The Care Quality Commission (CQC) has told the provider of Richmond Lodge in Kirkby-in-Ashfield, Nottingham, to make urgent improvements following an inspection in February.
This focused inspection was carried out to check on the progress of improvements CQC told the provider to make, after issuing them with three warning notices in August last year around safe care and treatment, person centred care and the need for consent and governance.
Following this recent inspection, the provider remained in breach of regulations. Also, additional breaches were identified in relation to medicines management, infection control, safeguarding, and management of the service.
The home’s overall rating and for being safe, effective and well-led, remains inadequate. Caring and responsive weren’t included in this inspection and remain rated as good.
The service remains in special measures which means it will be kept under review by CQC and re-inspected to check significant improvements have been made.
Richmond Lodge, run by Blue Sky Care Limited is residential care home that can provide personal care for up to five people with a learning disability. At the time of the inspection four people were living at the service.
Rebecca Bauers, CQC’s director for people with a learning disability and autistic people said:
“When we inspected Richmond lodge, we were very concerned to find the provider still didn’t have effective systems in place or enough oversight to ensure it was delivering high quality care. Also, the provider hadn’t addressed our previous concerns raised at the last inspection, and new issues were found which meant people weren’t safe and at risk of avoidable harm.
“It’s unacceptable for people using this service to experience poor standards of care. People should be safe and treated with dignity and respect. The leaders in this service were allowing a culture to exist where people weren’t given the opportunity to live fulfilled and meaningful lives. For example, people weren’t always given a choice in how they would like to spend their time. Someone who had been assessed as needing one-to-one support was provided with this by accompanying staff to the tip, there was no evidence to support this was what the person had chosen to do.
“Risks with the environment were badly managed. We found water temperatures weren’t monitored appropriately, and staff failed to take any action when water exceeded safe temperatures which increased the risk of scalding. Also, some people were at risk of absconding. However, the gate and all doors were left unlocked throughout our visits which placed people at risk of harm and must be addressed as a matter of urgency.
“There were signs of a closed culture. Staff failed to recognise some incidents as being abuse. For example, we observed an incident where staff spoke to someone in an inappropriate manner which caused the person to become distressed, however staff failed to recognise this as abuse. Also, we reviewed an incident where someone was becoming distressed, staff failed to act which resulted in another person being hurt. Staff failed to recognise this as a safeguarding incident which placed people at risk. The provider must take action and ensure staff are trained to recognise signs of abuse to safeguard people from the risk of harm.
"The home will remain in special measures and we will be keeping it under close review. We are also working closely with the local authority to mitigate any risk to keep people safe.
“We will not hesitate to take further action if we don’t see significant improvement. Even if this results in the CQC taking action which results in the closure of the home."
Inspectors found:
- Staff didn’t support people in the least restrictive way possible and in their best interests; the policies and systems in the service didn’t support this practice.
- Lessons weren’t learnt to reduce the risk of repeated incidents.
- Staff didn’t always understand how to protect people from poor care, neglect and abuse. Staff completed safeguarding training but didn’t always recognise incidents as abuse. Individual risks weren’t always accurately assessed or managed well, and this placed people at risk of harm.
- Medicines weren’t managed safely.
- Support plans showed people had been involved in creating these however the provider failed to effectively monitor records to ensure care was delivered in line with their needs and wishes.
- Governance systems remained ineffective as they didn’t identify areas for improvement and when they didn’t enough action had been taken to improve the quality and safety of care.