The Red House Care Home

The Red House Care Home provides accommodation for people who require nursing or personal care. People may be older, living with dementia and may have physical disabilities. The care home is registered to provide care for up to 60 people across two buildings. Each building provides accommodation over two floors. There were 34 people living at the service at the time of this inspection.

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

We found improvements had been made since the last inspection, however, further oversight in specific areas is required. At this inspection we found improvements were still required to ensure peoples’ supplementary charts, to support health and wellbeing, were consistently completed. Furthermore, some peoples’ records provided contradictory information for example, one person’s wound was graded differently within the care records. We identified some risks around safety, use of pressure relieving equipment, and completion of food intake records Some effective audits were in place; however, these required embedding, and further development, to ensure responsive action is taken outside of inspection processes.

We have recommended that the provider ensure that an effective system in place to ensure information is reviewed and kept accurate to enable staff to have all the required information to keep people safe at all times.

People living in the service and their relatives were all positive about the standard of care provided at The Red House Care Home. Comments included, “There has been much improvement and I have no complaints about the care.” “I am really happy and lucky to be here.” And “I don’t think anything could be done any better.”

People were kept safe and were confident any concerns they raised would be listened to. Staff understood how to safeguard people. People were cared for and supported by staff who knew how to manage risks they might face.

The premises was hygienically clean, and staff followed current best practice guidelines regarding the prevention and control of infection. Medicines systems were well-organised, and people received their medicine as prescribed. Protocols for medicines ‘when required’ needed additional information to give the action for staff to take prior to the administration.

There were enough staff to support the needs of people. The provider had followed safe recruitment practices. Staff had the right levels of training, support, and experience to deliver effective care and meet the needs of people living at the service.

People had access to a wide variety of food and drink that met their dietary needs and wishes. Improvements were required to the food charts to show the exact quantities people consumed to ensure effective monitoring and support was provided. People were helped to stay healthy and well.

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. Although some terminology in the records was not always respectful or dignified.

Most Staff treated people with respect and dignity and upheld their right to privacy. People were encouraged and supported to maintain their independence. People were encouraged to make decisions about the care and support they received and had their choices respected.

Person-centred care plans were in place, which enabled staff to understand and meet their needs and expressed wishes and preferences. Staff ensured they communicated and shared information with people in a way they could easily understand.

People were supported to participate in meaningful recreational and leisure activities that reflected their social interests. People's concerns and complaints were well-managed, and the provider recognised the importance of learning lessons when things went wrong. One relative told us, “I think the meetings are productive. They have asked for feedback, and you can just speak up when you are here.” People, their relatives and staff working in the service were all complimentary about the way the service was managed. People and their relatives told us how approachable the staff all were.

Plans were in place to help people nearing the end of their life receive compassionate care in accordance with their needs and expressed wishes. The provider promoted an open and inclusive culture which sought the views of people living at the service, their relatives, community health and social care professionals and staff working there. The provider worked in close partnership with various community health and social care professionals and agencies to plan and deliver people's packages of care and support.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 October 2022) and there were breaches of regulation. At this inspection we found improvements had been made, and the provider was no longer in breach of all regulations identified at the last inspection. However, a continued breach of 1 regulation was found.

This service has been in Special Measures since 24 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Red House Care Home provides accommodation for people who require nursing or personal care. People may be older, living with dementia and may have physical disabilities. The care home is registered to provide care for up to 60 people across two buildings. Each building provides accommodation over two floors. There were 47 people living at the service at the time of this inspection.

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

The service was not well-led. The provider did not operate safe and effective governance systems which meant people were at risk of harm. The provider did not respond to their own quality assurance findings to promote safety and improve care.

There were not enough staff to meet people’s needs. People were not protected from harm and lessons were not learnt when things went wrong. Risks to people’s safety were not appropriately assessed or reduced by staff, and oversight was not effective. Medicines processes were not safe, and staff failed to appropriately respond when a person displayed symptoms of an infection.

People were at risk from dehydration and malnourishment. People experienced weight loss which was not effectively recognised and responded to by staff. Peoples needs had not been appropriately assessed and agreed health plans were not always followed. Staff had not received effective training to keep people safe, and staff supervision methods were not effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always treated with dignity and respect by staff. Kind and considerate care was not always evident.

People, or their relatives if appropriate, were not always supported to be involved in the care planning process. Care plans were not developed for people living with dementia. Responsive care planning did not take place for people who experienced deterioration. Social opportunities, engagement and activities were not regularly available for people who remained in their bedrooms.

However, people told us they were supported with their medicines and received pain relief when it was required. People said they were happy with the quality of the meals which were provided and told us staff were friendly and kind to them.

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 (report published 3 April 2019).

At this inspection we found the service had deteriorated and the rating has changed to Inadequate.

Why we inspected

The inspection was prompted in part due to concerns about safe care and treatment; safeguarding, staffing, nutrition and hydration, person-centred care, privacy and dignity and good governance. We had undertaken an inspection at another of the provider’s locations and found these breaches of regulations were present. Furthermore, we had received concerns that common themes may be present at this location. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse; safe care and treatment; staffing; nutrition and hydration; person-centred care; dignity and respect and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

All visitors were required to book their visits and follow the provider’s ‘responsible visitors code’. This included a declaration about COVID-19, the procedures visitors had to follow and to take a rapid test for COVID-19. There was a designated entrance to the visitor’s room that was thoroughly cleaned after each use. Garden visits were also available to book.

The service took part in the national COVID-19 testing programme for care homes. People and staff had received their vaccinations. Individual risk assessments were completed for staff and people. Staff followed the provider’s robust infection prevention controls.

The provider had good supplies of personal protective equipment (PPE) and these were reviewed weekly. All staff received training on infection control, hand washing and the correct use and disposal of PPE. There was an area for staff to change into their uniforms at the start of their shift.

The infection control lead completed daily monitoring and visual checks to ensure best practice was maintained. Hand washing aids were used to develop good hand washing techniques.

The service looked clean and free from clutter. To ensure good infection control, appropriate cleaning products were used. Cleaning schedules ensured frequently touched areas were sanitised. Infection control audits were completed and monitored regularly.

The Red House Care Home accommodates up to 60 people across two buildings. The main building accommodates 48 people who may require nursing care and some of whom may be living with dementia. There is a further building in the grounds that accommodates 12 people who have personal care needs. Each building provides accommodation over two floors. There were 53 people living at the service at the time of this inspection.

What life is like for people using this service:

¿ People continued to feel safe living at the service. Risks in relation to people’s health, safety and welfare had been identified and action taken where appropriate. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. There were systems in place to monitor incidents and accidents and learn from these.

¿ Staff were skilled and knew the people they supported well. People’s care, health and cultural needs were identified so staff could meet these. People had their nutritional needs met.

¿ People were supported to maintain good health. Staff made referrals to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

¿ People continued to receive care from staff who were kind and caring. People’s privacy and dignity was protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

¿ Effective care planning was in place which guided staff to provide support that met people's needs which were in line with their preferences. People took part in a range of group activities depending on their choices. People said they knew how to make a complaint if needed.

¿ People, relatives and staff told us the service was well managed and had an open and friendly culture. The registered manager and staff worked in partnership with other agencies to ensure people got the care and support they needed.

¿ Systems were in place to monitor the service, which ensured that people's risks were mitigated and lessons were learnt when things went wrong.

Rating at last inspection: Requires Improvement (report published 23 February 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved to Good.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

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

The Red House Care Home accommodates up to 60 people across two buildings. The main building accommodates 48 people who may require nursing care and some of whom may be living with dementia. There is a further building in the grounds that accommodates 12 people who have personal care needs. Each building provides accommodation over two floors.

This comprehensive inspection took place on 18 January 2018 and was unannounced. At the time of this inspection care and support was provided to 57 people. This was the first inspection since HC – One Oval Limited was registered as the provider of this service.

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.’

There was not enough staff to meet the needs of people who used the service. People did not always receive the support that they needed in a timely way and staff said that they felt rushed.

Care plans did not consistently contain details about people's care and support needs. Whilst risks to people had been identified, the guidance available to staff in relation to managing these risks was limited.

Staff had been safely recruited and received on going training. However they had not all received supervision in line with the provider’s policy.

Suitable arrangements were in place to help safeguard people from harm. Staff knew what to do if a person made an allegation they were being harmed or if they had any concerns about anyone’s safety.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.

Staff were friendly and respectful and there was a good rapport between staff and people who used the service. Although, there was a lack of activities indoors for people to take part in, this could lead to people who chose to stay in their rooms becoming isolated. There was an opportunity for people to have days out.

Health and safety records showed checks were undertaken regularly to ensure that equipment was kept safe and in good working order.

The service was clean and there were arrangements in place to ensure that staff wore protective clothing such as disposable gloves and aprons. This reduced the risk of cross infection.

People were on the whole happy with the choices, quality and quantity of the meals and snacks available. People had access to health care professionals and received support with their health care needs in a timely manner.

Systems were in place for receiving and responding to complaints. A number of compliments had been received from relatives.

Systems were in place to monitor and audit the quality of the service provided but these were not always effective required actions had not been taken.

As a result of our findings 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 the report.