This unannounced comprehensive inspection took place on 30 November and 12 December 2016. We last inspected in August 2014 and found the service was rated good and was meeting all the regulations that we inspected at that time.

Red Brick House provides nursing and residential care for up to 50 people, some of whom are living with dementia. At the time of our inspection there were 42 people living at the service including one person who was in hospital and returned to the service on the last day of inspection.

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.

People told us they felt safe. Staff were aware of their safeguarding responsibilities and told us they would report anything of concern.

Medicines were managed safely and staff had received training and additional support with the introduction of a new electronic medicines system.

Any risks had been identified and risk assessments put in place. The provider had a robust risk monitoring procedure and risks were reviewed regularly and when any issues arose. Where accidents had occurred, they were recorded and monitored by the registered manager.

The premises were clean and there were no malodours. Checks and tests had been carried out to ensure that the premises and equipment were safe such as electrical and gas safety tests and lift maintenance. The registered manager ensured that emergency plans were in place in case of emergencies like flooding or fire and every person in the service had their own personal emergency evacuation plan to aid the emergency service should the building need to be cleared.

Safe recruitment procedures were in place and staff were checked prior to starting work to ensure they were suitable for their role and safe to work with vulnerable people. Staff told us they were well supported and received suitable training to allow them to complete their work safely. The majority of staff had worked at the service for some time or had been appointed from another care home.

A full induction programme was in place and when we checked it was comprehensive, but was not linked to the Care Certificate. The Care Certificate was officially launched in April 2015. It aims to equip health and social care workers with the knowledge and skills which they need to provide safe, compassionate care. It replaces the National Minimum Training Standards and the Common Induction Standards. The provider told us they would ensure that any new staff with no experience of care would complete their induction based on the Care Certificate.

The provider had enough staff on duty to meet the needs of people living at the service and had employed bank staff to support them when shortages due to sickness or holiday occurred. We saw that staff carried out their duties in a calm unhurried manner and were available to provide emotional support to people.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.

We saw that people enjoyed the food prepared for them and were able to confirm this when asked. There was a range of nutritious meals and refreshments were available throughout the day. We

At a previous inspection we identified shortfalls in the management of medicines. We carried out this inspection to check whether action had been taken to address these concerns. We found that improvements had been made to ensure that people were protected against the risks associated with medicines.

People told us they happy with medication administration within the home. One person said, "They (staff) bring my tablets and give them to me on a spoon. I always take them." Another person told us, "They (staff) stand with me while I take my medication."

We found that the provider managed medicines appropriately.

We spoke with ten people, five members of staff and three visiting relatives. People told us they were happy with the care and support they received. One person said, "They are looking after me quite well. If I need anything they (staff) go and get it for me." Another person said, "They (staff) are all very good. They are looking after me very well." One relative commented, "I am happy with everything and have no problems."

We found that people's care and support needs were appropriately assessed and their care and support was planned. Where people required input into their care from external healthcare professionals this had been arranged.

People received care which reduced the risk of poor nutrition and dehydration. Where necessary, external healthcare professionals had been consulted about people's dietary concerns.

We identified shortfalls in respect of medicine management which meant that people's health and welfare was put at risk.

Care was provided in an environment that was suitable for purpose and adequately maintained. People staff and visitors were protected from the risks associated with unsafe or unsuitable premises.

We found the provider had a structured staff selection and recruitment policy in place which aimed to ensure staff were suitably skilled, experienced and qualified to deliver care safely.

People told us they were happy with the care and support they received. One person said, "I have no complaints at all. I tell them and they do what I ask them to." Another person said, "They are looking after me well." One person's relative said, "I am very happy with the care for X. I wouldn't have chosen it otherwise."

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. Where appropriate we found that the provider acted in accordance with legal requirements if people did not have the capacity to consent themselves.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.

People were cared for in a clean and hygienic environment and we found that the service had appropriate measures in place to monitor and manage infection control.

There were enough suitably skilled and qualified staff on duty to met people's needs safely and appropriately.

We saw the provider had a complaints policy and procedure in place and people told us they were confident the manager would deal with any complaints they raised.

People told us that they were well looked after. They said they were happy at the home and had no complaints to make.

People described their care as "excellent" and "the best".

People told us they were involved in making decisions about their care and lifestyle. They told us, “They give me choices in meals. I can choose when I go to bed. I’m last to go to bed and first out!” Another person told us “I do what I want to do.”They said that they were satisfied that they got a good service that suited their individual needs. One person said, “It’s like a nine star hotel. They do everything for you here. Even when we had the trouble with the take over, there was no problems. The manager’s like a lion, she’s fantastic, she wants things done properly. I didn’t want to come here in the beginning. I came from hospital. But there’s nothing to fear, I’ve got my room and I’ve got all the freedom I want.” People said that the staff were “excellent” and they thought that they had a good understanding of their needs “The care is great you get what you need”

One relative said that the family were very happy with the support provided at Red Brick House and that any issues were reported to them by staff promptly. She also said that they were consulted and involved in planning her mother's care.

The staff at the home were positive about the care being provided to people living

there. One staff member said they would be happy for their own family members to live

at the home if they required care.

We spoke with a social care professional who was visiting the home to check that people are receiving appropriate care. He told us that he had, “No concerns about the quality of care.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was carried out over two days. We visited the service unannounced on 22 July 2014 with a specialist advisor and expert by experience and announced on the 1 August 2014.

The service met all of the regulations we inspected at our last inspection on 20 March 2014.

Red Brick House is a care home for up to 50 people who require nursing or personal care. There is a separate wing for those who are temporarily in receipt of care following a spell in hospital, or referral for respite from their GP. There were 34 people at the home on the days of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

There were procedures in place to keep people safe. Staff knew what action to take if abuse was suspected. Safe recruitment procedures were followed and staff said that they undertook an induction programme which included shadowing an experienced member of staff.

Staff were appropriately trained and told us they had completed training in safe working practices and were training to meet the specific needs of people who lived there such as those with complex nursing needs.

Staff who worked at Red Brick House were knowledgeable about people’s needs and we saw that care was provided with patience and kindness and people’s privacy and dignity were respected.

The registered manager assessed and monitored the quality of care. Surveys were carried out for people who lived there and their representatives. Audits and checks were carried out to monitor a number of areas such as health and safety, medication, care plans and meal times.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?’

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.