Red House Residential Home

This service is registered to provide both a domiciliary care agency and a residential service. It provides personal care to people living in their own houses and flats in the community. Red House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 11 people living at Red House. It is registered for 15 people. There was also a person coming in once a week for day care. The domiciliary care service supported 20 people.

Red house had shared communal areas and individual bedrooms on the ground and first floor. There are separate offices at the back of the house from where the domiciliary service is managed from.

The service had a registered manager overseeing two residential services in the local area of Thetford. Both come under separate registrations so require separate inspections. Attached to Red house residential service there is also a domiciliary care service which is registered under the same umbrella as the residential service. The general manager has responsibility and oversight for this service. They have delegated some responsibility to another member of staff who oversaw and managed the staff and coordinated the care.

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.

Improvements were noted at this inspection with regards to the safe administration of people’s medicines. We identified a few things which could be improved upon and these were actioned straight away by the general manager.

We found on the whole this was a solid good service which was small and personable. It also offered flexibility in as much as it supported people in their own homes as far as possible but also provided residential and some day care. This meant they could support people with a wide range of needs and had enough staff to do so. The service was well planned and well managed so people felt safe with their care delivery and found the service reliable. The only exception to this is some people living in the residential home raised concern about only having one member of night staff on duty. However, there was an on-call system and we did not find any evidence that people’s needs were not met at night.

Risks to people’s safety were well managed and the environment had been assessed as safe. Where risks were identified there were sufficient control measures to reduce the level of risk as far as reasonably possible.

Staff were well supported and were only appointed after going through a recruitment process. This could be a bit more robust to help ensure only suitable staff were employed.

The service was hygienically clean but refurbishment of the service meant it was difficult to assess this completely. People living in their own homes received support around their assessed needs which might include support with personal care, taking medicines, managing a home or social support.

The service monitored accidents and incidents and took steps to reduce these whenever possible. They also ensured staff learnt from specific events to help ensure they did not happen again.

Staff received training, induction and support around their specific job role. This could be explored further to ensure staff support was adequately recorded and staff were supported in accordance with the regulated activity they were carrying out.

Where needed, people were supported to eat and drink in sufficient quantities. People’s weights were monitored to help ensure a healthy weight was promoted and people stayed sufficiently hydrated.

People or, where appropriate, their relatives, consented to their care and their choices were respected. Staff had received training in the Mental Capacity Act 2005 (MCA). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. There remained some confusion in records with regards to consent to care and treatment but it was clear that people, or their relatives if appropriate, were being asked.

People had their health care needs met and there was enough information for staff about how to meet people’s needs. Some additional training around people’s specific needs might be helpful.

People had their needs assessed, planned for and reviewed and received effective care.

Care was provided around people’s preferred routines and preferences and care staff were respectful of people’s cultural needs and need for privacy.

People felt consulted about their care needs and the service considered feedback from people whether it was positive or less so. There was an established complaints procedure and a quality assurance system.

Some activities were provided in the residential service and people were supported to stay active and engaged. This varied from person to person and some felt there were not enough activities.

The service was well managed and transparent. All the staff from the general manager to the care staff contributed to the smooth running of both services.

Staff and people using the service had confidence in it and felt it to be well managed and well organised. This reduced risks and enhanced people’s wellbeing.

This was an unannounced inspection of the care home and home care office and took place on 29 March 2017. Phone calls were made to people who received care in their homes over the following week. The inspection was completed by one inspector.

Both the care home service and support to people in their own homes had a registered manager in post, one for each type of service. This was different from our last inspection, where one registered manager oversaw both sections of 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. The registrations for both managers were completed early in 2017, a year after our last inspection.

At our last inspection of this service in January 2016, we found two breaches of regulations in respect of the care provided in the care home. Staff lacked clarity in understanding how to support people if they were not able to make specific, informed decisions for themselves and this was not properly reflected in people's care records. Systems for monitoring and checking the quality and safety of the service were not effective in identifying where improvements were needed. At this inspection, we found the management team had taken action to address both breaches.

However, there was one new breach of regulations within the care home, associated with the management of medicines, which affected the safety of the service people received. Although staff used medicines pre-prepared by the pharmacy in a safe way, medicines in other packaging were not managed as safely as they should have been.

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

Checks on the safety of the service identified where improvements were needed to protect people’s safety. However, action to address one concern in relation to fire safety had not been rectified in a timely manner.

Staff understood risks to people's safety and welfare, for example of falls, not eating or drinking enough or to their skin integrity. They knew what action they needed to take to minimise these risks. They were also aware of the importance of raising any concerns or suspicions that people may be at risk of harm or abuse so that people were protected. Recruitment processes contributed to protecting people from the appointment of staff who were unsuitable to work in care.

There were enough staff to meet people's needs safely and they received training and support to deliver care competently. There had been improvements to the way they were trained so they could understand how to support people who may find it difficult to make specific, informed decisions about their own care. Appropriate guidance in relation to people’s consent needs had been documented within their care plans to help staff in this area.

People had enough to eat and drink to ensure their wellbeing and, where there were concerns about this or other aspects of their health, staff took action to seek advice promptly.

People received support from staff who were kind and compassionate. They took action to intervene promptly when people became anxious. Interactions between people using the service and staff were warm, respectful and polite. They took into account people's wishes, preferences and interests in the way they delivered care. There were recent improvements in the system for planning people's care so that it was easier for staff to see what care people wanted to receive and what was important to them.

People were confident that, if they had any concerns or complaints, the management team would listen to them and take action to address their concerns.

Systems for assessing, monitoring and improving the quality of the service had improved since our last inspection. Actions had been taken to improve the robustness of checks so that systems for supervision, training and accuracy of care plan records were properly monitored. The system provided for regular, formal consultation with people using the service and people received feedback about the findings and action that would be taken.

Staff were highly motivated and enthusiastic about their work. They understood the standard of care that they were expected to deliver. The management team had developed a culture within which people felt confident to express their views and staff knew they could raise concerns openly.

Red House Residential Home provides accommodation and personal care for up to 15 older people, some of whom may be living with dementia. At the time of our inspection there were 12 people living in the care home because double rooms were being used for single occupancy. The provider also operates a domiciliary care service from the same location, offering support and personal care to people living in their own homes.

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 registered provider has a nominated individual who takes responsibility for representing them as registered persons. The nominated individual maintained a regular presence within the service and was actively engaged with service delivery, particularly in relation to support people received in their own homes. The registered manager and nominated individual are referred to within the report as the management team.

People experienced a service that was safe. They received assistance from staff with their support needs in a timely manner. Staff and the management team understood their obligations to report any concerns someone may be at risk of abuse or harm. Staff also understood the risks to which people were exposed and how they needed to support them safely.

People’s medicines were stored and administered safely.

The service people received was not wholly effective. Staff had not been properly trained to understand how to support people who could not make decisions for themselves, and their responsibilities under the Mental Capacity Act 2005. People’s capacity to make specific informed decisions and to understand risks, was not properly assessed and recorded. We have told the provider they need to make improvements in this area.

Staff had a clear understanding of their roles and people’s needs and had access to support from the management team when they needed it. They ensured advice was taken from health professionals if people became unwell and tailored the care they delivered in response to changes in people’s health.

People had enough to eat and drink and were offered choices about their meals and drinks. Staff presented food in a way that was appetising and offered people condiments to go with it.

People received support from staff who were kind and compassionate. They took action to intervene promptly when people became anxious. Interactions between people using the service and staff were warm, respectful and polite.

Staff understood people’s preferences for the way they wished their care to be delivered and respected these. They communicated well with one another about people’s support and any changes that needed to be followed up. This helped to ensure people were supported in the right way.

People were confident that, if they needed to raise a complaint or concern, the management team would take this seriously and respond to them.

Systems for assessing and monitoring the quality and safety of the service were not sufficiently effective. This compromised the ability of the management team to identify improvements that were needed. There were shortfalls, particularly in relation to record keeping, assessments of risks and supervision, which had not been addressed promptly. We have told the provider they need to make improvements in this area.

Staff were highly motivated and enthusiastic about their work. They understood the standard of care that they were expected to deliver. The management team had developed a culture within which staff and people using the service felt free to seek support if it was needed, to ask for advice and to raise suggestions.

You can see the action we have asked the provider to take, at the back of the full version of the report.