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The Red House Nursing Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 10 October 2019

During a routine inspection

The Red House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Red House is registered to provide accommodation, nursing and personal care for up to 31 older people in one adapted building. There were 18 people using the service at the time of our inspection. Some people using the service were able to tell staff how they preferred their care provided.

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

We found there were four breaches of regulations three of which had continued since our inspection in July 2018. People did not always receive safe care and treatment to reduce risks to their health and safety. Staff did not receive the support and supervision they needed. Audits and checks on the quality of service people received had been undertaken and shortfalls had been identified. Action had been taken in some areas of the service and improvements had been made. Other areas needed more work and development to ensure improvements were embedded and sustained. Records were not kept up to date. The provider had not ensured that consent to care and treatment was in line with law and guidance.

This is the second time the service has been rated Requires Improvement.

The provider had identified that the service was not working as well as it should and had taken action. The provider had employed two consultants to re-assess and develop all the systems used within the service to make improvements. One of the consultants was a previous registered manager of the service. They knew the service well.

People were not always fully protected from risks. Risks had been identified but not all risks to people had been properly assessed and minimised. There was not always clear guidance for staff regarding risks relating to choking, when people became distressed and health conditions such as constipation.

People's capacity to make decisions about their lives had not been assessed. Meetings had not been held to make sure all decisions were made in people’s best interests.

Staff did not receive the support and monitoring they needed to undertake their roles effectively and safely. Nurses employed by the service had not received clinical supervision to make sure their skills were up to date and in line with best practise.

The service did not have a registered manager in post. The provider was in the process of trying to recruit a new manager but at the time of the inspection no appointment had been made.

The consultants had implemented new quality assurance systems. Audits and checks had been completed at the service. These checks had identified shortfalls, and improvements were being made. Some records were not up date.

People's needs were assessed before they started using the service. People were supported to express their views and make decisions about their care. People had care plans that provided guidance for staff to provide care that was responsive to people's needs. Care plans were personalised.

When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. People were safeguarded from the risk of abuse

Staff treated people with dignity and respect. Staff helped to maintain people's independence by encouraging them to do as much as possible. People were supported to do things they wanted to do.

People's medicines were safely managed, and systems were in place to control and prevent the spread of infection. People's needs were assessed before they moved into the service. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care. Staff were recruited safely. When shortfalls were identified in the recruitment procedure immediate action was taken.

People were given info

Inspection carried out on 11 July 2018

During a routine inspection

This inspection was carried out on 11 and 20 July 2018 and was unannounced.

The Red House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Red House is registered to provide accommodation, nursing and personal care for up to 31 older people in one adapted building. There were 24 people using the service at the time of our inspection. Most people using the service were able to tell staff how they preferred their care provided.

The service had a registered manager in post. A registered manager is a person who is 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.

This was the first inspection of The Red House under a new registration due to changes to the details of the provider’s registration, however the Red House was not a new service. It was still owned and managed by the same family as at our previous inspection. We last inspected the service in February 2018 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 were identified. We issued requirement notices relating to safe care and treatment, fit and proper persons employed, staffing and notifications: which are notices of change. We also issued a warning notice in respect of Good Governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve each of the key questions to at least good. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made. However, we found five breaches of the Regulations.

This is the first time the service has been rated Requires Improvement.

At this inspection we found that not all risks to people had been properly assessed and minimised. There was not always clear guidance for staff regarding risks relating to choking, moving people and health conditions such as epilepsy. We asked the provider to ensure this was reviewed immediately after the first day of our inspection. They confirmed this had been done and when we returned for the second day we checked this. The changes had been made to ensure clear and accurate guidance was available to staff.

Other risks to people had been identified and assessed. There was guidance for staff regarding how to support people who were living with healthcare conditions such as diabetes and supporting people with catheter care.

Staff were not consistently recruited safely. Some files did not contain all the necessary documents required to confirm a robust system of recruitment. Staff were not fully supported to complete training and development to make sure they were able to fulfil their role. Not all staff had received the opportunity to meet with a manager to discuss their role and any concerns they had. We were told this was planned in the weeks following our inspection. We will follow this up at our next inspection.

Staff completed induction training when they started to work at the service. We have recommended the registered persons review their induction process and introduce the Care Certificate.

Audits intended to identify shortfalls in the safety and quality of the service were in the process of being implemented. In their absence, some of the shortfalls we identified at out last inspection remained.

Staffing levels were not consistently safe. Staff were not always appropriately deployed and there was no formal assessment tool in place to demonstrate