Archived: Redhouse Nursing Home (UK) Ltd

At this inspection in November 2018, we found again that the provider had still not made sufficient improvements and has remained in breach of those regulations since May 2017. This has continued to put people at risk of poor and unsafe care. This inspection identified an additional two breaches of the regulations related to person-centred care and the provider’s failure to submit notifications to the Commission as required. We have taken further enforcement action in line with our processes, in response to this inspection and we have rated the service ‘Inadequate’ overall.

Redhouse Nursing Home is a ‘care home’ with nursing. 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. Redhouse Nursing Home accommodates up to 34 older people in one adapted building.

There was a registered manager who was present during our inspection and had registered in March 2018. 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 continued to be at risk of poor and unsafe care as the provider had still failed to provide a consistently safe service. We found various examples of how people’s risks were still not effectively assessed, monitored and mitigated. Lessons were not learned to improve the safety of the service and practices at the home put people at increased risk of harm. This amounted to a continued breach of the regulations in relation to safe care and treatment.

People’s relatives and friends felt the service was safe. One person told us they felt the service was safe, however this was not consistent feedback because two people told us they did not feel safe. Some improvements had been made to how some people’s risks were managed including people’s support with medicines and staffing level changes. Recruitment processes had not always been followed as planned to ensure people’s safety. The registered manager told us they intended to use an improved audit, and to appoint a new infection control lead to support ongoing improvements and ensure good infection control practices at the home.

Staff told us they felt supported and spoke positively about the supervision and training provided, however we found continued concerns that staff were not always equipped with the skills and knowledge to meet all people’s needs. People could not be confident all of their needs would be effectively monitored and met although we saw some positive examples of how people were supported. People were not supported to have maximum choice and control of their lives and staff did not support all people in the least restrictive ways possible.

We received mixed feedback about the food on offer and people’s own choices and preferences were not routinely gathered to help inform menu planning. Although we often found positive practice in these areas, improvements were required to ensure people always received safe and effective support in relation to their dietary and hydration needs and to access healthcare services when needed.

Although we often saw caring interactions from some staff, some people’s feedback showed staff did not demonstrate a consistently caring approach. We saw staff were often engaged in other tasks and did not often have opportunity to spend quality time and interact well with people. People were not involved in their care as far as possible and opportunities to gather people’s views about their care were missed.

Although we identified some people’s positive experiences of the service, we identified a breach of the regulations due to the continued concerns that people did not all receive care in line with their needs and wishes. People’s needs and preferences were not effectively gathered and met and this put people at risk of poor care. Improvements were required to how people’s care was planned, including end of life care. We found continued concerns around people’s poor access to activities. The design of the home including dining arrangements were not always developed around people’s needs and preferences. There was a complaints process and complaints had been recorded, logged, and responded to. Other systems such as regular care reviews were not in place however to help capture people’s feedback and identify any concerns or complaints they had, for example for some people who told us they did not feel comfortable making a complaint.

We found continued concerns in relation to the governance and leadership of the service. Despite some improvements since our last inspection, sufficient improvements were not made overall and systems and processes still failed to effectively assess, monitor and improve the quality and safety of the service. This put people at risk of poor and unsafe care and amounted to a continued breach of the regulations in relation to governance.

Systems failed to ensure risks to people’s health and wellbeing were shared, and that risks were effectively assessed, monitored and mitigated to safely meet all people’s needs. People were not given routine opportunities to discuss their care, and where some people had expressed needs and preferences, these were not always met. Incidents and shortfalls in the safety of people’s care were not rectified and learned from and this put people at risk of harm.

The overall rating for this is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

We undertook a comprehensive inspection of this home in May 2017 where we rated the provider as “requires improvement” in all of the five key questions we inspected. At our inspection in May 2017 we found the registered provider had breached two of the legal requirements. This was because we could not be sure risks to people’s health and safety were managed appropriately. The governance system operated by the registered provider was not effective in identifying and correcting issues raised by ourselves during the inspection. We issued two warning notices relating to each of the above two breaches. Warning notices are one of our enforcement powers. This inspection was planned and undertaken to look at the key questions of safe and well led, to check if the action required in the warning notices we issued had been taken. This report only covers our findings in relation to those requirements. You can read the full report from our last comprehensive inspection by selecting the “all reports “link for Redhouse Nursing Home on our website at www.cqc.org.uk.

At the time of our inspection the home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, the registered manager informed us during this inspection they had resigned from their post and would be leaving the service. Since our inspection the registered manager has de-registered with The Commission.

Although people told us they felt safe living at Redhouse, we found people were still not always protected from harm because risks to their health and safety were not always managed safely. People still did not always receive their medicines as prescribed.

We found the quality assurance system in place was still ineffective because the provider had relied solely on the registered manager and had no overview of the service which meant where concerns were highlighted the provider had failed to take action to protect people.

At the time 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.

Although people told us they felt safe living at Redhouse, people were not always protected from harm because risks to their health and safety were not always managed safely. People did not always receive their medicines as prescribed. The registered manager had failed to take appropriate action when potential safeguarding incidents occurred. People told us there were times when there were insufficient staff to meet their needs. The provider had a safe recruitment system which meant staff employed at Redhouse were safe to work with vulnerable people.

People’s rights were protected as the registered manager had applied the principles of The Mental Capacity Act, however people told us and we saw staff did not always seek consent before providing care. People had mixed views whether staff had received training to support them. We saw some of the training staff received was not effective.

People told us they were happy with the food at Redhouse and they got choices in their diet. People and their relatives told us and we saw people had access to other healthcare professionals to help them maintain good health.

Staff did not always have the time to spend with people but people told us when they did staff were kind and caring. Staff did not always support people in a dignified way. People told us staff encouraged them where possible to remain independent.

People did not always receive care which was responsive to their individual needs. People did not have access to activities because staff did not have the time to spend with them. There was a system in place should people wish to make a complaint.

The quality assurance system in place was not effective and failed to identify and act on issues that were on-going. Some of the issues that had not been acted on placed people at risk. The systems in place had failed to identify when issues identified at previous inspections remained unresolved. People and their relatives told us they knew the registered manager well and were happy at Redhouse. Staff told us they were supported by the registered manager and felt there was a positive culture within the home.

During this inspection we found breaches 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.

We checked the action taken to address the issues raised at our last inspection. We found that some work had been completed to address issues. Work was still needed to be undertaken on records to ensure that they were all accurate and up to date. The manager had introduced new care plans for everyone that lived at the home. These care plans had been reviewed on a monthly basis but not all of the information recorded was accurate or up to date.

Other records that we reviewed required more detail and this was discussed with the manager on the day of our visit.

We saw that improvements had been made to quality assurance systems. A residents'/relatives' meeting had been scheduled and satisfaction surveys had been completed. We looked at satisfaction surveys recently sent out to people who lived at the home and professional visitors to the home. We discussed the methods that the manager could use to code surveys so that they were aware of who the professionals were who had responded to surveys. This would provide a good audit trail.

We discussed fire risk assessments, particularly relating to those people who smoked cigarettes at the home. The manager contacted the West Midlands Fire Safety Officer for advice and had received instruction regarding the action to take.

We were told that there were 21 people who lived at the home and that the number of staff on duty had not reduced since our last visit. Staff were busy attending to people's needs in a caring manner.

We looked at the newly developed satisfaction survey and saw that people who lived at the home and external professionals had been given the opportunity to discuss what they felt about the quality of service provided.

We saw that action had been taken to reduce the amount of medication errors identified during audits.Three nursing staff were undertaking a safe handling of medication course, a further three staff were booked onto this course and we were told that all other nursing staff would undertake the course in the near future. We were told that medication audits would continue and further action would be taken if repeat errors were identified.

People who smoked cigarettes were able to continue to do so at Redhouse Nursing Home. However, the home had not provided a designated smoking area or asked for the views of the other people who lived at the home regarding the location of a designated smoking area.

Improvements were noted to care records. The manager confirmed that this was an ongoing process which may take some months before all records were up to date.

We looked at the care files of three people who lived at the home, we talked with staff who provided care for these people and we spoke with the manager. We saw that although everyone had a care plan, these documents did not contain information regarding personal preferences or routines. Some important information was not recorded. Staff were aware of the support needs of people who lived at the home.

Staff were attentive but did not appear to have time to provide activities or sit and chat with people. The people that we spoke with who lived at the home said that regular daily activities were not provided. Records seen confirmed this.

There were no systems in place to monitor the quality of the service provided. This issue was identified at our last visit to the home and no action has been taken subsequently to implement quality assurance systems.

Records reviewed were not all up to date. This was also identified at our last visit to the service.

We spoke with seven people who lived at the home and with six visitors to the service. People commented that they saw their doctor whenever they needed to and generally care was satisfactory. One person had raised issues with the manager and told us that when they visit the issue had not always been attended to by staff.

We looked at the medication and records for the people whose care file we reviewed and saw that these records were correct and medication was available at prescribed. Medication audits indicated that regular administration and record keeping errors were identified.

We observed that staff were extremely busy and did not appear to have time to provide one to one or group social activities. Staff worked well together and helped each other out as needed but appeared to be rushed when completing some of their duties. We saw that two people were left seated in their wheelchairs in the middle of the room whilst staff attended to other duties.

There were limited procedures in place to monitor the quality of the service provided.