Archived: The Red House Nursing Home

The Red House 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 Red House accommodates 31 older people in one adapted building. There were 27 people using the service at the time of our inspection. Most people using the service were able to tell staff how they preferred their care provided. No one using the service had complex or high risk health care needs.

The manager began working at the service in January 2018 and intended to apply to be registered but had not yet applied to CQC to be registered. 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. Staff told us the manager was approachable and supportive.

At the last inspection on 17 November 2016, we asked the provider to take action to make improvements to the way they managed medicines, supported staff and checked the quality of the service. Action had not been taken and the shortfalls continued. At this inspection we found further shortfalls in relation to the governance of the service, staff recruitment and the management of infection control risks. The rating for the key questions responsive and well-led had deteriorated.

The provider did not have oversight of the service, had not ensured that effective governance processes were in operation and did not have a clear vision for the service. They had not checked the quality of the service and relied on information provided by staff without checking it. Policies and procedures staff relied on had not been reviewed to make sure they reflected current guidance. Shortfalls we found had not been identified so action could be planned and implemented to address them and make sure they did not occur again.

The provider had not informed CQC when they ceased to be in day to day charge of the service and had delegated this responsibility to their family. The manager understood their role and responsibilities. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service.

Records in respect of how the service operates and each person were not accurate and complete and could not be used to review the quality of the service. The manager was unable to find much of the information we requested during our inspection. Guidance for staff about the care and treatment people required was not sufficiently detailed.

There were enough staff to provide the care and support people needed when they wanted it. However, the required recruitment checks had not been completed for all staff. Checks to make sure nurses were registered with the Nursing and Midwifery Council and kept their skills and knowledge up to date had not been completed. Disclosure and Barring Service (DBS) criminal records checks had been completed.

Records of the training staff had completed had not been maintained and the manager had not planned staffs’ training and development to make sure they were able to fulfil their role. Some staff had not had the opportunity to meet with a manager to discuss their role and any concerns they had since our last inspection. Nurses had not been offered regular clinical supervision to discuss their nursing practice.

The way people’s medicines were managed had not improved since our last inspection. Medicines were not always stored securely and some medicines had not been sent for destruction. Guidance was not available about how people preferred to take their medicines and how ‘when required’ medicines should be managed. Medical devices which were no longer or rarely used had not been serviced or removed and there was a risk that they may be used.

The provider did not have effective infection control processes in operation. Infection control audits were not completed and infection risks had not been identified.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however the policies and systems in the service did not consistently supported this practice. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and knew when assessments of people’s capacity to make decisions were needed. Staff assumed people had capacity and offered them any support they needed to make decisions.

The manager had taken action to reduce the risk of accidents happening again after each accident occurred. However, accidents and incidents had not been analysed to identify any ongoing patterns and trends so action could be taken to stop them happening again.

The manager had identified that people had not been offered the opportunity to fully discuss their end of life wishes and had plans in place to do this. People who had chosen to receive their end of life care at The Red House had been supported to do so by staff, health care professionals and their loved ones.

The building was well maintained and systems such as the fire detection and hot water systems were checked regularly to make sure they were safe and effective. The building and grounds were accessible to everyone, and plans were in place to further improve people’s access to all areas of the garden.

Staff felt supported by the manager and worked as a team to meet people’s needs. The manager was taking action to make sure all the staff were clear about their roles and responsibilities. A member of the management team was always available to provide the support and guidance staff needed.

Staff were kind and caring to people and treated them with dignity and respect at all times. People told us staff gave them privacy. Everyone was encouraged and supported to be as independent as they wanted to be. People told us they had enough to do each day and enjoyed a range of activities.

People were not discriminated against and received care tailored to them. Assessments of people’s needs were completed in line with best practice and any risks had been identified and managed. People had planned their care and treatment with staff and received support to meet their individual needs and preferences.

Changes in people’s health were identified quickly and staff supported people to contact their health care professionals. Staff followed the advice of people’s doctors. People were offered a balanced diet, which met their needs and preferences. People had been involved in planning the menus and suggestions they had made, such as more fresh vegetables, had been acted on.

Staff knew the signs of abuse and were confident to raise any concerns they had with the manager and provider. A process was in place to investigate and responded to complaints. People told us they were confident to raise any concerns they had. The views of people, their relatives, and community professionals were asked for and acted on.

The manager had a willingness to work in partnership with others including the local authority safeguarding team and Clinical Nurse Specialist for Older People to develop the service and keep their skills up to date.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating under their previous legal entity in the entrance hall of the service and on their website.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of the inspection there were 24 people using the service.

On the day of our inspection there was a registered manager in place. 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 risk of avoidable harm or abuse because staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were regularly assessed and reviewed, although care planning and risk assessing the risks in relation to people’s medicines were not always in place. Protocols for the administration of ‘as needed’ medicines needed to be implemented. There were enough staff to keep people safe and no unnecessary restrictions were placed on people.

Staff completed an induction prior to commencing their role, although a formal induction for agency staff was not in place. The majority of staff training was up to date with courses booked where needed. A more consistent approach to ensuring all staff received regular supervision of their work was needed.

The principles of the Mental Capacity Act (2005) had not always been consistently followed when decisions were made about people’s care. Where needed, appropriate deprivation of liberty safeguards were in place. People raised concerns about the quality of the food. People’s day to day health needs were met by staff, but this was not always reflected in their care records. People had access to external healthcare professionals and referrals to relevant health services were made where needed.

Staff understood people’s needs; they showed a genuine interest in what they had to say and were kind, caring and compassionate. People’s privacy and dignity were maintained and staff spoke with them in a respectful way. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

People spoke positively about the activities provided at the home. People’s care records were person centred and focused on providing them with care and support in the way in which they wanted. People were provided with the information they needed if they wished to make a complaint, although some people were unaware of the process for doing so.

Quality assurance processes were in place, although these were not always effective in identifying areas that required improving at the home. People were encouraged to provide feedback about the quality of the service and this information was used to make improvements where needed. Staff enjoyed their job and spoke highly of the management team. Staff understood and could explain how they would use the whistleblowing process.

People told us that they received the care and support they needed to remain well and healthy. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans had been completed when a care need or a risk was evident. Care plans had specific detail about how to meet the person's needs. Potential risks were identified and assessed. This included the risks of malnutrition, dehydration, pain and sore skin. The service worked proactively and took action to help maintain people's health and well-being. This meant that staff had the guidance to follow about how to support people's needs and reduce potential risks

There were effective systems in place for checking the quality of the service. People told us they were asked about what they thought of the care and support that they received. One person said, 'The staff always ask me if everything is alright and if there is anything else that I need, they are very obliging and do everything they can to make my life comfortable'.

We found that where possible people were asked to give consent and were involved in the decisions about the care and support they received. People told us that they were asked for consent before any care took place and their wishes respected. One person said, "The staff always ask me if it is alright if they do something. They explain what they need to do".

Some people told us that they thought they received the care and support they needed to remain well and healthy. However, we found that although people's needs were assessed, care and treatment was not always planned and delivered in line with their individual care plan. Some care plans had not been completed when a care need or a risk was evident. This meant that staff had no guidance to follow about how to support people's needs and reduce potential risks. We found some plans that had identified risk were not being adhered to by the staff and therefore left people at risk.

People received their medicines safely and when they needed them.

There was enough staff on duty to meet support and meet people's needs. People and their relatives told us that staffing levels were satisfactory and we saw that staff attended to people promptly when they needed attention.

There were systems in place for checking the quality of the service but some of these were not effective.