The Red House Nursing Home

The Red House Nursing Home provides accommodation and nursing care for up to 32 people. The building has accommodation spread across three floors. Twenty six people were living at the home at the time of our inspection.

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

Practices at the home did not always keep people safe and ensure they were protected from avoidable harm. We found safeguarding referrals had not always been made to the local authority when required. We had not been notified of significant events which providers are required to inform us about. This included skin tears and a fractured thumb.

The home carried out checks when recruiting staff. Agency workers were used to cover gaps on the rotas, when necessary. The provider had not ensured it had obtained satisfactory evidence of recruitment and training from the agency, to make sure people were always cared for by workers with the right skills and experience.

People were not adequately safeguarded from the risks of fire. Records of fire drills were insufficient to demonstrate all staff had been effectively trained and would know what to do in the event of a fire or other emergency.

The provider had not ensured there was effective governance of the service, to make sure people received good standards of care. The nominated individual (representative for the provider) regularly visited the home but there were insufficient records of findings or suggestions for improving care practice.

Providers are required to act in an open and transparent way when things go wrong (duty of candour) and there are specific things they need to do in these circumstances. The registered manager was able to describe some actions taken, such as informing relatives or speaking with the person affected, but they were unable to demonstrate full compliance.

We have made recommendations regarding the risk assessment format for moving and handling, medicines practice and recording of accidents and incidents. We have made a further recommendation regarding the provider’s monitoring of record keeping at the service.

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.

People were protected from the risks of infection as staff followed good hygiene practices. Staff worked in partnership with other agencies to promote people’s health and well-being. Improvements had been made in some areas to enhance people’s quality of care.

Relatives spoke positively about the home. One relative told us “I will never be able to thank the staff for the happiness and kindness that they have brought into our lives during this difficult time. I would recommend The Red House to anyone in need of care.” People we spoke with were complimentary of staff. One said “Staff are brilliant,” another commented “They’re very good to me.”

Rating at last inspection

The last rating for this service was good (report published 6 November 2018). We also carried out a thematic inspection looking at infection prevention and control (report published 10 March 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to fire safety measures, safeguarding practice, ensuring sufficient recruitment checks have been carried out for temporary workers, notification of significant events, duty of candour and good governance at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visitors were asked to provide evidence of completing a lateral flow (rapid result) swab test on the day of the visit and asked to sign in. Personal protective equipment (PPE) was available in the entrance area and there were signs requesting visitors wear it.

People were admitted to the home safely. Appropriate testing was carried out to ensure people did not have the coronavirus when they moved in to the home.

Staff had access to PPE to protect themselves and others from the risk of infection. There were PPE stations around the home and staff were seen wearing PPE. Training had been undertaken on correct use and disposal of PPE. The home had not experienced any issues in obtaining supplies of PPE during the pandemic.

There had been regular testing of staff and people living at the home.

The home had experienced two outbreaks of coronavirus during the pandemic. People were able to isolate in their rooms, where able.

Assessments had been carried out to protect staff who may be clinically vulnerable and at higher risk if they contracted COVID-19. There had not been any disruption to people’s care as a result of staff needing to isolate.

There were policies and procedures to provide guidance on safe infection prevention and control practice. Audits were carried out to check standards were being maintained.

The home was kept clean.

The registered manager told us the home had been offered support from the mental health team to promote the well-being of staff. They also said staff were asked how they were managing during their supervision meetings.

The Red House Nursing Home is a care home with nursing. It is registered to provide support to older people living with dementia, mental health and or physical disability. It can accommodate 32 people. At the time of our inspection 24 people lived at the home. The care home is in a rural village in north Buckinghamshire. Accommodation was over three floors. People had access to a small dining room and had a choice of two communal seating areas.

At our last inspection we rated the service good. However, we made a recommendation about ensuring people received effective care and records relating to care were accurately recorded. At this inspection we found some improvements had been made. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People gave us positive feedback about their experience of the home. Comments included, “The staff here are lovely and [Name of person] is always very well looked after" and ”They are very caring here and their approach is good" and "The good staff are fun as well as doing a good job.”

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. We found some improvement were required to ensure decisions made for people who lacked capacity were made in line with the code of practise of the Mental Capacity Act 2005. We have made a recommendation about this in the report.

Risks to people had been assessed and many actions required to minimise risks were made. However, the provider did not always make recommended changes in a timely way. We have made a recommendation about responding to action plans following the completion of risk assessments.

Improvements could be made to the senior managerial oversight of the service. No service improvement action plan was in place. We have made a recommendation about this in the report.

People were supported by staff who had been recruitment safely. Staff were supported to keep their skills and knowledge up to date.

People could be confident they would receive their medicines when required. Medicines were stored safely.

People were supported by staff who knew how to recognise signs of abuse and knew what to do in the event of a concern being raised.

People’s dignity was respected and people were encouraged to be independent.

Further information is in the detailed findings below.

The Red house is a care home for older adults, some of whom may have a physical disability or are living with dementia. It is registered to provide accommodation for 32 people who have nursing needs. At the time of our inspection 29 people lived at The Red house.

We previously inspected the service on 11 February 2014.The service was meeting the requirements of the regulations at that time.

The service had 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 Red House is located in a Buckinghamshire village, it has developed good links with the local community and people are encouraged to join in ‘dementia friendly’ activities in the community.

Risks to people are recorded, and plans are put in place to reduce risks. However care plans are not always evaluated with up to date information. This meant that staff were sometimes unaware of what care and treatment was required.

People are protected from harm and staff had a good understanding of how to recognise abuse and take appropriate action should a safeguarding concern be raised.

The service had a very stable workforce, this contributed to the knowledge the staff had about people they cared for. Positive relationships had developed with staff and people living at The Red House.

The service had a clear vision to provide a high quality service. Staff felt supported by the management and feedback was sought from people and their relatives.

The service was open to driving up improvement and engaged with external parties. It had agreed to be part of a clinical trial in medicine.

Where required the service ensured that onward referrals were made to external health care professional.

We have made a recommendation about training for staff on care planning and reviewing.

People's needs were assessed and care plans were clear and individualised, reflecting the needs of people who use services. Risk assessments were undertaken to manage people's choices and safety. Staff plan activities and arrangements were made to take people regularly to a local national trust home and gardens.

Staff provided a healthy balance and choice of food that was cooked on the premises. People were provided with home made cakes in the afternoons. Dietary needs were met and staff were properly trained in food hygiene. Specialist dietary advice was followed in the management of people's medical needs.

Clear systems were in place for the management of medicines and staff were trained to ensure medicines were handled safely, securely and appropriately.

Staff were trained to care for people who used the service and staff demonstrated a good understanding of the needs of those people. Planning of staff rostas and strategies for coping with shortfalls in staffing were in place.

The home had assurances in place to assess and monitor the quality of services.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they are still a Registered Manager on our register at the time.

During our visit we saw that staff assisted people who lived at the home in a kind and compassionate way. We found people were treated with dignity and respect. We joined people in the dining room during lunch time. We observed staff offering people choices of food and provided discreet assistance to those who needed help. People were not rushed and enabled to eat their lunch at their own pace.

People's needs had been assessed before a placement at the home had begun. This ensured their needs could be met appropriately. A pre admission assessment was undertaken and included risk and needs assessments. Care plans addressed people's individual needs, were detailed, reviewed and updated regularly.

Daily activities were provided to those who wished to take part. These included one to one activities and group activities.

The provider had systems in place to monitor and regularly assess the quality of service that people received.