We carried out a review of the data available to us about Redlands 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 Redlands, you can give feedback on this service.
Redlands is a residential care home providing personal care to up to eight people. The service provides support to adults with learning disabilities, autism and other multiple needs. The service was a residential home which fitted into the environment like other domestic homes in the area. There were multiple shared spaces and bedrooms had ensuites. At the time of our inspection there were seven people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. The service could show how they met the principles of Right support, right care, right culture.
Right Support: People lead confident, inclusive and empowered lives where they were in control and could focus on areas of importance to them. The ethos, values, attitudes and behaviours of the management and staff provided support in the way each person preferred and enabled them to make meaningful choices.
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.
Right Care: Care and support plans were holistic and reflected people's needs. These reflected a good understanding of people’s needs with the relevant assessments in place, such as communication and sensory assessments. Support focused on people’s quality of life outcomes and met best practice. People were able to input into choosing their food and planning their meals. Staff offered people opportunities to be involved in preparing and cooking their food and drink. We saw positive interactions between people and staff. We observed staff engage with people in a respectful and kind manner.
Staff understood people’s different communication support needs. We saw people being supported using their preferred communication methods and staff demonstrated an awareness and understanding of people's needs. People told us they enjoyed the activities available to them and that there was lots to do.
Right Culture: The needs and quality of life of people formed the basis of the culture at the service. Staff undertook their role in making sure that people were always put first with enthusiasm. They provided care that was genuinely person centred and directed by each person.
The management team had the skills, knowledge and experience to perform their roles and understood the service they managed. They had a vision for the service and for each person who used the service. They were visible in the service and approachable for people and staff. The provider's vision and values focused on person-centeredness, being passionate about making a difference to people's lives and ensuring positive outcomes for people. We observed the registered manager and staff understood and cared for people in a manner that was in keeping with these principles.
People confirmed they felt safe and told us they were happy living at Redlands. People confirmed there were enough staff to meet their needs. Relatives and staff were in agreement. Relatives consistently told us there had been significant improvements to the service. Staff had a high degree of understanding of people’s needs. People’s care and support was provided in line with care plans. A system was in place to record and monitor all incidents. This was overseen by the registered manager to ensure appropriate actions were taken to support people safely.
Since the last inspection the provider had carried out an extensive refurbishment and redecoration programme. The registered manager told us how they had supported people and their relatives to be involved with this programme. The shared spaces had been designed to meet the needs of all the individuals living at the service.
Since our last inspection the registered manager had implemented a robust agency induction programme with detailed guidance on how people preferred to be supported, their likes and dislikes and how to support them. We found the provider had implemented robust systems and processes to monitor the service and drive improvements.
People, and those important to them, worked with managers and staff to develop and improve the service. Staff told us they were involved in developing the service and felt listened to. The provider sought feedback from people and those important to them and used the feedback to develop the service. People, relatives and staff all told us the service had improved and they were happy with the changes.
The provider had worked closely with other health and social care professionals and professionals confirmed there was effective partnership working with the provider which achieved positive outcomes for people.
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 inadequate (published 6 June 2022). 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 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.
This inspection was carried out in response to the previous inspection where multiple breaches in regulation had been found. The provider had submitted an action plan and this inspection was to check they had followed their action plan and to confirm they now met legal requirements.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Redlands is a residential care home providing personal care to seven people at the time of the inspection. The home can accommodate up to eight people in one building and there are multiple shared spaces. They predominately support people living with a learning disability and/or autism.
People’s experience of using this service and what we found
The provider had not established an effective system to ensure people were protected from the risk of abuse. Risks to people's health and wellbeing had not been monitored or mitigated effectively. People were at risk of harm because staff did not always have the information, they needed to support people safely. At our last inspection we found safeguarding incidents had not always been reported as required to the local authority. At this inspection we identified a continued lack of reporting of safeguarding incidents. Care plans and risk assessments lacked sufficient detail to ensure people were supported safely.
People were not supported to have maximum choice and control of their lives. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The provider was not able to demonstrate how they were meeting the underpinning principles of right support, right care right culture. The service was not maximising people's choices, control or independence. People were not always supported to make meaningful choices. There was a lack of person-centred care and people's human rights were not always upheld. A lack of timely action by leaders to ensure safeguarding incidents were responded to meant people did not lead inclusive or empowered lives. People had care plans in place. However, these were not always written in a way that was person centred and easy to understand; we found inconsistencies in care plans, a lack of detail and care plans which had not been updated to reflect the current support people were receiving. We observed people were not always supported in an open, inclusive and empowering way.
The service was not well led. At our last inspection the quality assurance systems to assess and monitor the service were not always in place, and where they were, they were not effective. At this inspection we found the provider did not have enough oversight of the service to ensure it was being managed safely and quality maintained. Quality assurance processes had not identified all of the concerns in the service. Records were not always complete. Indicators of a closed culture were identified, and staff morale was low. This meant people did not always receive high quality care. The provider had failed to notify CQC of significant events that happened in the service as required by law.
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 8 October 2020) and there were breaches of regulation. 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 the provider remained in breach of regulations.
Why we inspected
We received concerns in relation to the safeguarding processes within the service. As a result, we made the decision to undertake a focused inspection to review the key questions of safe and well-led only. We inspection and found there were additional concerns, so we widened the scope of the inspection to become a comprehensive inspection which included all five key questions.
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.
The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.
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 staffing, person-centred care, safe care and treatment, management of risk, safeguarding people from abuse, premises and equipment, assessing and monitoring risk, good governance and failure to report to CQC.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Redlands is a residential care home providing accommodation and personal care and support for up to eight adults who have learning disabilities or autistic spectrum disorder. The accommodation is spread over two floors. There were seven people living in the home at the time of our inspection.
People’s experience of using this service and what we found
The service was not always safe.
We were not assured that people were protected from abuse as procedures needed to be tightened to ensure they were robust enough to keep people safe from harm.
The service was not always well-led. Staff spoke of a closed culture where they felt unable to raise concerns.
There were systems in place to monitor the quality and safety of the service provided, however these were not always effective as safeguarding concerns were not always reported or action taken to ensure peoples safety.
We could not be assured that all notifications were sent to us as part of their registration.
Staff did not always feel supported by the previous management team however relatives we spoke with were happy with the service provided.
There had been no cases of COVID-19 at Redlands and staff were aware of infection control procedures to follow to keep people safe. However, some areas in the home needed redecoration.
The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.
Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. Staff told us staffing levels had recently improved.
Medicines administration records (MAR) confirmed people had received their medicines as prescribed.
Staff working at the service understood people’s needs and supported people in a personalised way
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 27 September 2018).
Why we inspected
We received concerns in relation to safeguarding people from abuse, lack of recording and staff not feeling supported. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can also 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 Redlands on our website at www.cqc.org.uk.
Enforcement
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.
We have identified breaches in relation to failing to protect people from abuse 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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection on 1 June 2017 the service was given an overall rating of Requires Improvement. At this inspection we found improvements had been made and we have given the service an overall rating of Good.
Redlands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Redlands provide accommodation and personal care and support for up to eight adults who have learning disabilities or autistic spectrum disorder. The accommodation is spread over two floors. There were seven people living in the home at the time of our inspection.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The service has a registered manager. 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 a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences. People and their families were supported to express their views and be involved in making decisions about their care and support.
There were systems and processes in place to protect people from harm, including how medicines were managed. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.
Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.
Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.
People were supported to have 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.
People received regular and on-going health checks and support to attend appointments. They were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.
The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.
The registered manager was promoting an open, empowering and inclusive culture within the service. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.
The service provides care and support for people who may have a learning disability, a mental health condition or physical disabilities. Some people living at the home displayed behaviours that were challenging to others and required interventions from staff to keep them and others safe. Some people could not speak with us due to their difficulty in communicating effectively.
There is a registered manager at Redlands. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
This inspection was carried out in response to concerns raised by healthcare professionals and the general public. They told us they had concerns about staff deployment and safeguarding.
We received conflicting information about the deployment of staff and could not be assured people’s needs were consistently met at all times.
Systems and processes were in place to drive improvement and arrangements were in place to obtain feedback from relatives, however staff working in the home and healthcare professionals told us improvements were needed.
Staff knew people well and communicated with them in a kind and relaxed manner.
Good supportive relationships had been developed between the home and people’s family members.
People were supported to maintain their dignity and privacy and to be as independent as possible.
Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with advocacy agencies, healthcare professionals and family members to ensure decisions made in people’s best interests were reached and documented appropriately
People were not unlawfully deprived of their liberty without authorisation from the local authority. Staff were knowledgeable about the deprivation of liberty safeguards (DoLS) in place for people and accurately described the content detailed in people’s authorisations.
Staff received training appropriate to people’s needs and were regularly monitored by a senior member of staff to ensure they delivered effective care.
Staff interacted with people and showed respect when they delivered care. People’s records documented their hobbies, interests and described what they enjoyed doing in their spare time.
Records showed staff supported people regularly to attend various health related appointments. Examples of these included visits to see the GP, hospital appointments and assessments with other organisations such as the community mental health team.
The registered manager responded appropriately to any complaints.
Staff were complimentary about the registered manager and told us they could access support when needed.
Records showed care reviews took place on a regular basis or when someone’s needs changed.