CQC report explained · a nursing home
What the CQC found at Richmond Court Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2023
Rated Requires Improvement overall, with an Inadequate well-led rating and concerns about safety, consent, dignity and record keeping.
This was an unannounced inspection on 4 and 5 May 2023. One inspector and a nurse specialist adviser spoke with people, relatives, staff and professionals. They also checked care plans, medicine records, recruitment files and management audits.
Inspectors found that people were not always protected from harm. Dietary needs, food and fluid intake, infection control and medicine storage were not managed reliably. Some people were not always treated with dignity, and records about care, risks and consent were sometimes inaccurate or incomplete.
There were also positive findings. Staffing levels were suitable, medicines were generally given as prescribed, people received day-to-day choices, and staff knew people's likes and dislikes. The new manager had started an improvement plan and professionals reported positive changes.
The overall rating is Requires Improvement. All five questions were rated Requires Improvement except Well-led, which was rated Inadequate. The report says this was the second consecutive inspection with an overall Requires Improvement rating.
Staffing and recruitment
Staffing levels were maintained at a suitable level, and people received support in a timely way. Recruitment checks had been completed before staff started work.
“Staffing levels were maintained at a suitable level to support people safely.” from the report
Day-to-day choices
People were supported to choose things such as when they got up and went to bed. Staff knew people's likes and dislikes.
“People were supported to make day to day choices.” from the report
Activities
A range of group activities took place in communal areas. Inspectors saw people enjoying games and pastimes and noted a good rapport with the activity coordinator.
“We saw people enjoying a range of games and pastimes.” from the report
Learning from incidents
The new manager had improved the detail and quality of accident and incident reviews. Actions were recorded and updated when completed.
“Records showed the new manager had improved the quality and detail of this analysis.” from the report
External support
The home worked with community and other professionals to support people's health needs. Professionals reported a significant improvement since the new manager started.
“They reported a significant improvement in the overall service people receive since the new manager had been in post.” from the report
Nutrition and hydration risks
seriousDietary needs were not always assessed or recorded correctly. Food and fluid monitoring did not reliably identify reduced intake over several days, and some people at risk of weight loss were not properly supported.
“Risks to people's individual nutritional needs were not adequately assessed, documented and managed safely.” from the report
Consent and least restrictive care
seriousCapacity assessments and best-interest decisions were not always specific, recorded correctly or reviewed when circumstances changed. Records did not show how some conditions of a deprivation of liberty authorisation were being met.
“People's capacity to consent or best interests regarding restrictions imposed by the provider weren't always considered and documented.” from the report
Dignity and respect
seriousInspectors saw care and communication that did not always protect people's dignity or privacy. Some care records also used judgemental rather than factual language.
“People did not always receive compassionate care that upheld their dignity.” from the report
Management oversight
seriousAudits did not identify important problems in care, records, clinical monitoring or staff practice. This meant the provider could not show that improvements were being managed effectively.
“Quality assurance systems had failed to identify the areas of concern we highlighted during our inspection.” from the report
Time alone and complaints records
needs fixingPeople cared for in bed could spend long periods alone, and records did not clearly show how room visits met their individual needs. Earlier complaints records did not show how concerns had been investigated.
“People who were cared for in bed spent large periods of time alone.” from the report
- 01What has been done to make sure each person's dietary texture, fortified food needs, food intake and fluid intake are recorded and monitored correctly?
- 02How are medicines, supplement drinks, sharp items and clinical equipment now stored and checked?
- 03How do you record and review mental capacity, best-interest decisions, bed rails and any deprivation of liberty conditions?
- 04What training and supervision do nursing staff now receive for wound care and other clinical needs?
- 05How do you make sure people cared for in bed receive meaningful, person-centred contact and activities rather than just recorded room visits?
This was an unannounced inspection that assessed all five key questions, including infection prevention and control under Safe; the inspection was prompted by concerns about nutrition, hydration, health monitoring and management. This explanation was written from the published report of 2 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2019
Requires Improvement; inspectors found safe, kind and effective care, but activities were not tailored well and leadership checks were not effective enough.
Inspectors made an unannounced visit on 16 and 17 October 2019. They spoke with people, relatives, staff and a health professional. They observed care and reviewed care, medicines and management records.
The home was rated Good for Safe, Effective and Caring. Inspectors found enough staff, safe medicines, suitable training, good access to healthcare, and kind care that respected people's privacy, dignity and choices.
The home was rated Requires Improvement for Responsive and Well-led. Activities still did not reflect most people's interests, and checks by managers had not identified or fixed this. The overall rating fell from Good at the previous inspection to Requires Improvement.
Safe medicines
Inspectors found that people received their medicines as prescribed. Nurses were trained and their competence was checked.
“People received their medicines as they were prescribed.” from the report
Kind and respectful care
Staff were observed treating people with kindness and compassion. Privacy, dignity and independence were also promoted.
“Staff were observed being compassionate and kind to people.” from the report
Choice and healthcare
People could make choices about food, drink and their daily routines. The home worked with health professionals and helped people access healthcare when needed.
“People were supported to have maximum choice and control of their lives.” from the report
Activities did not match people's interests
needs fixingMost people did not take part in activities that reflected what they wanted or enjoyed. Inspectors found little improvement since the previous inspection.
“Activities were not person centred and did not consistently reflected the interests people had.” from the report
Management checks did not drive improvement
needs fixingThe home carried out audits and spot checks, but they had not picked up or fixed the continuing problem with activities.
“a lack of monitoring to ensure activities were being tailored to people's interests and hobbies showed spot checks were not effective.” from the report
- 01What activities are available now that match my relative's interests, hobbies and preferences?
- 02How do you find out what each person wants to do, and where is this recorded?
- 03How do managers check that activities are person centred and take action when they are not?
- 04What improvements have been made since inspectors found little improvement in activities?
- 05How are my relative's communication needs and choices included in their daily care?
This was an unannounced planned inspection covering all five CQC questions; the previous rating was Good, published on 21 April 2017. This explanation was written from the published report of 20 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Richmond Court Nursing Home
4 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- November 2019Requires improvementdown from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- March 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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