The RedHouse Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. In line with our current assessment framework, we have considered the evidence from this inspection alongside that of the previous inspection, when the service was rated good.

Based on this combined view, the overall rating for the effective key question remains good. We found clear evidence of improved practice in mental capacity assessments and more structured best interest decision-making processes. However, we identified a significant concern regarding the use of CCTV in communal areas and the medicines room without informed consent or a clear legal basis. Despite these concerns, the overall evidence showed that people continued to experience positive outcomes. Feedback from people using the service was consistently positive, and improvements in key areas of practice demonstrated the provider’s ongoingcommitment to delivering effective care. The provider was no longer in breach of Regulation in relation to need for consent.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not consistently deliver care and treatment in line with evidence-based guidance or individual clinical recommendations. While recognised assessment tools were in use, professional advice was not always followed in practice.

The service used clinical tools to assess risks relating to nutrition, pressure damage, and skin integrity. Speech and Language Therapists (SALT) were involved in assessing people with swallowing difficulties. However, we found that their guidance was not reliably followed. On the third day of our inspection, kitchen staff served food that did not meet the requirements of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. For example, green beans were served to a person on a Level 5 (minced and moist) diet, creating a serious risk of choking.

Care records contained inconsistent recording in relation to decision-making. For example, fluid intake charts included frequent gaps, with limited evidence that people’s low fluid intake was identified or followed up. Care plans reflected the use of evidence-based assessments. However, because staff were not consistently following professional advice, those people needing modified diets or hydration support were at increased risk of potential harm .

Overall, people and their families generally felt well cared for. One person told us, “Staff are very kind and if they could do more they would,” and a relative said, “Drinks are always available… I’ve had to buy [person] larger trousers so he must be eating well !”.

Following our feedback, the provider acted promptly. Face-to-face training on dysphagia, IDDSI guidance, and person-centred nutrition was arranged for all kitchen staff. Senior staff also began regular audits of food and fluid records to improve oversight and ensure compliance with clinical advice. While no harm occurred, the shortfalls in following professional advice, particularly in relation to nutrition and hydration, meant care was not always evidence based.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Hospital passports were maintained and regularly updated. These documents summarised key health, care, and communication needs and supported continuity when people accessed external services, such as hospitals or community healthcare. The passports were detailed and person-centred, helping professionals understand people's needs quickly and deliver appropriate care. Care plans showed involvement from a range of professionals, and staff described how external clinical input informed their day-to-day care delivery. There was clear evidence that relevant professionals were engaged in people’s ongoing care planning.

Communication between internal teams was structured and consistent. Staff received regular handovers, and clinical discussions were led by senior staff to promote joined-up care. Healthcare professionals gave positive feedback about their experience working with the service. One told us, “The staff at Red House always make time to speak to me when I visit or call.” Relatives also described improvements since the change in management, with one saying, “There is always someone to talk to… very welcoming.”

Staff were well-informed about people’s needs, which supported continuity across shifts and promoted timely responses to changes in health and wellbeing. The systems for communication and multidisciplinary working were effective and helped ensure people’s care was coordinated and consistent.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider routinely monitored people’s care and treatment to support continuous improvement. They aimed to achieve positive and consistent outcomes that aligned with clinical guidance and people’s individual preferences.

Care plans were regularly reviewed and updated following changes in health, medication, risk, or mental health needs. Records showed that overall staff responded promptly to changes. A variety of assessment tools and regular team discussions supported outcome monitoring. People were encouraged to participate in setting personal goals where possible. For example, one person staying for a short stay told us their confidence in their mobility had increased and they looked forward to returning home. Relatives shared positive feedback about improvements in their family members health and wellbeing. One relative said, “[Name] just uses a Zimmer frame, nothing else. When [Name] was at home, she did fall a lot but since the care home she hasn’t had a fall.” Another commented, “[Name] has access to the mental health team and it was 3 monthly assessments but because [Name] has stabilised and is doing well it is now yearly.".

People also expressed satisfaction with the care they received. One person told us, “They have been smashing it.” Staff actively sought feedback from people and relatives through reviews, meetings, and daily conversations. They used this information to make meaningful improvements, contributing to better experiences and support for independence.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Whilst there was clear evidence of improved practice in mental capacity assessments and more structured best interest decision-making processes, there was a key concern related to the use of CCTV in communal areas and the medicines room. People and relatives were not consistently made aware of this surveillance. Only one CCTV sign was displayed at the main entrance, falling short of legal transparency requirements.

Consent forms were not completed for people with capacity, and there was no documented evidence of best interest decisions for those lacking capacity. There was also no clear rationale or risk assessment justifying the use of CCTV in the medicines room, which had been installed by a previous manager. Staff described CCTV as a safeguarding measure, but the lack informed consent meant people’s rights were not fully upheld. One person told us, “Yes, they did tell me about that when I first arrived, and it doesn’t bother me because it’s there for my safety. It’s a TV that is keeping an eye on you and keeping us safe from attacks from strangers and to alert the staff if we are unwell and for example fall. They can see on the TV how it happened.” A relative said they did not recall receiving any formal notification about the installation of CCTV but expressed no concerns about it, adding that they felt it was a positive safety measure.

The absence of clear, informed consent increased the risk of care or monitoring without people’s full understanding, undermining transparency and accountability. In response, the provider developed accessible consent forms and began distributing them to relatives. Staff initiated best interest discussions where appropriate. Additional CCTV signage was installed before the inspection ended, and the camera in the medicines room was removed and repositioned to a public hallway.