of the relatives we spoke with said that food within the home had been raised as an issue within the recent relatives meeting and that this was something the newly appointed manager of the home had agreed to look into.

We spoke with four people who used the service about medication. They told us that they received their medication on time and had never had any concerns about their medication.

One person told us that they requested pain medication when needed and that nurses always responded quickly to this request. Another person told us that they got their medication on time and stated, “you can set your clock by them”. The same person was positive about the level of observation from one of the nurses and their prompt action when they experienced an adverse reaction to one of their medications.

We spoke with people and their relatives about staffing within the home. One person said, “all the staff are good to me.” Another person said, “I can’t say anything wrong about them, they’re very good.” One person who had recently moved into Richmond Heights told us, “the staff are lovely and friendly and made me feel at home.” Relatives and one visitor we spoke with were positive about both the nursing and care staff at Richmond Heights.

We saw that relatives and friends are welcomed and the atmosphere in the home was informal friendly with a number families visiting throughout the day of our visit. Comments received from people using the service and their relatives were generally positive and one told us they were “Quite satisfied”. We were told however, there were times when staff took a while to answer the nurse call system and some relatives indicated communication could be improved, as they were uncertain of how to make a formal complaint. We also saw an instance when information had not been passed on to some relatives. We observed a group of people taking part in a game of organised bingo and we were told about other activities including visits out to the pub and a trip on a barge. A number of people using the service were observed to be frail and supported in bed, whilst others told us they preferred the privacy of their own room as they didn’t like to take part in activities.

We observed that information about the food to be provided for lunch was displayed in the dinning room, with a choice of either home cooked braising steak and new potatoes or jacket potato and salad, followed by apple crumble and custard. People using the service told us the quality of the food was generally good, although one told us “There are too many stews”.

Staff indicated they were aware of their responsibilities concerning their duty to protect people using the service from harm and the homes training statistics indicated 89% of them had completed training on the protection of vulnerable adults.

We observed that the building was generally being kept clean, tidy and free from offensive smells. People living in the home told us they were generally happy with their rooms and able to bring items of their belongings to help them personalise their rooms.

We were told there were two nurses and eight carers split between the two floors of the home to meet the needs of the forty three people using the service and that at night this figure was reduced to two nurses supported by three care staff. Staff were observed interacting with people using the service in a friendly and cheerful manner, however one person told us there were times staff took a while to answer the nurse call system.

People using the service told us staff generally did a good job and staff confirmed they had regular supervision and training to help them carry out their role.

A range of monthly audits of various aspects of the home are made by the acting manager to identify trends and ensure the quality of the service can be monitored and improvements made when needed. We were told various policies and procedures were in place to minimise risks and ensure the health, safety and welfare of people that use the service is safeguarded from harm.

People that use the service and their relatives told us they were generally satisfied with the service provided and details about how to make a complaint were displayed in the reception area of the home. However some visiting relatives told us they were still unclear about how to make a complaint.