The RedHouse Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 6 quality statements in the safe key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. During our assessment of this key question we found shortfalls relating to the application of the Mental Capacity Act 2005. We were not assured the provider were able to demonstrate people’s human rights were consistently upheld and protected. People’s records in relation to mental capacity assessment and best interests were not always completed in line with current guidance and legislation which increased the risk to people of their human rights being breached. This has resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they were supported to raise concerns and were confident they would be listened to and supported. They told us they felt incidents and complaints were managed well; investigated, responded to and lessons learnt. One relative told us, “I came in that day, and I was told about the incident straight away. I appreciated being told face to face rather than over the phone.” They went on to tell us they had felt reassured by the staffs’ prompt response and felt that they had learnt from the incident.

The registered manager told us they had worked hard to create a culture of transparency, openness and learning. Staff mostly confirmed this culture was in place within the service. Staff told us events, incidents and accidents were discussed and learning shared. Staff mostly felt there was a focus on learning and a ‘no blame’ culture. One staff member told us, “We have the handover, manager passes over to us what has happened, the advice given, and action taken, what is happening about it and what has been done about it.” The registered manager told us it was important to them to develop staff and their knowledge and provided staff with opportunities to be involved in the different stages of accident and incident management. This included liaising with partners and sharing learning. They told us they promoted an ‘open door’ policy and encouraged staff to ask questions and be involved. We experienced this in practice during the assessment; Throughout our discussions with staff when gathering feedback, we found staff taking the initiative to discuss a safeguarding incident in detail to ensure they had fully understood and learnt from it and were confident they knew what they would do if a similar incident were to occur in the future. Throughout the assessment we saw further examples of this culture being demonstrated by the provider, registered manager and staff team. It was evidence this culture was lead from the top down; from the provider and nominated individual, registered manager to the staff team.

The provider had systems and processes in place to investigate and learn from safety incidents and complaints. The registered manager utilised different methods of sharing learning with staff and could evidence these different methods. Such as handovers, supervisions, and team meetings. However, we found some of these processes for recording were not as robust as they could have been. For example, the provider carried out monthly analysis of all accidents and incidents, whilst this analysis had consistently taken place, there were instances where an increased risk to people had been identified but this change in risk had not always been updated in people’s care planning documentation. We did not identify any impact as a result of this for people as we found the appropriate referrals had been made to external professionals and staff had been able to demonstrate they were aware of the changes in risk for people and what action had been taken to mitigate those risks. We have reported on this in more detail in the Governance, management and sustainability quality statement.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe. One person told us, “I feel very safe here.” Relatives were confident their family members were safe and protected from harm. One relative told us, “If I’m concerned about something I speak to the staff. They’re all very helpful.” Another relative told us, “I have no concerns. If I did, I know who to talk to.” Relatives confirmed they were kept informed and updated on any safeguarding events. For example, one relative described a safeguarding incident and how they had been informed promptly. We received feedback from professionals who are involved with the service and visit regularly. They told us they felt people were safe and had no concerns. One professional told us, “Absolutely without a doubt … care they provide is always safe.”

The registered manager and staff were able to describe the mental capacity act and what this meant in practice. However, they were not able to demonstrate they had consistently applied it in their practice to ensure people’s human rights were always upheld and protected. Whilst they were able to provide some positive examples of supporting people to advocate for their rights, we found this was not always consistent and they needed to develop their practices to ensure they were able to consistently advocate and where necessary challenge other professionals. Staff were able to demonstrate their understanding and knowledge in relation to safeguarding and were able to describe in detail the action they would take in the event of a safeguarding concern. Staff were confident appropriate action would be taken. The registered manager told us they were passionate about ensuring staff at all levels were confident in reporting concerns and ensuring appropriate action was taken. They developed staff by involving them in the safeguarding process and ensuring they were comfortable in working with external professionals to share information and learning.

We observed people receiving safe care and support throughout the assessment. People knew staff and the management team and appeared comfortable. We observed people had the opportunity to talk to staff and the management team and that they were responsive to this; they would stop what they were doing and sit with people and gave them the time to discuss what they wanted. Where they couldn’t do this immediately, they would communicate they would come back after they had finished what they were doing, and we observed they consistently did return as they had said they would. People had opportunities to talk in confidence or in shared spaces and we observed people being given the choice. Although there were locked external doors, people were able to access any shared space they wanted to and were able access outside the locked doors with support as they wanted.

The provider had safeguarding systems, processes, and practices in place to ensure people were safe from risk of harm and to promote people’s human rights. However, these were not always effective. People’s records in relation to mental capacity assessments (MCA) and best interests (BI) were not always completed in line with current guidance and legislation and increased the risk of people’s human rights being breached. They were not always decision specific and lacked detail. Where a best interest’s meeting was required, the records lacked detail. The provider was responsive and took action to address the concerns; they provided assurances all MCA and BI records would be reviewed, additional support provided to those completing these records and further training provided in relation to the Mental Capacity Act 2005. The provider had appropriate safeguarding policies and procedures in place to ensure people were safe from risk of harm and abuse. Staff had completed safeguarding training and had access to the policies. We saw evidence of collaborative partnership working with the local safeguarding adults’ team to ensure appropriate action was taken to keep people safe from abuse or neglect. Incidents were effectively investigated and reported, with action taken to ensure people were safe. The provider was able to demonstrate appropriate referrals had been made to fully explore potential risks or changes for people to ensure they had the support, advice and equipment they needed to remain safe. However, the provider’s records could be more detailed and robust. We have reported on this in more detail in the Governance, management and sustainability quality statement.

People we spoke with told us they participated in discussions about their care and any associated risks. Although some people were not able to confirm they were involved in discussions about their care, their relatives told us their care planning was based on their likes and dislikes and preferences. Activities and household tasks people enjoyed doing prior to coming into the home were supported to carry on by the provider where people wanted this; where necessary the provider risk assessed and made adjustments to enable this. One professional told us, “They do a lot of positive risk assessing as well; for example, visits out in the community they do it in a safe way, look at risk involved, consult professionals, and then do it in a safe and manageable way.” Another professional told us, “[person] likes to change her room around and so will move her bedroom furniture around a lot and staff support her to do this in a safe way and not restrict it at all.”

Staff were able to describe in detail how they supported people to manage risks. Such as in relation to falls, supporting people when experiencing emotional distress and overcoming communication barriers. We received mixed feedback from staff in relation to people’s care planning documentation. Some staff told us they had time to read care plans and risk assessments whilst other staff told us they preferred to learn through observation and talking to people and staff. Not all staff felt people’s care planning documentation was easy to access and digest. However, all staff were able to describe in detail the measures in place to mitigate risks for people, the action they would take when necessary and how and when they would escalate to more senior staff or appropriate external professionals. For example, A staff member described in detail the preventative measures taken to support someone to manage the risk of pressure sores effectively, could identify what signs they would be observant for in relation to skin breakdown and what action them would take/who to contact. Other examples; staff were able to describe how they supported a person in a positive way when they were distressed; they detailed the early warning indicators they would be observant for in relation to a change in the person’s emotional wellbeing and how they would proactively respond to redirect and deescalate. Staff were able to describe how they supported people to manage the risks of falls, how they would support people in the event of a fall; during and after to ensure they were safe and supported to access appropriate support.

We observed people being supported by staff to communicate their needs and emotions in a positive way which promoted their dignity and was reflective of the support staff had described to us when providing feedback. People responded positively to the approaches used by staff and throughout the interactions observed staff continuously communicating and seeking people’s consent using their preferred communication methods. We observed staff talking to a person about an activity they wanted, but were hesitant, to do. They discussed through the concerns the person had and how they could support them to positively manage their concerns to enable them to do the activity safely with support.

There was a culture of positive risk taking within the service which was supported by the provider’s processes and systems. This enabled a balanced and proportionate approach to risk that improved people’s quality of life. For example, the provider enabled flexibility in staffing levels to enable people to be supported with new activities and additional support where needed. People were involved in reviews about their care with the provider and other professionals. However, although the provider had processes and systems in place, we found a concern with the recording in relation to risk assessments. People’s risk assessments were not always sufficiently detailed and personalised. Some people had generic risks assessments and it wasn’t always clear how the risks identified were a specific risk to the person. The provider recognised their electronic care planning system was not suited to their needs as it prepopulated information which made the wording of the risk assessments generic, unclear and at times compromised the comprehension of the risk assessment. Prior to this assessment the provider had started to take action to address this. Following the assessment the provider implemented a new electronic care planning system.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives had no concerns in relation to staffing levels. People confirmed staff were responsive to their needs and were available when they needed them. People told us staff and the management team spent time talking to them and they felt listened to. People confirmed they felt staff were trained in meeting their needs and whilst they did not know the specific training staff had had, they felt staff knew what they were doing and had no concerns. One professional we spoke with told us, “I'm very impressed with the home overall. Especially their knowledge around mental health. The manager always mentions the different types of training they have. This home was always jumping at any training offered … They are always willing to learn. I think it is a really good home.” Another professional told us, “Yes there is enough staff and there is even staff in supporting the dance sessions.”

Staff confirmed there were enough staff to support people’s needs. Staff told us they had time to provide 1:1 support for activities, such as supporting someone to access the local community. One staff member told us, “There is always enough staff … If one person needs to be taken off the floor to write care plans than have capacity to do this which is nice.” The registered manager regularly reviewed the staffing levels and had effective arrangements in place to cover staff absences. The registered manager told us they were supported by the provider to plan their rotas to provide for people’s emotional wellbeing as well as their physical support needs. This meant they had flexibility in planning their rotas to provide for people to have 1:1 activities and to enable people to access the community when they want without having to wait for it to be planned. The registered manager was very passionate about this and how it enabled them to be responsive in the moment and to utilise opportunities to support such activities as they arose, they told us, “It is really important to have additional staff in the building for those spontaneous moments.” The registered manager told us staff were supported with regular supervisions and staff confirmed this. Staff confirmed they had been supported with inductions and had received the training they felt they needed to be able to meet people’s needs. The registered manager told us, “When we induct staff they go through a whole induction checklist, first 2 weeks they are not included in the numbers, paired up and put on shifts with competent staff and mentors. Care is scary for a new person who hasn't done it, we don't want them to feel overwhelmed. It is about supporting them and so if they are competent and happy that translates to the residents.” Staff felt if additional training was needed the provider would support them to access the training. Staff told us they were supported to develop professionally.

We observed sufficient staffing levels during the assessment. We observed staff having time to speak with people and have conversations beyond discussions about what immediate support needs they had. Staff were visible and responsive to people. People appeared comfortable with staff and knew them. Staff were familiar with people and understood people’s preferred communication methods. People were supported at their preferred pace and were not rushed by staff. Where people were able to do things for themselves, staff supported this, they were not task orientated.

The provider had systems and processes in place to ensure safe recruitment of staff. This included the completion of a check with the disclosure and barring service and the gathering of references. Staff completed training in a wide range of subjects. This included, skin integrity and pressure ulcers, sepsis awareness, falls and hydrate, slips, trips and falls, pressure ulcer prevention, loss and bereavement and obesity in adults. At the time of the assessment the provider was in the process of creating a more robust training matrix to be able to more effectively record the training completed by staff and easily identify when refresher training was required. Staff were supported with regular support and supervision. The registered manager had implemented different supportive measures for staff which included different themed supervisions, competencies and wellbeing checks.

People and relatives had no concerns about the cleanliness of the home. They told us cleaning was regularly carried out. One person told us, “Staff do all the cleaning. They wait until I have gone downstairs. One cleaner used to get down on her hands and knees and go under the bed with a brush and dustpan. She would chat to you as she worked.” One relative told us, “I would say it’s very clean here. A very sterile environment." People confirmed staff wore appropriate personal protective equipment, such as gloves and aprons.

Staff confirmed they had access to personal protective equipment (PPE) and there were sufficient supplies. They were able to describe when and how they would use the PPE in line with the provider’s policy and their training. The registered manager was able to demonstrate their understanding of infection prevention and control policies and procedures and how they ensured people were protected as much as possible from the risk of infection. They knew where to access relevant national guidance and had contacts with external professionals they could access for additional advice and guidance if needed.

The premises and equipment appeared visually clean. This assessment was unannounced, and it was evident cleaning had actively been in progress prior to the assessment team being on site. Throughout the assessment we observed regular cleaning taking place. Staff were observed consistently wearing appropriate personal protective equipment (PPE). There was PPE available throughout the home and appropriate waste disposal systems in place. There were hand washing facilities throughout the home and hand sanitiser. We observed these were regularly used and replenished throughout the assessment.

There were effective processes and systems in place to manage the risk of infection in line with current national guidance. The provider could evidence effective partnership working with relevant partners to ensure they were able to access up-to-date guidance, advice and recommendations. Information was shared effectively with staff in relation to infection prevention and control. The provider had clear roles and responsibilities in relation to infection prevention and control and the registered manager had effective oversight.

People told us they were supported with their medicines. Comments included, “I’m on lots of meds. They bring them and I take them. I never leave them”, “I don’t know what they’re all for. I think some are for my blood pressure and paracetamol for pain”, “I’m on lots of tablets. I don’t know what they’re for. Some are for pain and that.” People confirmed their medicines were reviewed. One person told us, “When I first came here, I was taking 10 tablets every morning. Now I’m down to 2. I’m pleased about that.” We observed people being supported with their medicines, the staff member administering the medicines followed the person’s care plan and checked people’s wellbeing during and after the administration of their medicines.

Staff we spoke with were knowledgeable about people’s needs and their medicines. Staff told us they received training and ongoing competency assessments. Staff told us they knew when to raise medicines concern and were able to approach the registered manager if they had any concerns.

Medicines procedures were in place. However, they were not always followed safely. Where medicines were administered occasionally records were not always completed correctly. This meant there was a risk of people not receiving their medicine as prescribed. The provider had already identified this as a concern prior to the assessment and had had a team meeting to rectify this. Storage temperatures were monitored, and we observed suitable arrangements for storage, and disposal of medicines. Eye drops were dated when opened, stored safely and disposed of every 28 days, ensuring safe usage. However, some of the creams were not dated when opened, which meant the provider could not be assured the cream was safe to use and within the safe use dates. The provider took prompt action in response to our feedback and reviewed their medicines systems and processes to ensure they were robust. The provider engaged well with persons’ GP services regarding any necessary changes to persons’ medicines and their administration. The registered manager completed monthly audits of medicines. Medicines errors were accurately recorded and discussed at a recent staff meeting. The provider had appropriate contingency plans in place in case of a fridge breakdown. Medicines that required stricter controls by law were correctly stored and were always signed by 2 trained staff members.