We carried out a review of the data available to us about The Red House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Red House Nursing Home, you can give feedback on this service.
The Red House Nursing Home is a residential care home, set over two floors, in Canterbury, providing personal and nursing care to up to 31 people. At the time of the inspection there were 24 people living at the service, some of whom were living with dementia.
People’s experience of using this service and what we found
People and their relatives were happy with the levels of care and support provided. Comments included, “I am happy here and extremely well looked after, thank you”, “[My loved one] is safe and cared for very well” and, “[The registered manager] and staff have been utterly brilliant.”
People were supported to stay as safe and healthy as possible. Referrals to health care professionals were made when needed to make sure people continued to receive the right support.
People were supported by a consistent team of nurses and carers, many of whom worked at the service for a long time. Staff had been recruited safely. Staff met regularly with their line manager to discuss their performance and development and kept up to date with their training to make sure they were supporting people in line with best practice.
People were supported to have their medicines as prescribed. Nurses checked to make sure medicines were managed safely.
People lived in a service which was clean and free from unpleasant odours. Staff completed regular training about infection control and understood their responsibilities to maintain high standards of cleanliness and hygiene in the service. The registered manager ensured people, staff and visitors were informed of processes to keep up to date with current national guidance.
People health care needs were assessed before they moved into the service. Regular reviews of important records, such as risk assessments and care plans were completed and updated when required to make sure staff could meet people’s needs. People’s lifestyle choices, such as religion, sexuality, disability and race were discussed to ensure their needs were met.
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.
Regular checks were completed to monitor the safety and quality of service delivered. When a shortfall was identified, action was taken to address it.
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 requires improvement (published 17 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 10 and 15 October 2019. Breaches of legal requirements were found around safe care and treatment, staff supervision and appraisal and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We inspected to check these actions had been completed.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Red House Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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 information in a way they could understand. People were supported to pursue their hobbies and interests. People's religious, spiritual and cultural needs were discussed to make sure these needs were met.
There were arrangements to quickly investigate and resolve complaints. People were treated with compassion at the end of their lives, so they had a dignified death. Staff were supporting people to make decisions about what they wanted to happen at this time in their lives.
People enjoyed the food and had enough to eat and drink.
People and their relatives were asked their opinions on the service by attending meetings and completing surveys, suggestions had been acted upon. People and their relatives gave positive feedback about the service they received.
Staff said they were listened to and that their opinions and suggestions were acted on. When there were any incidents and accidents these were recorded, and steps were taken to prevent any reoccurrence.
The provider and their team were committed to learning lessons when things went wrong.
Rating at last inspection and update
The last comprehensive inspection was completed on 11 July 2018 and 20 July 2018. The inspection report was published on 11 October 2018. The rating for the service was Requires Improvement.
The registered person completed an action plan after the inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made or sustained and the registered persons were still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified three continuing breaches of regulations. People did not always receive care and treatment that was safe and person-centred. Staff did not receive the care and support to ensure they carried out their roles effectively and safely. The service was not consistently well-led. There was a new breach of regulations. This was because some people’s mental capacity had not been assessed to ensure they were able to make informed decisions.
Please see the action we have told the registered persons to take at the end of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Red House on our website at www.cqc.org.uk.
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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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 how the staffing levels had been determined. We received mixed feedback from people and staff about the staffing levels. Medicines were now managed safely and people received their medicines on time and in the way they preferred.
People were protected from the risk of abuse. Some, but not all staff had received current safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.
Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.
Staff worked well together and tried to ensure clear communication between themselves and external health professionals took place; for example, with GP's and district nurses. We were told by staff that there was not always a strong morale between the staff team. We have recommended the registered persons seek feedback and identifies ways to improve staff morale and team work.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The care and support needs of each person were different, and each person's care plan was personal to them. People had care plans, risk assessments and guidance in place to help staff to support them in an individual way. Some plans did not contain clear and specific guidance for staff, however, after we highlighted this to the manager they took steps to ensure this was put right.
Staff encouraged people to be involved and feel included in their environment. People were offered and participated in varied social activities. Staff knew people and their support needs well. Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people were comfortable and at ease with the staff.
There were suitable arrangements for managing complaints and provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.
People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people's likes, dislikes and dietary requirements and promoted people to eat a healthy diet.
Feedback had been sought from people, relatives and professionals about the quality of the service. Action was taken to implement improvements. Staff told us that the service was generally well led and that they felt supported by the registered manager to make sure they could support and care for people safely and effectively. Staff said they could go to the registered manager at any time and they would be listened to.
We identified five breaches of the Regulations. You can see what action we told the provider to take at the back of the full version of the report.