This comprehensive inspection took place on 12 August 2016 and was unannounced. The inspection team consisted of two adult social care inspectors. At the time of the inspection, there were 47 people living at Richmond House.

Richmond House is registered to provide accommodation with care and nursing support for up to 49 people. Ten of the bedrooms are for use by people requiring intermediate care and support for a short period of time. The home is set within its own grounds with car parking facilities.

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 we spoke with who lived at Richmond House told us they felt safe. Staff rotas showed that there was sufficient care staff on duty to meet the needs of people who used the service. The service took into account people's needs and their dependency level, using a dependency level tool based on information in people’s care files.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. Staff demonstrated an awareness of safeguarding and were able to describe how they would make a safeguarding referral. The home also had a whistleblowing policy in place.

We looked at six staff personnel files and found there was evidence of robust recruitment procedures, including background checks.

Medicines were managed safely within the home. All staff authorised to administer medicines had completed the necessary training as well as having their competency assessed.

The home was clean and free from any malodours. Bathrooms had been fitted with aids and adaptations, including different coloured hand rails and toilet seats, to assist people with limited mobility and to help people living with a dementia to better orientate in these rooms.

Staff were aware of precautions to take to help prevent the spread of infection. The home was adequately maintained and any equipment used was serviced and maintained appropriately to ensure it was safe to use.

There was an up to date a fire policy and procedure. There was an emergency contingency plan in place which included information of what action to take as a result of an unforeseen event.

There was an accidents/incidents record book which had been appropriately completed.

Staff received appropriate training and supervision/appraisal in line with the frequency identified in the supervision policy.

Staff were subject to a formal induction process and probationary period and had completed training in a variety of areas relative to their job role.

The service was working within the principles of the MCA and any conditions on authorisations to deprive a person of their liberty were being met. Staff were aware of how to seek consent from people before providing care or support. Relatives told us that communication with them was good.

The mealtime experience for people living at Richmond House was positive. We saw that when serving meals staff made reference to a meal list which identified what each person had chosen and who was on a specialist diet.

There were some adaptions to the environment, which included pictorial signs on the doors and contrasting coloured grab rails in the toilets/bathrooms which would assist people living with a dementia. People’s bedrooms were personalised with items of furniture and personal belongings such as ornaments and pictures. Peoples’ bedrooms had their picture on the door, which would assist people living with a dementia to find their own room.

People who used the service and their relatives told us that staff respected their privacy, promoted their independence, were kind and caring and respected their choices. Staff were aware of

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

Staff members had undergone safeguarding training during their induction and received reviews of safeguarding procedures on a regular basis. A whistleblowing policy was in place at the care home and staff members we spoke with told us they would not hesitate to use it.

Accidents and incidents were logged by the manager and uploaded onto the provider`s DATIX intranet system. This system allowed prompt, thorough reporting and required the provider to review and record the action taken, so learning from incidents were disseminated. Accidents and incidents were reviewed by the quality assurance team and monthly reports were sent to the care home identifying any trends for further investigation.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. No person who used the service was subject to a DoLS at the time of our inspection.

Is the service effective?

Senior staff members had undertaken pre-admission assessments with people who used the service. The care plans we saw had been signed by the person which showed they agreed with, and were involved with creating their care plans.

People`s needs had been taken into account with signage and the layout of the care home. This helped them to move around the care home safely and freely. Richmond House had been sensitively adapted which met the needs of people with limited mobility.

Is the service caring?

We spent time in communal areas and saw staff treated people with dignity and respect. Staff members were patient and took their time to understand the needs of people who used the service.

People`s choices and preferences had been recorded and care and support was provided in accordance with their wishes. People who used the service and their families had been involved in satisfaction surveys. We saw any shortfalls had been addressed.

Is the service responsive?

We saw evidence that people who used the service were involved in activities both in the care home and within the local community. The home had its own minibus which helped people stay involved in events around the local area.

People we spoke with told us they were aware of the complaints procedure and knew what to do if they needed to complain about the service. One family member told us, "I have never had to complain but I know who to see if I needed to."

Is the service well led?

The provider had procedures in place that monitored the quality of service provided to people who used the service. We saw any shortfalls had been addressed which meant the quality of service continually improved.

We saw evidence the care home worked well with other agencies, which included GPs. The manager told us, "We have a good relationship with community health workers. We have one doctor who calls in every day." This showed the provider had a multi-disciplinary approach to providing care.

We spoke with 18 people who lived in the home. They told us that the home was "a nice place to live" and staff treated people with respect at all times. People said they had been given all necessary information about the staff and services provided and their care and support needs had been discussed prior to admission. They told us that they made their own decisions around personal and health care such as times they wanted to go to bed and get up and where they spent their time.

Staff told us that they received regular supervision for their role from their line manager. Supervision records viewed identified that all staff had received regular structured supervision sessions as an on-going process. The nursing staff told us that they had regular supervision sessions with the Deputy Manager and found these sessions to be most useful.

Staff members told us "there is always someone available to speak to if you have a concern", "the manager and her deputy are very approachable","this is a pleasant, friendly home in which staff work well together."

During our inspection we saw that all mandatory staff training was up to date. We also saw that some further training relevant to their roles and responsibilities had been provided, such as personalisation and restraint.

The purpose of this visit was to see what records were being maintained for people in receipt of intermediate care services at Richmond House. During our visit the service we looked at the care planning files and records for eight people in receipt of intermediate care services.

We found that the majority of records in care plans were maintained appropriately. However, we saw that some improvements needed to be made in how staff record information.

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 available. This was because 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

joined by an Expert by Experience who has personal experience of using or

caring for someone who uses this type of service and a practising professional.

We spoke to nine people living at the home and their comments about the meals they received included “it was ok”, “it was up and down”, “the food is very good” and “I like the food.”

All of the people we spoke to told us that they had a choice of meals. Their comments included “always have a choice” and “if you tell the cook he’ll do anything you fancy.”

One person commented to us that they thought it was important that food and drink was provided that met people’s religious and cultural needs. They told us that their wishes were being catered for.

People spoke highly of the service they received. Their comments included “I feel very safe here, very comfortable. If I wasn’t happy I can tell the staff. If it was a complaint I’d tell the manager.”

Two people we spoke with were adamant that staff were caring and kind.

Other comments included “I feel very safe here, very comfortable. If I wasn’t happy I can tell the staff. If it was a complaint I’d tell the manager.”

Two people we spoke with were adamant that staff were caring and kind.

People told us they were happy with the service they received from the staff team. One person told us that staff were “absolutely brilliant” and another person told us “nothing is too much trouble.”

Another person told us that help and assistance was constant – the response to their call bell was always available and had no cause to complain.

One person told us that both they and their relative were fully aware of their care plan. Another person told us that they were most certainly aware of his therapy, medication and treatment.