The RedHouse Care Home

The RedHouse is a residential care home providing personal care for up to 36 people aged 65 and over. There were 35 people living at the home at the time of the inspection.

People’s experience of using this service and what we found

The registered manager and provider shared a clear vision and strong values. They led by example and were committed to providing good quality individualised care and support. They demonstrated a commitment to continuous improvement and took great pride from the service's achievements.

People's views were listened to and were at the heart of how the service was provided. The provider had made improvements to their activities arrangements and quality monitoring systems since our last inspection. Quality monitoring systems had been fully embedded and used to ensure appropriate action was taken when shortfalls had been identified. The registered manager had ensured that improvements which had been made before the last inspection, were now consistently operated.

People felt safe living at The Red House Care Home. People's risks were known by care staff. Care staff were fully aware of their responsibilities to raise concerns and the registered manager and provider ensured lessons were learnt from any incidents or accidents.

Staff had a detailed knowledge of people's histories, their likes, dislikes and how they wished to be supported. This information was used to support people in a way that valued them as individuals and respected them for who they were. Staff ensured people had access to a wide range of activities that met their individual needs.

The provider and register manager ensured the home was safe, well maintained and free from infection.

Staff were positive about the management of the home and felt valued and respected. This had a significant and positive impact on the quality of care and support of people living at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff had been safely recruited, provided with training relevant to the roles they performed which met people's health and social care needs. There were enough staff to provide people with the personalised care and support they needed.

Everyone was very positive about the registered manager, staff, and their approach to providing personalised care. Quality checks and audits enabled the registered manager to identify risks and actions to ensure quality standards were maintained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 19 August 2019). We identified two breaches of the regulations relating to person centred care and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe,

responsive and well led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The red house care home on our website www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

During our previous inspection we found a number of failings. These included, unsafe recruitment procedures, a lack of staff training and stimulation in the home and poor governance arrangements. Whilst we found improvement at this inspection there were still areas of the service that required development.

The service did always not provide sufficient stimulation for people.

Care plans did not always provide appropriate detail to assist people with their medicines.

Governance systems were not always effective in driving improvement.

Feedback from people, staff and relatives confirmed the management were respected and led by example.

Staff told us that they felt their achievements were recognised and that they felt valued. Staff had a clear understanding of their roles and responsibilities.

People, their families and professionals told us they felt the service was safe. Staff had received safeguarding training and had their competency in this subject checked. They were aware of the types of abuse that could happen to people, what signs to look out for and their responsibilities for reporting any concerns.

The manager had a good understanding of their responsibilities to notify the CQC of important events that happened within the service. People and their families had been given information so that they knew what to expect from the service.

People who required assistance with their medicines were supported by appropriately skilled and qualified staff.

Staff received appropriate induction into their role and learning opportunities were made available.

Staff said they felt supported in their role. They told us they received regular supervision and appraisal.

Staffing levels met the needs of the people using the service. Staff had been recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had good access to healthcare services.

People, their families and other professionals had been involved in an assessment before the service provided any support. The assessment had been used to create care and support plans that addressed people’s individual identified needs. Staff demonstrated a good understanding of the actions they needed to take to support people.

A complaints procedure was in place and people told us they were confident that concerns would be dealt with appropriately by management.

Staff were supported and encouraged to share ideas about how the service could be improved and had been pro-active in supporting changes. They spoke enthusiastically about the positive teamwork and support they received.

Rating at last inspection: The last rating for this service was requires improvement (published 20 June 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected: The service was inspected within our inspection timeframes.

Follow up: We found two breaches of the Health and Social Care Act 2008. You can see what action we have asked the provider to take at the end of this full report.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The RedHouse is a ‘care home’. People in care homes receive accommodation and nursing or 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. The home was providing personal care and accommodation for up to 36 people. The service cared for older people living with dementia, mental health needs or physical disability. The home consisted of three floors accessed by stairs or a lift. During the inspection there were 31 people living in the home

We carried out a comprehensive inspection of The RedHouse in August 2017 where a rating of Requires Improvement was awarded. This was because the management of medicines was not safe. At this inspection we found that improvements had been made to the management of medicines. However, we found concerns around poor recruitment practice, accurate records had not been maintained, staff training was not sufficient and the provider failed to operate a robust quality assurance framework. The service remains as Requires Improvement.

At the time of the 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. During the inspection the registered manager was not available. The provider had put measures in place to ensure the continued running of the service and an interim manager was in post. Throughout the report, we refer to this person as the manager. The manager had been working in that capacity for two weeks before the inspection.

We found that records related to various parts of the service needed improvement, including; recruitment records, staff training records, health and safety records, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) records, topical medical administration records and food and fluid charts.

Monitoring of the service by the registered manager had failed to identify concerns found during this inspection. The provider had not undertaken any additional audits or other processes to identify these concerns. The service had not sought any feedback from people or relatives for the purposes of continually evaluating and improving the service since August 2017.

The provider was unable to demonstrate they applied consistent safe practice when recruiting staff. One recruitment record did not have evidence that a Disclosure and Barring Service (DBS) check had been completed and one record had an unexplained gap of six years in employment history.

The training matrix was not up to date and showed significant gaps in important training for example, manual handling, first aid, Diabetes, falls training, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff told us they worked within guidelines from the National Institute for Health and Care Excellence (NICE) around medicines administration but were unable to tell us about any other current guidelines and best practice they were following. We have made a recommendation about best practice guidelines.

Staff told us that there were sufficient numbers of staff to meet people’s needs and we found this to be the case. However, there did not appear to be enough staff available to ensure that people could participate in meaningful activities when the activities coordinator was not available. We have made a recommendation about the provision of meaningful activities.

The MCA provides a legal framework for making specific decisions on behalf of people who may lack the mental capacity to do so for themselves. We found that the service was working within the principles of the MCA, though records needed improvement.

Staff could recognise signs of abuse and were confident to raise concerns to the manager or other appropriate agency.

Risks to people using the service were assessed and managed by staff. These risks were documented in people’s care records.

Staff knew their responsibilities in infection control and the home was clean and tidy. Rooms were pleasant and personalised to the individual.

Staff received supervision and felt well supported by the manager.

Staff knew people well and we observed them speaking to people in a kind and compassionate way.

Complaints had been investigated and responded to in a timely manner.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The home provides accommodation and personal care for up to 36 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 26 people lived at the home.

There was no 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.

Whilst there has not been a registered manager at the location for two the provider had taken action over this time to ensure there was a manager present at the service in which they intended to be registered with the Commission.

At the last inspection we found that systems were not effective in monitoring the care provided at the service. At this inspection we found there had been an improvement and the manager and provider had carried out their monitoring The regulation had been met.

At our last inspection in February 2017 we found safe medicine practices were not followed. At this inspection we found safe medicines practice continued to not be followed.

People and their relatives said they received a safe service.

The interactions between people and staff were positive. People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home.

Staff had a good understanding of people's needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Staff encouraged people to be independent and promoted people's choice and freedom. People moved freely around the building as they chose.

Care records contained detailed information about how individuals wished to be supported. People's individual method of communication was taken into account and respected. People's risks were well managed, monitored and regularly reviewed to help keep people safe.

People were supported to take part in a range of activities inside the home and they reflected people's interests and hobbies.

People were supported to maintain good health through regular access to health and social care professionals, such GPs and speech and language therapists. People's dietary needs and any risks were understood and met by the staff team.

The manager and most staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported where possible to make everyday choices such as what they wanted to wear, eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

Staff described the management as supportive and approachable. Staff were well supported through induction and on-going training.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

A registered manager was not in post at the home. 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. Although our register shows a registered manager was in post at this home, this person had not worked in the home since March 2016. A manager was employed in the service from March 2016 and applied to become the registered manager; however they had withdrawn this application and left the service in October 2016. A new manager had started at the home in November 2016 and was present at this inspection. They had applied to be the registered manager of the home.

We inspected this home in June 2016 and found the registered provider was not compliant with Regulation 9 (person centred care), Regulation 11 (need for consent) and Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (registration) Regulations 2009. Following this inspection the registered provider sent us an action plan stating they would be compliant with all the required regulations by August 2016. At this inspection we found the registered provider had failed to be compliant with all the required regulations.

Whilst people were supported by staff who understood how to identify signs of abuse and report these appropriately, we nevertheless found incidents of safeguarding were not always identified and investigated in a prompt manner to identify and apply any learning from these incidents in the home.

Whilst medicines were stored safely they were not always managed in a safe and effective manner. The registered provider had identified the need to change the system of administration of medicines.

The risks associated with people’s care needs had been assessed and plans of care were informed by these however these records were not always up to date and available for staff.

There had been a very high turnover of staff in the home and processes were in place to check the suitability of staff to work with people. However not all staff had received training to ensure they had the skills to meet the needs of people and training records were not always up to date.

Health and social care professionals were involved in the care of people and care plans reflected this.

Staff ensured people who were able to consent to their care were involved in making decisions about their care. However, where people could not consent to their care staff were not always guided by proper assessed consideration of the Mental Capacity Act 2005.

People’s nutritional needs were met in line with their preferences and people enjoyed the food they received. People enjoyed activities in the home.

Care plans in place for people reflected their identified needs and the risks associated with these, however these records had not always been updated. People and their relatives were involved in the planning of their care.

There was a lack of consistent and effective leadership and management in the home. Whilst staff felt supported by management there was a lack of structure and awareness of roles and responsibilities in the home. Records held in the home were not always clear, accurate or complete.

Systems and processes which the registered provider had in place at the home to monitor, assess and improve the quality of the service provided had not been effective in identifying the concerns we found at the home.

We have identified two repeat breaches and three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one repeated breach of the Care Quality Commission (Registration) Regulations 2009 during this inspection. You can see what action we have told the registered provider to take at the end of this report.

The RedHouse Care Home provides accommodation, support and care for up to 36 people, some of whom live with dementia. There were 26 people living in the home at the time of our visit. The home is built on three levels and there is a lift between the floors. There are three communal areas on the ground floor where people can socialise and eat their meals if they wish.

Although our register shows a registered manager is in place at this home, this person has not worked in the home since March 2016.

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. A new manager had been appointed and commenced work in the home in March 2016. They had submitted an application to become the registered manager. Throughout the report we refer to this person as the manager.

Prescribed creams and as required medicines, lacked clear guidance and recording of their administration. While risks to people were known to staff these were not always clearly assessed and plans developed to reduce the risks. Some risks were known due to staff’s personal experience rather than training and guidance. Consent was not always sought appropriately. Staff did not fully understand the Mental Capacity Act 2005 and did not implement this appropriately.

Care plans were not always personalised, although staff knew people well. Staff involved people but this process was not formalised and we have made a recommendation about this. People’s nutrition and hydration needs were not effectively monitored and care plans did not always provide clear guidance to staff.

Systems used to assess quality and drive improvement were not effective as they had not been fully embedded and carried out early enough to take prompt action. The systems used by the manager and the provider had not always identified the concerns we had. Records were not accurate and the provider had not notified CQC of authorised Deprivation of Liberty Safeguards.

Staff understood their responsibilities in safeguarding adults at risk. We have made a recommendation that the manager review the way safeguarding investigations are recorded.

Staff had not been receiving the training and support they needed. The new manager was addressing this at the time of the inspection. We made a recommendation about this.

The manager had identified some concerns and had plans to address these. Staff spoke positively of the new manager and the changes they were making.

Staff treated people with dignity and respect. They understood the need for confidentiality. No one we spoke had any complaints but were confident to raise these and feel listened to. Staffing levels were sufficient to meet the needs of people and staff were recruited safely.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

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 caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found-

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and provided care which was in line with their agreed plan of care. People told us staff were kind and responsive to their needs at all times. We saw that people's needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind and respectful manner.

Is the service responsive?

People's needs were assessed and reviewed regularly to ensure their needs were met. People and their representatives were encouraged to participate in care planning and review. The registered manager or deputy manager regularly spoke with people and their representatives to ensure their needs were being met.

People's nutritional needs were met according to their needs and were altered as people's needs or requests changed. This meant that people were able to express their views of the care they received and have them acted upon.

Is the service safe?

People told us they felt safe in the home and when being cared for by staff. People were cared for by staff who had the appropriate skills and experience to ensure their safety and welfare. Staff had a good awareness of the people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw the home had appropriate policies and procedures in place to ensure the safety and welfare of people who were supported with their medicines. This meant people received care which ensured their safety and welfare.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received the care they needed to maintain their independence and dignity. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is the service well-led?

People told us the registered manager and provider were very approachable. Whilst people had not completed a formal feedback questionnaire for the service since our last inspection in June 2013, people told us they were always able to feedback to any of the staff from the home. People told us the staff team worked well together and were very responsive to any concerns or issues they raised.

Staff received appropriate support through supervision sessions and discussions with the registered manager or their deputy. This meant staff were clear about their roles and responsibilities and management were supportive of their roles.

On the day we inspected there were 32 people living at the home. During our inspection we spoke with four members of staff, three relatives and six people who use the service.

We saw that the home was well maintained and that people had access to lounge areas within the home to engage with others and could also access their own private rooms at any time. There was also a smoking area for people to use. We observed people participating in board games in a planned activity session and that a programme of activities was available for people to attend. One person had chosen to remain in their room to watch television. People had personalised their rooms with their own possessions including their own furniture.

We saw that the home risk assessments in place for people who needed equipment to support their independent living safely. We saw that people had their care discussed and agreed with them and that formal agreement to these care plans was in place.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. We observed people at a mealtime have positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. People were given reassurance and support as they needed it at the mealtime. Special dietary needs for people were recognised with a vegetarian diet prepared for one person.