The Red House

We found the following examples of good practice.

The premises were clean and well maintained. Additional cleaning schedules had been introduced since the beginning of the COVID-19 pandemic. High touch areas such as door handles and light switches were cleaned throughout the day and there were posters on display throughout the building to remind staff of the importance of good hand hygiene. Hand sanitiser and wipes was readily available in all parts of the home.

Service users who tested positive for COVID-19 were assigned a dedicated staff team who supported them with all of their care and nursing needs during their period of isolation. Clinical waste was safely disposed of and staff had ready access personal protective equipment (PPE). People’s clothes and bed linen were washed separately in red bags to prevent cross-contamination.

Visiting was in line with government guidance. People were supported by staff to see their family members in a COVID-safe way, which included visiting in their room or in a specially designed visiting pod in the garden.

All staff had received recent training in infection prevention and control (IPC) and were seen to be following correct IPC practices at all times. The registered manager was accepting of all advice and guidance offered by external agencies including the local health protection team, CCG, Surrey County Council and CQC. The designated IPC lead shared all current policy government updates with staff and family members.

The registered manager and senior leadership team supported staff to provide people with good day to day care. The provider maintained a testing programme in line with current government guidance for both staff and visitors to the 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. The registered manager was at the home during the time of our inspection.

This inspection was carried out on 15 January 2019 and was unannounced.

At our last inspection in 2016 we rated the service good in all five domains. At this inspection we found significant improvements had been implemented which has increased the overall rating to outstanding.

Why the service is rated Outstanding.

People were at the heart of everything the service did. Staff had an excellent understanding of people's needs and provided person-centred care to a very high standard. The provider and registered manager demonstrated a passion to provide people with love and a life of value, regardless of their age or disability. This was reflected in the many positive comments we received about the home and its staff from the people who lived there, their relatives, and the visiting health care professionals. Everyone we spoke with told us the service gave an outstanding level of care and support to people.

The registered manager, and the provider, had a clear vision and set of values for this service. These were based on dignity and respect, and working together with a commitment to providing quality care and support. They were also focussed on getting to know the people they supported. This compassionate and clear message was clearly shared by the staff team. This had a positive impact across all five of the key questions we asked and the lives of the people who used this service.

The service strived to be known as outstanding and innovative in providing person-centred care based on best practice. The registered manager had established a culture that put people at the centre of the service. This resulted in people taking back control of their lives, either from being unwell for long periods of their life, or overcoming obstacles due to their disabilities or age. Staff were confident and knowledgeable in their ability to support and care for people. Their passion for supporting people to live a fulfilled life was evident throughout the inspection. The programme of activities and events hosted by the staff were fully based around people’s interests and enabled them to achieve lifelong goals.

This passion for innovation and leading on best practice also extended to supporting people who were at the end of their life. The staff at the home had worked closely with local hospices to develop new guidelines for ensuring people were supported in a kind and compassionate way as they neared the end of their lives. Relatives who had family members pass away at the home were thankful for the way their loved ones and themselves had been supported by staff at this most difficult time.

The staff were exceptionally kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff asking people's advice about how to proceed with tasks, or having a laugh and a joke with them. People were relaxed and happy with the staff and it was clear that caring relationships had developed between them. People's relationships with family and friends and dramatically improved due to the support and guidance given by the staff.

People told us they enjoyed the food. People where unanimously positive about the quality and choice of the food and drinks at the Red House. They received a balanced diet and they were encouraged to keep hydrated using innovation and staff involvement in developing best practice guidelines with health care professionals.

People's safety was paramount at The Red House, as was their involvement in keeping themselves and others safe. Through an understanding of people and their support needs, staff worked with them to manage risks and enable them to live their lives in the way they wanted. Risks of harm to people had been identified and guidelines were in place to minimise these risks, without restricting people's freedom.

There were sufficient staff deployed to meet the needs of the people who lived at the home. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received an induction when they started work at the home and ongoing training. This was tailored to the needs of the people they supported, and gave the nursing staff the training and clinical supervision to keep their registration with the Nursing and Midwifery Council up to date.

There was a very low turnover of staff, which enabled people to get to know them, and build positive relationships. It was also a testament to the care and support the provider and registered manager gave to the staff at the home.

Staff managed medicines in a safe way and were trained in the safe administration of medicines. The home was clean and staff practiced good infection control measures, such as hand washing, hygienic cleaning of the environment and equipment and correct use of personal protective equipment.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Accidents and incidents were reviewed to minimise the risk of them happening again.

Before people moved into the home, their needs were assessed to ensure staff could provide the care and support they needed.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health was seen to improve because of the effective care and support given by staff. Staff worked with local health authorities on initiatives to continue to improve the care people received.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

The registered manager had a clear vision and set of values based on providing personalised care to people. Staff understood this and demonstrated these values during the inspection in their interactions with people. Quality assurance processes were used to make improvements to the home and the experience of people who live here.

People had the opportunity to be involved in how the home was managed. Regular house meetings took place to give people a chance to have their say. Surveys were completed and the feedback was reviewed, and used to improve the home and the people's experience of living there.

People had a very positive experience living at The Red House. They were supported by staff that really enjoyed their job and really involved them in their care and support. The registered manager gave an outstanding level of leadership to make people's lives happy and fulfilled.

There was a registered manager in post, who was present on the day of the inspection. 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 positive and caring interaction between people and staff. People gave clear indications to us that they were happy living here. One person said, “Everything is just perfect. They do an excellent job.” A Relative said, “These are my family members friends, we are all going to get old and I can only hope I find a home like this for myself.” People could only praise the staff and the facilities. We observed nothing that would contradict this. Staff were all were extremely happy in their work and proud of the job they do.

People had access to a wide range of activities that met their needs. Staff also encouraged people to continue in past hobbies, and to achieve lifelong dreams. They supported people at the end of their life to achieve goals and aspirations and live their life to the fullest extent.

People were safe at The Red House because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding board or the police.

In the event of an emergency people were protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. The premises provided were safe to use for their intended purpose.

Staff recruitment procedures were robust to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines. All medicines were given to people and any excess disposed of in a safe way.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People had access to drinks and snacks at any time during the day and people were able to have a cup of tea during the night if they asked.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff talking with people and showing interest in what they were doing. People could have visitors from family and friends whenever they wanted. The staff knew the people they cared for as individuals, and had a good rapport with relatives, giving a family feel to the home.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical, social and psychological needs. They gave a good level of detail for staff to reference if they needed to know what support was required.

People knew how to make a complaint. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. When complaints had been received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.

The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people. The senior management from the provider regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.

There was a very positive culture at the home. The registered manager had a clear vision about the values and quality of the service, which was shared by staff. The staff team benefitted from strong leadership and the registered manager led by example. A person said, “It’s excellent here. I’m always involved in my care. Yes, it’s the very best care home.” a relative said, “I can’t fault the home.”

The people that we spoke with and a relative told us they felt that they were respected by staff. One person told us 'Oh yes, I do feel respected. Staff chat to me and are interested in what I am doing.' Another person said 'Staff call me by my preferred name and they knock on my door before coming into my room.' A relative told us 'Absolutely they respect my family member. Staff are very nice and friendly.'

We saw that assessments of people's needs had been carried out. Care was provided that met those needs. One person told us 'Overall I think my care is good.' Another person told us 'They meet my needs, and I can always ask if I need anything.' A Relative told us they had been kept up to date with the care needs of their family member.

The people we spoke with told us they felt safe with the staff. Staff understood they had to report any suspicion of abuse.

We saw that the provider carried out appropriate checks when employing staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

The provider had an effective system in place for dealing with complaints. People we spoke to said they knew how to make a formal complaint.

One person told us 'Staff ask if I want to do things.' And 'I'm supported to do the things I want.' Another said 'Staff explain things to me so I can understand what is happening.' Staff were seen to interact well with people who used the service.

We saw that decisions around consent to care had been documented. We heard staff asking people if they wanted to do things, for example taking medication, or deciding what clothes to wear.

We saw that people and their relatives had been involved in the planning of care. Risks had been identified to protect the welfare and safety of people.

We observed staff dispensing medication so that people received the right medication at the right time.

All the staff we spoke with said they felt supported to do their job.

We saw that the provider had systems in place to seek the views of people who used the service and they responded to the feedback given.