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Inspection carried out on 19 October 2017

During a routine inspection

The Red House provides accommodation and personal care for up to 23 older people. Twenty-two people were living at the home at the time of our inspection visit. The service was rated Good at our previous inspection in July 2016.

Since our previous inspection, we received information of concern about the service. The concerns alleged that risks were not managed, people were offered unsuitable meals, people were not treated with dignity and respect and relatives were not kept informed about changes in their relation’s needs. We undertook this responsive, comprehensive inspection on 19 October 2017, in response to the concerns raised.

The concerns raised with us were not substantiated at this Inspection. The service continued to meet all relevant fundamental standards. The service remained Good in all five questions and Good overall.

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 were protected from the risks of harm or abuse because staff were trained in safeguarding and understood their responsibilities to raise any concerns with the registered manager. The registered manager made sure there were enough suitably skilled, qualified and experienced staff to support people safely and effectively. Medicines were stored, administered and managed safely.

People and their families were included in planning how they were cared for and supported. Risks to people’s individual health and wellbeing were assessed and their care was planned to minimise the risks. The provider and registered manager regularly checked the premises, essential supplies and equipment were well maintained and safe for people to use.

People continued to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink enough to maintain a balanced diet that met their needs and preferences. People were supported to maintain their health and were referred to healthcare professionals when their health needs changed.

People, relatives and staff felt well cared for. Staff understood people’s diverse needs and interests and supported them to enjoy their lives according to their preferences. Staff respected people’s right to privacy and supported people to maintain their dignity.

People were supported and encouraged to socialise in the home and in the local community. People and relatives had no complaints about the service.

People and relatives knew the registered manager well and were invited to share their views of the service through conversation and regular questionnaires. The registered manager and provider regularly checked the quality of the service to make sure people’s needs were met safely and effectively.

Further information is in the detailed findings below.

Inspection carried out on 5 July 2016

During a routine inspection

We inspected this service on 5 July 2016. The inspection was unannounced.

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.

The service provides accommodation and personal care for up to 23 older people who may live with dementia. Twenty people were living at the home on the day of our inspection.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies. The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks.

There were enough staff on duty to meet people’s care and support needs. The registered manager checked staff’s suitability to deliver care and support during the recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

People’s needs were met effectively because staff received appropriate training and support. Staff understood people’s needs and abilities because they read their care plans and worked with experienced staff until they knew people well. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had applied to the Supervisory Body for the authority for to restrict people’s rights, choices or liberty in their best interests. For people with complex needs, their representatives or families and other health professionals were involved in making decisions in their best interests.

People were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs, which minimised risks to their nutrition.

People were cared for by kind and compassionate staff who knew their individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

People and their representatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed and updated when people’s needs changed.

The provider’s quality monitoring system included consulting with people and their relatives to ensure planned improvements were focussed on people’s experience.

Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. Staff were guided and supported in their practice by a registered manager they liked and respected.

Inspection carried out on 8 April 2014

During a routine inspection

During our inspection we spoke with three people who lived at the home, two visitors, the registered manager and three staff. We looked at five outcomes to answer the following questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Most of the people who lived at the home were not able to tell us how they were cared for because of their complex needs. However, we looked at people’s care plans and observed how people were cared for.

Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s care plans were regularly reviewed and changed appropriately when new risks were identified. Relatives told us the manager kept them informed of any changes in their relation’s needs and abilities. Staff told us they knew when people’s needs had changed because they shared information at handover and kept daily written reports.

People received their prescribed medicines when they needed them. Staff made all the necessary arrangements to ensure medicines were obtained, managed, administered and disposed of safely.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. The provider checked staff were suitable to work with vulnerable people and had appropriate skills and experience to support people who lived at the home. Staff told us they felt well prepared to work because they shadowed experienced staff, got to know people and had effective training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The manager had checked with the authorities that their planned actions to keep one person safe were not classed as a deprivation of their liberty. This meant the manager was clear about their responsibilities under DoLs.

Is the service effective?

People’s health and care needs were assessed with them and their relatives, and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs were identified in people’s care plans where required. We saw people’s care plans were reviewed every month and updated to reflect their changing needs.

Each member of staff was a designated ‘best friend’ to three or four people. Staff told us best friends looked after people’s clothes, updated their care plans and liaised with their families. Relatives told us staff were always able to answer their questions about their relations’ care and support needs.

Staff attended mandatory training and training that was relevant to people’s needs. A member of staff told us, “We had dementia training. It was very interesting and really useful. It answered some of my questions.”

Is the service caring?

People were supported by kind and attentive staff. We saw care workers encouraged people to be as independent as possible and to make their own decisions. A member of staff told us, “I like the job, it’s so rewarding. When someone smiles or answers, it’s wonderful.”

We saw a visitor brought some artefacts to the home for a reminiscence session. People were encouraged to share stories about their childhood and previous lives.

Staff were observant and noticed when people needed extra attention. When one person did not eat all of their lunch, we saw a member of staff offered to get them a different meal that they might enjoy more. One person told us, “Staff know what I like. Staff know what time I like to get up and go to bed.” Visitors told us their relation was very well cared for by good staff.

Is the service responsive?

The manager assessed people’s needs before they moved into the home. The manager identified risks to people’s health and well-being and planned the actions staff should take to care for and support them. Staff told us they read people’s care plans and they were given a verbal explanation of people’s needs and life histories.

The care plans we looked at described people’s preferences, likes and dislikes. People told us staff supported them to spend time in their preferred way. People said, “I went to the pub for lunch on Monday. It was lovely” and “The hairdresser comes on Wednesday.”

People told us they saw other health professionals when they needed to. People said, “They will get the doctor for me when I need him” and “I had an eye test and will get some new glasses.”

Is the service well-led?

The manager told us they had organised meetings for people and their relatives, but people did not want to attend formal meetings. Visitors we spoke with told us they preferred to speak with the staff and manager when they visited. They said they could visit when they liked and the staff and manager responded appropriately when they made suggestions for changes.

Staff told us they felt well informed about people’s needs and how the home was managed. Staff were clear about their own roles and responsibilities.

The manager’s quality assurance system included checking there were enough staff, equipment and supplies to meet people’s needs. The manager checked team leaders regularly reviewed people’s care plans and that staff managed people’s medicines safely. The manager monitored and analysed accidents and incidents and took action to minimise the risk of a reoccurrence.

Inspection carried out on 15 May 2013

During a routine inspection

Records we looked at showed that people or their relatives had consented to their care and support when they first moved into the home. Many of the people who lived at the home were not able to speak to us about their care and support because of their complex needs. We observed that staff asked people if they would like to be helped before supporting them. A relative we spoke with told us, “The staff are really absolutely lovely here.”

The three care plans we looked at minimised risks to people's health and well being. We saw that people’s needs and abilities were assessed and detailed instructions for staff were written. People’s preferences were identified and we saw that staff understood people well.

The provider followed the Department of Health guidance to prevent and control the risk of infection. The home was clean and organised so that people could live there comfortably.

Staff we spoke with told us they felt well prepared to work with the people who lived at the home. They told us they received regular training and worked as a team. Care staff we spoke with told us the manager always responded to suggestions and they had plenty of opportunities to raise any issues. One member of care staff told us, "You need to have a real interest and passion for the work."

The manager had an effective quality assurance system which included checking that people received the care and support they needed. The manager responded to people’s changing needs and abilities.

Inspection carried out on 4 July 2012

During a themed inspection looking at Dignity and Nutrition

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 and drink 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 CQC inspector joined by an Expert by Experience, that is a person who has experience of using services and who can provide that perspective.

Many of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We talked with seven people who lived at the home, a relative and three staff. We looked at the care plans for five people who lived at the home to see how their needs should be met. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Everyone we talked with said that the staff were all very kind. One person said, “The staff are very good to me,” and another person said, “Staff are never too busy.” A relative told us they were very happy with the care and support their relation received.

Reports under our old system of regulation (including those from before CQC was created)