Archived: The Red House Care Home

This comprehensive inspection took place on 8 March 2016 and was unannounced.

A registered manager was in post at the time of our inspection and had been registered since 9 November 2015. 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.

Staff were knowledgeable about identifying and reporting any incident of harm that people may experience. People were looked after by enough staff to support them with their individual needs. Measures were in place to cover staff absence and there was monitoring of sickness levels of individual members of staff. Satisfactory pre-employment checks were completed on staff before they were allowed look after people who used the service. People were supported to take their medicines as prescribed and medicines were safely managed.

People had sufficient amounts of food and drink. People were offered choices of food and drink and people liked the choices that were available. They were also supported to access a range of health care services and their individual health needs were met.

People’s rights in making decisions and suggestions in relation to their support and care were respected. Where people were not able to make such decisions, their needs were met in their best interest.

People were looked after by staff who were trained and supported to do their job.

The CQC monitors the operation of the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS] which applies to care services. When people were assessed to lack capacity, their care was provided in their best interests. However, DoLS applications had not been made to responsible authorities when some of the people had restrictions imposed on them. Therefore, the provider was not acting in accordance with the requirements of the MCA.

People were treated by kind and attentive staff. They and their relatives were involved in the review of people’s individual care plans.

People’s care was provided based on their individual needs and they were supported to maintain contact with their relatives. People were encouraged to take part in a range of hobbies and interests. There was a process in place so that people’s concerns and complaints were listened to.

Staff were trained and supported to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Monitoring procedures were in place to review the standard and quality of people’s care.

We found the provider was in breach of one regulation in relation to lack of submission of DoLS applications to the appropriate authorities. You can see what action we told the provider to take at the back of the full version of the report.

Prior to the inspection, concerns about the service being provided to people in residence at The Red House Residential and Nursing Home had been raised with the Care Quality Commission (CQC). These concerns were from four different sources and covered a range of issues.

During this inspection we spoke with seven people who lived at the home, two people's relatives and six staff, including the manager. We looked at various records, including staff rotas, and records of the care that people had received.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

People told us they were happy living at The Red House Residential and Nursing Home. Several people made very positive comments, especially about the staff. One person said, 'Taking it all round I think it's very good.' This indicated that people felt they were safe.

Prior to the inspection we had had a number of concerns raised with us, from different sources, which included that the home was short of staff and that there was a high use of agency staff. The manager told us that recruitment had taken place and was ongoing. However, all except one of the people we spoke with, relatives and staff all told us that the home was often short staffed. On the day we inspected people were still being assisted to get up, washed and dressed at lunchtime and we were given other examples of when care had not been delivered as people needed or wanted. This meant that people were at risk of not receiving the care they needed to keep them safe.

We found that some of the record keeping was poor. Supplementary charts, put in place to record the care people received, had not been fully completed. This meant we did not know whether or not people had received care according to their assessed care needs. We found that staff rotas did not always accurately reflect which staff had been on duty.

Assessments of people's capacity to make decisions, as required by the Mental Capacity Act 2005, had been carried out and recorded. This meant the provider was acting in accordance with the law and people's rights were being upheld in this area.

Is the service effective?

We met one person who told us that in the two years they had lived at The Red House Residential and Nursing Home they had never had to make a complaint, never met any staff they did not like and that they 'couldn't be happier'. However, other people and relatives we spoke with were not so complimentary about all aspects of the service and had raised issues about the service they or their family member had received. Although people generally looked clean and appropriately dressed, we saw some examples, such as dirty fingernails and people who had not been shaved, which showed that care was not always delivered as required.

Activities or entertainment were organised every afternoon in the main lounge/dining room, which several people enjoyed. But people told us that, 'We used to go out but we don't anymore.' Activities for people who stayed in their rooms were very limited or did not happen at all. One relative said they visited every day because their family member was so bored and did not get any stimulation.

Is the service caring?

We saw that staff spoke to people in a kind and friendly way, they were attentive to people's needs and their actions showed respect for the people they were caring for. People told us they liked the staff. One person said, 'They are all very kind and willing to help you if you need help.'

Is the service responsive?

Records showed that people's needs were assessed before they were admitted to the home, to ensure the home could meet each person's individual needs. At the time of this inspection care plans were in the process of being reviewed and updated to make sure that the plans met people's changing needs. The revised care plans we looked at gave staff clear, detailed guidance on the ways in which each person preferred their care to be delivered.

We saw that people's health needs were monitored as people had access to a range of other healthcare professionals, such as GPs, district nurses, optician and chiropodist.

People and their relatives were given opportunities to express their views about the running of the home. People told us they knew how to complain. One person said, 'No complaints whatsoever.' However, one of the complainants who had approached CQC stated they had not had a satisfactory response from the management of the home.

Is the service well-led?

The registered manager had not been in post very long at the time we inspected the home. She told us she had inherited a range of problems and that she knew it would take time to get the home running as she wanted it to. She had developed an action plan to address issues she deemed to be priorities and we saw that these actions were taking place. For example, staff were being recruited and care records were being reviewed and updated. One person said, 'They all say the manager is very nice.' One member of staff told us, 'Kate's a very good manager' and another said, 'I think Kate is trying to do a very good job, considering what she's been left with.'

The provider had a system in place to make sure that the service delivered to people by the staff was of a high standard. This included a number of audits of different aspects of the service, carried out by employees of the provider who were independent of the home, and by the home's own staff. Issues that had been identified by these audits had been added to the manager's action plan.

We found that the provider was not compliant with some of the regulations in the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

During our inspection on 10 September 2013, we found that the provider had increased staffing levels and had recruited new members of care staff to the home.

A new manager had started at the home and our inspection took place on his third day of working there. People we spoke with, especially relatives and staff, told us that they were feeling very positive about the future with the new manager in charge. They said that the atmosphere in the home had already changed for the better.

Care plans were personalised, detailed and gave staff good guidance on the way each person wanted their care delivered by staff. People's health was monitored by a range of healthcare professionals.

Overall the home was clean and hygienic and the manager assured us that he would rectify the few issues that we found. The provider had a complaints system in place and people we spoke with knew how to complain should they have needed to. One relative said, 'The care is fine and I've never had to complain.'

People told us how much they liked most of the staff. However, they also said that there were times when there were not enough staff on duty, and too much reliance on agency staff who did not know people's needs well enough. Staff we spoke with confirmed this.

We spoke with staff and with people who lived at the home. They all said that there had been improvements as there was now a consistent team of care staff made up of permanent staff rather than the high reliance on agency staff that there had been at the time of our previous inspection. They also said that the number of staff on duty did not fall below the assessed minimum number needed to meet people's needs. Staff told us that improved organisation and allocation of work had also meant that it was easier to meet people's needs in a timely way.

We consider that the improvements to the provision of staff taken by the provider means that they have met the compliance action that we issued at the last inspection.