Redcote House Residential Care Home

Redcote House Residential Home is a residential care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 18 people.

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

Records for medicines did not always accurately reflect stock and information for administration was not always clear. Staff did not always receive safeguarding training but understood how to keep people safe. Some equipment was damaged which posed a risk to infection control, however, staff took other measures to reduce the risk of infection to people. We made a recommendation in relation to equipment which poses an infection risk.

Quality assurance processes were in place where some shortfalls had been identified. However, some shortfalls had not been identified prior to inspection and where they had, actions had not always been prioritised. We made a recommendation in relation to timely action following audits.

The environment was worn and required updated. Some staff did not receive ongoing training nor on induction. We made a recommendation in relation to training and the environment.

Accidents and incidents were recorded and monitored. Risks associated with people’s care had been identified and measure were put in place to reduce the risk of avoidable harm. The registered provider carried out pre-employment checks on staff.

Staff shared a vision with the registered manager to deliver good care to people. Staff and relatives spoke highly of the management team. The registered manager understood their duty to be open and honest. The service worked with others to promote positive outcomes for people.

People were supported to maintain a diet they enjoyed. People’s needs had been assessed prior to admission to the service. Staff worked with other healthcare professionals. People’s capacity had been assessed. People’s end of life care wishes had been recorded.

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 interacted and engaged with people using the service in a positive way. Staff knew the people they were supporting well. People’s dignity was considered and respected. People were given choice in care.

People had comprehensive care plans in place. Activities were available to people which were organised around their hobbies and interests. Complaints were investigated and responded to appropriately. Information was available to people in different formats.

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

Rating at last inspection

The last rating for this service was good (published 13 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

At the last inspection on 31 March 2015 December the home was rated Good. At this inspection we found the home remained Good.

Our inspection was carried out on 20 June 2017 and was unannounced.

The home was run by a company that was the registered provider. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. In this report when we speak about both the company and the registered manager we sometimes refer to them as being, ‘The registered persons’.

Staff knew how to respond to any concerns they identified so that people were kept safe from harm. People were helped to promote their wellbeing and staff followed the care needs identified for each person in order to reduce the risk of accidents occurring.

Background checks had been completed before any new staff started to work at the home and there were enough staff available over each shift to ensure people’s social and health care needs were met.

Staff had received the right levels of training and guidance and had the skills each needed in order to care for people in the ways required. In addition, people had been supported to receive all of the healthcare assistance they needed. Arrangements were also in place for helping people to take the medicines they needed safely.

People received all of the help they needed to maintain their physical health and had access to the food and drinks they enjoyed and needed to ensure they maintained a balanced diet.

People had been consulted with regarding the care and support they needed and were able to undertake a range of planned and individual activities in order to help them maintain and further develop any interests they had.

People were involved in making decisions about their care and how they wanted to be supported. The registered manager had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken the necessary steps needed to ensure that people’s rights were protected. At the time of this inspection seven people had their freedom restricted and the registered persons had acted in accordance with the Mental Capacity Act 2005 (MCA).

Staff understood people’s needs, wishes and preferences and people were treated with kindness and compassion. The registered manager and staff recognised people’s right to privacy, promoted their dignity and respected confidential information. People had access to information about advocacy services so that they could make informed choices about using these if they chose to.

There were systems in place for handling and resolving any concerns or complaints they received from people and the registered persons had ensured the home was run in an open and inclusive way.

People benefitted from staff acting on good practice guidance and learning and staff were encouraged to speak out if they had any concerns.

The registered persons had a range of meetings, checks and audit systems in place to enable them to assess, monitor and continually improve the quality of the services they provided.

The evidence we reviewed demonstrated the provider had taken action to ensure systems were in place to reduce the risk and spread of infection and they were followed appropriately.

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at people's care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

During our inspection we focused on our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

When we visited there were 17 people living at the home. A single inspector carried out this inspection.

We spoke with three people and also observed how staff provided care and support to people who lived in the home. This was because some people either chose not to speak with us or had problems with their memory and could not tell directly us about their experiences of the care they received.

We also spoke with four visiting relatives, the manager, home owner, five staff members and a local doctor who visited the service.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service caring?

One person told us, 'The staff are very caring. They talk to us like people and are respectful.' A visiting relative said, 'I think the staff are very caring and I like the fact it's a small home. It always feels very homely.'

Throughout our inspection we observed staff were sensitive in their approach to meeting people's needs. We saw people were supported to have the care they needed, when they needed it.

Is the service responsive?

Records showed people were involved in an assessment of their needs and care was given by staff who knew about each person's individual needs. Where changes to care needs had been identified, staff acted promptly to update records and respond to the changes needed.

The manager and home owner confirmed any concerns raised with them had been addressed straight away and we found responses had been open and timely. People could therefore be assured that informal concerns were addressed and systems were in place to make sure more formal complaints would be investigated in the right way.

Is the service safe?

People told us that they felt safe living at the home. We saw safeguarding procedures were in place and that staff understood how to safeguard the people they supported.

The manager had policies and procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant people were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements.

Equipment was well maintained and serviced regularly and therefore did not put people at unnecessary risk. We saw staff used the right ways to move people around the home with equipment such as hoists and wheelchairs. Up to date risk assessments were in place for issues such as falls, fire evacuation and nutrition.

Accidents and incidents were appropriately recorded and body charts were in place to identify any injury to a person.

Systems were in place to reduce the risk and spread of infection. However, they were not always appropriately followed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of risks related to infection control.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

We also saw where risks had been identified reviews had been undertaken together with the person and their representative to identify how the risk could be reduced.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The service worked well with other agencies and services to ensure people received their care in a joined up way. The manager had a quality assurance system and records seen by us showed that any shortfalls identified were addressed in the right way.

As part of our inspection visit we spoke with six people who lived at the home and five relatives who visited the home. We also spoke with the manager, home owner and four staff members.

People told us staff were caring and responsive. One person said, 'They (staff) treat you like normal people.' Another person commented, 'I'm not just saying this because you are here but you only have to press a bell at night and staff are there.'

We found people were supported to undertake activities of their choice. One person said they liked listening to music. The person said. 'We do exercise to music, it's fun and I just enjoy being around people.'

People said they enjoyed all the meals at the home. A relative commented, 'I visit two or three times a week unannounced and the food is consistently good. They provide homely meals here and I think that's good.'

Staff told us they received the training and support they needed from senior staff and the manager to meet people's needs.

The home owners and manager demonstrated they took action to respond to any issues raised with them and learned lessons from them.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We asked the provider to tell us how they were going to address the issues we raised and they sent us an action plan in a timely manner.

During this visit we saw the actions the provider said they would take had been completed. For example, we saw all of the staff had a training file and a personal training plan.

We did not speak with people who used the service or staff during this visit.

Comments included,"I feel safe and secure here" and "Staff look after me well."

During the visit we spoke with visitors who expressed their satisfaction with the standards of care at the home. They told us the staff were very good, friendly and patient.