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Inspection carried out on 29 January 2019

During a routine inspection

About the service:

Scarlet House is a nursing care home for up to 86 older people and people living with dementia. At the time of our inspection 65 people were living at Scarlet House or were staying at the home for short term respite.

The service had a manager registered with the Care Quality Commission. On the 1 February 2019, the manager became registered with the CQC. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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

Rating at last inspection:

We previously inspected the service on 13 and 15 November 2017 and awarded a rating of Requires Improvement. (The last report was published 19 January 2018). The provider had taken the required improvement actions and our rating of the service improved at this inspection. The legal requirement regarding people’s person-centred care had been met. However, the provider needed time to make some further improvements to ensure people always received person centred care, especially those living with dementia, to avoid breaching this legal requirement again in future and to improve the service.

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We also follow up on progress against agreed action plans to address the breaches in regulation we found at our previous inspection in November 2017. Previous CQC ratings and the time since the last inspection were also taken into consideration.

People’s experience of using this service:

• People were safe living at Scarlet House.

• People did not always receive fully person-centred care. People told us sometimes staff didn’t always do the little things which would make them more comfortable. The manager and provider were aware of this and were taking action to improve staff skills, particularly in relation to training in supporting people living with dementia.

• People’s care records were not always current or reflective of their needs. People’s care plans were starting to become person centred, following improvement plans of the provider.

• People had access to a range of activities and events which they enjoyed, including music and movement and engagement from local community organisations.

• The manager and provider had clear plans to increase the stimulation and support people living with dementia received. This included refurbishment of the home’s nursing dementia unit to promote people’s independence and wellbeing.

• People’s dignity and rights were protected. People were supported by caring and compassionate staff.

• People and their relatives felt the service had improved since we had last inspected in November 2017. They felt the manager was approachable and were hoping for continued stability in the day to day management of the home.

• Care and nursing staff spoke positively about the service and felt they were supported and had access to appropriate training. Staff discussed the training and support they were receiving with the aim of the service making sustained improvements.

• People’s individual dietary needs and preferences were met.

• The provider and manager had a clear improvement plan for Scarlet House and had taken actions to ensure people’s needs were being met and their wellbeing maintained. This included a screening of new clients to ensure staff had the skills they required to meet their needs.

• The provider had provided additional support for the service whilst the management team became settled.

• The manager had a clear vision for the service and spoke positively about the changes they had made.

• People’s needs were met by sufficient numbers of staff who were available to ensure people’s safety and well-being.

• Staff understood their responsibility to report concerns and poor practices

Inspection carried out on 13 November 2017

During a routine inspection

We inspected Scarlet House on the 13 and 15 November 2017. Scarlet House provides accommodation, nursing and personal care to 86 older people and people living with dementia. It also provides short term respite for people as well as people who require rehabilitation support. At the time of our visit 80 people were using the service. Scarlet House is located near Stroud in Gloucestershire. The home is located closely to a range of amenities. This was an unannounced inspection.

We carried out this inspection following concerns raised to us by the provider and local authority safeguarding team regarding the quality of the service. We also reviewed information provided by the HM Coroner in relation to the service and an on-going inquest.

We last inspected the home on 14, 15 and 19 April 2016. At the April 2016 inspection we rated the service as “Good”. We found the provider was meeting all of the requirements of the regulations at that time. At this inspection we rated the service ‘Requires Improvement’ overall.

A registered manager was not in position at the service, the registered manager had previously left the service and an interim manager had been appointed. They were planning to register with CQC until a permanent manger had been recruited. 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 did not always receive care which was personalised to their individual needs. Some staff did not yet have the confidence to follow up on people’s well-being concerns and ensure people received the support of healthcare professionals. Opportunities had not always been taken by the service and staff to ensure people received care which ensured their wellbeing and cultural needs were met and maintained.

People and their relatives told us they or their relatives were safe living at the home and enjoyed the meals they received. Care and nursing staff treated people with dignity and ensured they had their nutritional needs met and received their medicines as prescribed. Catering and care staff were aware of and met people’s individual dietary needs.

There were enough staff deployed to ensure people’s needs were being met. Care staff were receiving the training they needed to meet people’s needs. Staff spoke positively about the change in management and felt they were now receiving the support and communication they required.

Care staff were caring and were aware of people’s health needs. Care staff treated people with dignity. People and their relatives felt their concerns and views were listened to and acted upon. Relatives told us they were informed of changes and felt the new management team was responsive and approachable.

The manager and provider had implemented system to monitor and improve the quality of service people received at Scarlet House. Progress was being made to improve the service however a range of actions identified by the provider and manager were still to be completed.

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.

Inspection carried out on 14 April 2016

During a routine inspection

This unannounced inspection took place on 14, 15 and 19 April 2016.

Scarlet House provides nursing, residential and respite care for up to 86 people. At the time of our inspection 79 people were living there. There was a registered manager. 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. There was one legal breach of legal requirements at the last inspection in March 2015.

People were provided with personalised care and support. Staff knew what they valued and how they liked to be supported. Their interests and life histories were recorded to help staff get to know them well. Relatives told us the staff communicated with them and they were confident staff cared for people with compassion and dignity. Healthcare professionals supported people and told us the staff were kind and calm particularly when people were living with dementia and became anxious.

Peoples care was regularly reviewed and any specific care needs were recorded and evaluated to record progress. People had freedom to access all areas of the home and any risks were identified and minimised. Some people needed individual staff to support them most of the time and staff were sensitive to their privacy and dignity. The homes café was a place where people and their visitors could spend time together and make their own drinks and enjoy the homemade snacks provided.

There was a range of activities provided and people joined in with them. People’s individual interests were catered for and they requested activities they liked. There were art sessions, arm chair exercises, baking and regular films in the cinema. There were good links with the community where school children visited and people went to their school. A gentlemen’s club took place in a local pub and ladies enjoyed knit and natter sessions. People had a good choice of meals and special diets were provided. The catering staff knew peoples likes and dislikes and made sure the menus included their preferences.

People were supported by staff who were well trained and had access to training to develop their knowledge. There were sufficient staff and they were well supported to fulfil their role. Relatives and people told us the staff were kind and always cheerful and showed compassion for their wellbeing. Staff knew how to keep people safe and were trained to report any concerns.

The registered manager monitored the quality of the service with regular audits and when necessary action was taken. People and their relative’s views and concerns were taken seriously. They contributed in meetings and regular reviews of the service and improvements were made. Staff meetings were held and staff were able to contribute to the running of the home.

Inspection carried out on 17 and 18 March 2015

During a routine inspection

This inspection was conducted over two days on the 17 and 18 March 2015 and was unannounced. Scarlet House can accommodate up to 86 people. At the time of the inspection there were 42 people living in the home. The home had opened in September 2014.

Scarlet House was divided into four units. There were two residential units on the ground floor, a nursing and a dementia unit on the first floor. Each unit was self-contained with a lounge, kitchenette, dining area and activity rooms. Staff were designated to work in a particular area to provide the care support to people. Nursing staff were working in both the nursing and dementia unit.

There was a registered manager working at the service. 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’s medicines were not always managed safely. People were protected against abuse because staff had received training on safeguarding adults and they knew what to do if an allegation of abuse was raised. People were observed moving freely around their home.

People received a safe service because risks to their health and safety were being well managed. Staff were aware of the potential risks to people and the action they should take to minimise these.

People were receiving care that was effective and responsive to their changing needs. Care plans were in place that described how the person would like to be supported and these were kept under review. Some improvements were required as there were gaps in recordings on the delivery of care for people. This included food and fluid intake and positional changes for people.

People had access to healthcare professionals when they became unwell or required specialist help. They were encouraged to be independent and were encouraged to participate in activities both in the home and the local community.

People were treated in a dignified, caring manner which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done through involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care. Newly appointed staff underwent a thorough recruitment process before commencing work with people.

The service was well led. There was a team that was supported by a registered manager. Staff confirmed they received support and guidance from the management of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We completed this inspection at a time when the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were in force. However, the regulations changed on 1 April 2015, therefore this is what we have reported on. You can see what action we told the provider to take at the back of the full version of this report.