Aurem Care (The Red House)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the safe monitoring of people’s care and staff deployment and training.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

A relative fed back, “I feel confident that I will be contacted if there are any changes or concerns and that changes in mum’s health or wellbeing will be noticed and acted on.”

Staff were encouraged and supported to raise concerns about risks to safety, and people told us when they had raised concerns, action was taken immediately. Safety incidents were recorded and investigated. The registered manager told us safety incidents were used as an opportunity for learning, and staff confirmed this. We saw as a result of 1 person having more frequent falls they had consented to having a sensor mat as a precaution.

The registered manager told us, “We investigate, we do the reflective account, how we could have avoided that. If it is individual staff involved, they do separate learning sessions, supervisions, and then their reflective account on what happened, how that could be avoided, and in the future, what will change their practice, looking into that reflecting on that incident.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People and relatives spoke positively of the referral process which showed how the collaborative approach between external professionals and the service worked in practice. One person told us, “I came from hospital about 3 years ago and there were no problems, it went smoothly.”

The collaborative approach, between health and social care partners ensured the safe transfer of people between services. The registered manager told us, “When we have admissions, before the admission, family come in, I invite them to come and have a look around. I'll have a good chat with them, take all the details and see whether we can take the precedence according to our settings here. Once they confirm that we are happy, we go and do the assessment wherever they are in the home or hospital.” A health professional told us, “The Red House has an excellent reputation for careful planning of discharges so that patients return home feeling well supported and safe.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and relatives said they felt safe with staff and knew how to escalate concerns about their safety. Comments included, “Very safe, extremely safe. If I needed to, I would talk to my [family member] and she would speak to them” and “She’s safe and well looked after”.

Staff understood safeguarding adults procedures and what to do if they suspected any type of abuse. They told us, “If it was bruises, I would fill in the skin integrity form and report it to the nurse. It is important they know about it” and “[Registered manager] is very strict at reporting everything as a safeguarding. I will often say to her, ‘it’s only a small skin tear, it’s not a safeguarding’ but she insists.”

There was a safeguarding adults policy that staff were able to access, and staff had received training in safeguarding people. The registered manager had systems and processes for the management and escalation of safeguarding concerns.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We fed back to the provider that more detailed information was needed in relation to decisions around restrictions, particularly around the use of CCTV, the provider understood their responsibility in relation to safeguarding people’s rights and what would constitute a restrictive practice. Applications were submitted to the local authority, and we saw that applications had considered the least restrictive ways and involved relevant partners in the decision-making process.

The provider did not always ensure that they worked well with staff to understand and manage risks associated with people’s care.

Where people had a catheter, staff were required to record the levels of urine output. However, according to the catheter reports, staff were more often than not, failing to do this. Accurate monitoring is crucial because urinary output is a direct, indicator of a person’s kidney function and hydration status. The registered manager told us they did not require staff to routinely record a person’s fluid intake unless they had identified a concern. They told us that currently, “We don't need to monitor them. There is no reason for it.” However, where people did have a catheter, the risk assessment stated that the person’s fluid intake needed to be monitored which we found was not happening. Recording this information is crucial for maintaining a balance between the fluids consumed and the urine drained, ensuring the catheter functions correctly and the person remains hydrated.

Where people were at risk of constipation, staff were often not recording either the type of bowel movement or whether the person had opened their bowels. Poor documentation hides the progression of constipation, prevents early intervention, and can lead to significant health issues. We raised this concern with the registered manager who provided us with an action plan of how they had addressed this.

We also saw from a risk assessment guidance for staff on what a seizure may look like. However, this was not person-centred and lacked information on the history of the person’s seizures, the type of seizure they used to have, and at what stage staff needed to ring 999 after a seizure occurred. We note that the person had not had any recent seizures however should this occur, a delay in emergency intervention could result in significant health concerns.

Staff told us the care plans were very long, so it was difficult to recall all of the information around people’s risk. Staff we spoke with did not always have knowledge around people’s health needs.

However, we did find other risks associated with people’s care were managed in safe way. This included the management of falls and pressure sores. We observed that where people needed to be repositioned to reduce the risk of pressure sores, this was being done. We did observe people being hoisted safety with staff clearly explaining the process to people to reduce the risk of anxiety. One person told us, “I can’t walk so I have to be hoisted onto the commode, I don’t like it, but I do feel safe as I can’t fall”.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment and facilities supported the delivery of safe care.

Whilst we acknowledge the service was an aging building, we identified concerns with the day-to-day maintenance which placed people at risk. In 1 person’s room the socket was hanging loose from the wall. In 2 rooms the curtains were hanging off the rail. In one of the communal corridors there was a slight incline and decline and at each end which was hidden under the carpet and was a trip hazard. In some people’s rooms the portable hoist used to safely transfer people from their beds was not stored away. These were left on the bedroom floor with 1 still plugged in at the wall which was a trip hazard for people.

There were elements to the fire safety protocols that were not robust. We saw from the fire safety grab folder that 2 people’s Personal Evacuation Plans stated the wrong room the person was in. This meant emergency services would not have accurate information on people in the service. On the day of the visit there was required to be a fire alarm test at 10.00am however this did not take place. Also, we noted that there was a door connecting 2 people’s room’s and on both sides of the door it stated this was the fire exit. This could cause confusion for people and staff on which way they were required to leave in the event of a fire.

We did find regular other Health and Safety checks were undertaken by the maintenance team including water temperature, electrical tests and mobility equipment checks.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

Some people told us they did not always feel there were sufficient staff particularly at night. Comments included, “If I press the buzzer they take a long time”, “I’ve said I’m a little upset as my pad has been overflowing and I had to stay all night soaking wet”, “Getting up I need a carer and it can take a time for them to come so I have to wait” and “They seem to be dealing with a lot of clients but I do think they could do with employing more people”. One external professional fed back that they recommended, “Maintaining consistent staffing levels during busy periods to ensure the highest standards are upheld at all times.”

The registered manager told us there was required to be 2 nurses all day and 5 care staff on duty in the morning reducing to 4 care staff in the afternoon. However, according to 2 weeks of rotas for April 2026, there were 4 days where there was only 1 nurse. There were 5 days where the second nurse was the registered manager and there were other days where 1 of the 2 nurses was undertaking training. In addition, there were times where care staff who were included in the rotas as one of the 5 on duty were also required to attend 3 hours of training. This meant they would not be available to support people during this duration.

On the day of the visit, whilst we observed there were plenty of staff available, some of the staff providing care included ancillary staff. This included the housekeeping and maintenance staff who, for the majority of the day, were supporting people in the lounge with care staff. The registered manager told us they had a ‘whole home approach’. They said, “The main thing here, all our staff, including [ancillary staff], when they finish their work, they have to spend time with the residents.” Whilst this is positive to a ‘whole home approach’, we found it was impacting on the duties the ancillary staff were employed to undertake. This included maintenance and cleanliness concerns.

The registered manager told us that all staff, regardless of their employed role, would undertake all training including falls training. However, when we reviewed the training matrix, it was recorded that falls training was not applicable for 7 staff and 4 other staff members’ training was out of date. It was recorded that diabetes training was not applicable for all the care staff despite there being several people with this health condition. There was no evidence that any staff had received training on Dementia or Parkinson’s despite supporting people with these health conditions.

Where new staff started work, there was a lack of confidence from people around the effectiveness of their work. One person told us, “Some of the new [staff] they employ, can’t understand you, [due to their level of English]’. Most know what they are doing but new staff don’t always understand, I think it’s a language problem.” Some staff we spoke with were not able to tell us people’s primary health condition with one telling us, “I am not aware of any medical conditions.”

There were people and relatives who felt there were enough staff, comments included. “There are enough staff. I don’t feel rushed”, “Not short staffed, there are always people milling around” and “There seems to be a lot of staff. There is always someone in the conservatory and they are quick to get help if you need it.”

The provider did not always ensure the service was cleaned appropriately.

Hygiene and cleaning standards were inconsistent at the service. When we arrived, we noted a smell of urine which we identified came from 2 people’s rooms. We also observed a senior member of staff handed a member of staff an air freshener which they used to spray the corridors. The registered manager has since confirmed the carpets in these 2 rooms are now being replaced.

The building was aged and furnishings and furniture were in a state of disrepair making it difficult for effective cleaning to take place. This included walls, handrails, skirting, flooring and the laundry room. We were told there were plans in place to renovate these areas. However, there were areas that, despite the age of the building would have benefited from more appropriate cleaning. For example, in 1 of the bathrooms, staff had recorded this had been cleaned at 09.30. However, when we entered this room after this, the toilet seat and flooring had not been cleaned. We observed the housekeeping staff spent the majority of the inspection interacting with people in the lounge.

Other areas of the service were cleaned well including the medicine room, communal rooms and some people’s bedrooms. Comments from people and relatives included, “When they’re cleaning the room, I have to go downstairs, it’s about every two weeks. I like everything neat and tidy” and “She is always immaculately clean with clean clothes every day and her hair done nicely.”

The provider did not always make sure that medicines and treatments were safe.

Whilst the majority of people received their medicine as prescribed, there were some elements to the management of medicines that were unsafe. We identified that staff were not always following the prescription guidance in relation to the length of time given between doses of an ‘as and when’ anti-psychotic medicine. They were also not clearly recording what steps they had taken before they resorted to giving the medicine.

We raised with the registered manager who confirmed they had taken action to address this. We also found that ‘as and when’ medicine required more person-centred information relating to people.

Staff were trained, and had competency checks to help ensure they were able to administer medicines safely. The provider had newly introduced a new electronic system for managing medicines. Staff told us this helped with administration and oversight. Medicine administration records had no gaps and there was clear information around how people preferred to take their medicines. One relative fed back, “My [family member] hasn’t had too many health issues but her medication is administered and recorded well, and I get regular feedback from the nursing team.”