This inspection took place on 20 and 25 June 2018 and was unannounced.

The RedHouse 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 home was providing personal care and accommodation for up to 36 people. The service cared for older people living with dementia, mental health needs or physical disability. The home consisted of three floors accessed by stairs or a lift. During the inspection there were 31 people living in the home

We carried out a comprehensive inspection of The RedHouse in August 2017 where a rating of Requires Improvement was awarded. This was because the management of medicines was not safe. At this inspection we found that improvements had been made to the management of medicines. However, we found concerns around poor recruitment practice, accurate records had not been maintained, staff training was not sufficient and the provider failed to operate a robust quality assurance framework. The service remains as Requires Improvement.

At the time of the inspection there was 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. During the inspection the registered manager was not available. The provider had put measures in place to ensure the continued running of the service and an interim manager was in post. Throughout the report, we refer to this person as the manager. The manager had been working in that capacity for two weeks before the inspection.

We found that records related to various parts of the service needed improvement, including; recruitment records, staff training records, health and safety records, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) records, topical medical administration records and food and fluid charts.

Monitoring of the service by the registered manager had failed to identify concerns found during this inspection. The provider had not undertaken any additional audits or other processes to identify these concerns. The service had not sought any feedback from people or relatives for the purposes of continually evaluating and improving the service since August 2017.

The provider was unable to demonstrate they applied consistent safe practice when recruiting staff. One recruitment record did not have evidence that a Disclosure and Barring Service (DBS) check had been completed and one record had an unexplained gap of six years in employment history.

The training matrix was not up to date and showed significant gaps in important training for example, manual handling, first aid, Diabetes, falls training, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff told us they worked within guidelines from the National Institute for Health and Care Excellence (NICE) around medicines administration but were unable to tell us about any other current guidelines and best practice they were following. We have made a recommendation about best practice guidelines.

Staff told us that there were sufficient numbers of staff to meet people’s needs and we found this to be the case. However, there did not appear to be enough staff available to ensure that people could participate in meaningful activities when the activities coordinator was not available. We have made a recommendation about the provision of meaningful activities.

The MCA provides a legal framework for making specific decisions on behalf of people who may lack the mental capacity to do so for themselves. We found that the service was working within the principles of the MCA,

We carried out an unannounced inspection of this home on 21 August 2017.

The home provides accommodation and personal care for up to 36 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 26 people lived at the home.

There was no 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.

Whilst there has not been a registered manager at the location for two the provider had taken action over this time to ensure there was a manager present at the service in which they intended to be registered with the Commission.

At the last inspection we found that systems were not effective in monitoring the care provided at the service. At this inspection we found there had been an improvement and the manager and provider had carried out their monitoring The regulation had been met.

At our last inspection in February 2017 we found safe medicine practices were not followed. At this inspection we found safe medicines practice continued to not be followed.

People and their relatives said they received a safe service.

The interactions between people and staff were positive. People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home.

Staff had a good understanding of people's needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Staff encouraged people to be independent and promoted people's choice and freedom. People moved freely around the building as they chose.

Care records contained detailed information about how individuals wished to be supported. People's individual method of communication was taken into account and respected. People's risks were well managed, monitored and regularly reviewed to help keep people safe.

People were supported to take part in a range of activities inside the home and they reflected people's interests and hobbies.

People were supported to maintain good health through regular access to health and social care professionals, such GPs and speech and language therapists. People's dietary needs and any risks were understood and met by the staff team.

The manager and most staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported where possible to make everyday choices such as what they wanted to wear, eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

Staff described the management as supportive and approachable. Staff were well supported through induction and on-going training.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an unannounced inspection of this home on 7 February 2017 following concerns which had been raised with us about the care and welfare of people at the home. The home provides accommodation and personal care for up to 36 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 28 people lived at the home.

A registered manager was not in post at the home. 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. Although our register shows a registered manager was in post at this home, this person had not worked in the home since March 2016. A manager was employed in the service from March 2016 and applied to become the registered manager; however they had withdrawn this application and left the service in October 2016. A new manager had started at the home in November 2016 and was present at this inspection. They had applied to be the registered manager of the home.

We inspected this home in June 2016 and found the registered provider was not compliant with Regulation 9 (person centred care), Regulation 11 (need for consent) and Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (registration) Regulations 2009. Following this inspection the registered provider sent us an action plan stating they would be compliant with all the required regulations by August 2016. At this inspection we found the registered provider had failed to be compliant with all the required regulations.

Whilst people were supported by staff who understood how to identify signs of abuse and report these appropriately, we nevertheless found incidents of safeguarding were not always identified and investigated in a prompt manner to identify and apply any learning from these incidents in the home.

Whilst medicines were stored safely they were not always managed in a safe and effective manner. The registered provider had identified the need to change the system of administration of medicines.

The risks associated with people’s care needs had been assessed and plans of care were informed by these however these records were not always up to date and available for staff.

There had been a very high turnover of staff in the home and processes were in place to check the suitability of staff to work with people. However not all staff had received training to ensure they had the skills to meet the needs of people and training records were not always up to date.

Health and social care professionals were involved in the care of people and care plans reflected this.

Staff ensured people who were able to consent to their care were involved in making decisions about their care. However, where people could not consent to their care staff were not always guided by proper assessed consideration of the Mental Capacity Act 2005.

People’s nutritional needs were met in line with their preferences and people enjoyed the food they received. People enjoyed activities in the home.

Care plans in place for people reflected their identified needs and the risks associated with these, however these records had not always been updated. People and their relatives were involved in the planning of their care.

There was a lack of consistent and effective leadership and management in the home. Whilst staff felt supported by management there was a lack of structure and awareness of roles and responsibilities in the home. Records held in the home were not always clear, accurate or complete.

Systems and processes which the registered provider had in place at the home to mo

This comprehensive inspection took place on 7 and 9 June 2016. The inspection was unannounced following information of concern we had received.

The RedHouse Care Home provides accommodation, support and care for up to 36 people, some of whom live with dementia. There were 26 people living in the home at the time of our visit. The home is built on three levels and there is a lift between the floors. There are three communal areas on the ground floor where people can socialise and eat their meals if they wish.

Although our register shows a registered manager is in place at this home, this person has not worked in the home since March 2016.

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. A new manager had been appointed and commenced work in the home in March 2016. They had submitted an application to become the registered manager. Throughout the report we refer to this person as the manager.

Prescribed creams and as required medicines, lacked clear guidance and recording of their administration. While risks to people were known to staff these were not always clearly assessed and plans developed to reduce the risks. Some risks were known due to staff’s personal experience rather than training and guidance. Consent was not always sought appropriately. Staff did not fully understand the Mental Capacity Act 2005 and did not implement this appropriately.

Care plans were not always personalised, although staff knew people well. Staff involved people but this process was not formalised and we have made a recommendation about this. People’s nutrition and hydration needs were not effectively monitored and care plans did not always provide clear guidance to staff.

Systems used to assess quality and drive improvement were not effective as they had not been fully embedded and carried out early enough to take prompt action. The systems used by the manager and the provider had not always identified the concerns we had. Records were not accurate and the provider had not notified CQC of authorised Deprivation of Liberty Safeguards.

Staff understood their responsibilities in safeguarding adults at risk. We have made a recommendation that the manager review the way safeguarding investigations are recorded.

Staff had not been receiving the training and support they needed. The new manager was addressing this at the time of the inspection. We made a recommendation about this.

The manager had identified some concerns and had plans to address these. Staff spoke positively of the new manager and the changes they were making.

Staff treated people with dignity and respect. They understood the need for confidentiality. No one we spoke had any complaints but were confident to raise these and feel listened to. Staffing levels were sufficient to meet the needs of people and staff were recruited safely.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We carried out a routine inspection of this home on Tuesday 29 April 2014. At the time of our visit there were 36 people living at the home. On the day of our visit we spoke with the registered provider, the registered manager, the deputy manager, the chef and three members of care staff. We spoke with eight people who lived at the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found-

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and provided care which was in line with their agreed plan of care. People told us staff were kind and responsive to their needs at all times. We saw that people’s needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind and respectful manner.

Is the service responsive?

People’s needs were assessed and reviewed regularly to ensure their needs were met. People and their representatives were encouraged to participate in care planning and review. The registered manager or deputy manager regularly spoke with people and their representatives to ensure their needs were being met.

People’s nutritional needs were met according to their needs and were altered as people’s needs or requests changed. This meant that people were able to express their views of the care they received and have them acted upon.

Is the service safe?

People told us they felt safe in the home and when being cared for by staff. People were cared for by staff who had the appropriate skills and experience to ensure their safety and welfare. Staff had a good awareness of the people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw the home had appropriate policies and procedures in place to ensure the safety and welfare of people who were supported with their medicines. This meant people received care which ensured their safety and welfare.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received the care they needed to maintain their independence and dignity. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

Is the service well-led?

People told us the registered manager and provider were very approachable. Whilst people had not completed a formal feedback questionnaire for the service since our last inspection in June 2013, people told us they were always able to feedback to any of the staff from the home. People told us the staff team worked well together and were very responsive to any concerns or issues they raised.

Staff received appropriate support through supervision sessions and discussions with the registered manager or their deputy. This meant staff were clear about their roles and responsibilities and management were supportive of their roles.

We carried out an unannounced scheduled inspection on 11 June 2013.

On the day we inspected there were 32 people living at the home. During our inspection we spoke with four members of staff, three relatives and six people who use the service.

We saw that the home was well maintained and that people had access to lounge areas within the home to engage with others and could also access their own private rooms at any time. There was also a smoking area for people to use. We observed people participating in board games in a planned activity session and that a programme of activities was available for people to attend. One person had chosen to remain in their room to watch television. People had personalised their rooms with their own possessions including their own furniture.

We saw that the home risk assessments in place for people who needed equipment to support their independent living safely. We saw that people had their care discussed and agreed with them and that formal agreement to these care plans was in place.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. We observed people at a mealtime have positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. People were given reassurance and support as they needed it at the mealtime. Special dietary needs for people were recognised with a vegetarian diet prepared for one person.