This inspection was carried out on 11 and 20 July 2018 and was unannounced.

The Red House 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 24 people using the service at the time of our inspection. Most people using the service were able to tell staff how they preferred their care provided.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

This was the first inspection of The Red House under a new registration due to changes to the details of the provider’s registration, however the Red House was not a new service. It was still owned and managed by the same family as at our previous inspection. We last inspected the service in February 2018 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 were identified. We issued requirement notices relating to safe care and treatment, fit and proper persons employed, staffing and notifications: which are notices of change. We also issued a warning notice in respect of Good Governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve each of the key questions to at least good. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made. However, we found five breaches of the Regulations.

This is the first time the service has been rated Requires Improvement.

At this inspection we found that not all risks to people had been properly assessed and minimised. There was not always clear guidance for staff regarding risks relating to choking, moving people and health conditions such as epilepsy. We asked the provider to ensure this was reviewed immediately after the first day of our inspection. They confirmed this had been done and when we returned for the second day we checked this. The changes had been made to ensure clear and accurate guidance was available to staff.

Other risks to people had been identified and assessed. There was guidance for staff regarding how to support people who were living with healthcare conditions such as diabetes and supporting people with catheter care.

Staff were not consistently recruited safely. Some files did not contain all the necessary documents required to confirm a robust system of recruitment. Staff were not fully supported to complete training and development to make sure they were able to fulfil their role. Not all staff had received the opportunity to meet with a manager to discuss their role and any concerns they had. We were told this was planned in the weeks following our inspection. We will follow this up at our next inspection.

Staff completed induction training when they started to work at the service. We have recommended the registered persons review their induction process and introduce the Care Certificate.

Audits intended to identify shortfalls in the safety and quality of the service were in the process of being implemented. In their absence, some of the shortfalls we identified at out last inspection remained.

Staffing levels were not consistently safe. Staff were not always appropriately deployed and there was no formal assessment tool in place to demonstrate