The Red House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Red House is registered to provide accommodation, nursing and personal care for up to 31 older people in one adapted building. There were 18 people using the service at the time of our inspection. Some people using the service were able to tell staff how they preferred their care provided.People’s experience of using this service and what we found
We found there were four breaches of regulations three of which had continued since our inspection in July 2018. People did not always receive safe care and treatment to reduce risks to their health and safety. Staff did not receive the support and supervision they needed. Audits and checks on the quality of service people received had been undertaken and shortfalls had been identified. Action had been taken in some areas of the service and improvements had been made. Other areas needed more work and development to ensure improvements were embedded and sustained. Records were not kept up to date. The provider had not ensured that consent to care and treatment was in line with law and guidance.
This is the second time the service has been rated Requires Improvement.
The provider had identified that the service was not working as well as it should and had taken action. The provider had employed two consultants to re-assess and develop all the systems used within the service to make improvements. One of the consultants was a previous registered manager of the service. They knew the service well.
People were not always fully protected from risks. Risks had been identified but not all risks to people had been properly assessed and minimised. There was not always clear guidance for staff regarding risks relating to choking, when people became distressed and health conditions such as constipation.
People's capacity to make decisions about their lives had not been assessed. Meetings had not been held to make sure all decisions were made in people’s best interests.
Staff did not receive the support and monitoring they needed to undertake their roles effectively and safely. Nurses employed by the service had not received clinical supervision to make sure their skills were up to date and in line with best practise.
The service did not have a registered manager in post. The provider was in the process of trying to recruit a new manager but at the time of the inspection no appointment had been made.
The consultants had implemented new quality assurance systems. Audits and checks had been completed at the service. These checks had identified shortfalls, and improvements were being made. Some records were not up date.
People's needs were assessed before they started using the service. People were supported to express their views and make decisions about their care. People had care plans that provided guidance for staff to provide care that was responsive to people's needs. Care plans were personalised.
When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. People were safeguarded from the risk of abuse
Staff treated people with dignity and respect. Staff helped to maintain people's independence by encouraging them to do as much as possible. People were supported to do things they wanted to do.
People's medicines were safely managed, and systems were in place to control and prevent the spread of infection. People's needs were assessed before they moved into the service. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care. Staff were recruited safely. When shortfalls were identified in the recruitment procedure immediate action was taken.
People were given information in a way they could understand. People were supported to pursue their hobbies and interests. People's religious, spiritual and cultural needs were discussed to make sure these needs were met.
There were arrangements to quickly investigate and resolve complaints. People were treated with compassion at the end of their lives, so they had a dignified death. Staff were supporting people to make decisions about what they wanted to happen at this time in their lives.
People enjoyed the food and had enough to eat and drink.
People and their relatives were asked their opinions on the service by attending meetings and completing surveys, suggestions had been acted upon. People and their relatives gave positive feedback about the service they received.
Staff said they were listened to and that their opinions and suggestions were acted on. When there were any incidents and accidents these were recorded, and steps were taken to prevent any reoccurrence.
The provider and their team were committed to learning lessons when things went wrong.
Rating at last inspection and update
The last comprehensive inspection was completed on 11 July 2018 and 20 July 2018. The inspection report was published on 11 October 2018. The rating for the service was Requires Improvement.
The registered person completed an action plan after the inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made or sustained and the registered persons were still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified three continuing breaches of regulations. People did not always receive care and treatment that was safe and person-centred. Staff did not receive the care and support to ensure they carried out their roles effectively and safely. The service was not consistently well-led. There was a new breach of regulations. This was because some people’s mental capacity had not been assessed to ensure they were able to make informed decisions.
Please see the action we have told the registered persons to take at the end of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Red House on our website at www.cqc.org.uk.
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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.