The inspection of Red House took place on 9 March 2017 and was unannounced. At the last inspection on 8 and 9 October 2015 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’ because the registered provider was in breach of three regulations. These were with regard to staffing numbers, consent and quality monitoring of the service.

Red House is a care home that is registered to provide care and accommodation for a maximum of 48 older people. The home has two units both on one level, with one specialising in support for people living with dementia. These are Burlington and Bayle units. The home is located in Bridlington, a seaside town in East Yorkshire, close to the seafront and within easy access of the centre of the town. All bedrooms are single occupancy and many have en-suite bathroom facilities.

We found that at this inspection the registered provider had made improvements in all three areas where breaches of regulation had occurred and was now compliant with these regulations. We saw there were four care staff and one senior staff on duty in each of the units: a total of ten care staff. This was an increase in staffing numbers since the last inspection and was sufficient to meet people’s needs. Rosters corresponded with those staff that were on duty.

Where people were assessed as having no capacity to make specific decisions, the registered manager now arranged for best interests decisions to be reached, DoLS applications to be made and reviews to be carried out. People’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager explained how the service worked with other health and social care professionals and family members to ensure a decision was made in a person’s best interests where they lacked capacity to make their own decisions.

Quality audits were completed on a regular basis and were effective at identifying shortfalls. Satisfaction surveys were issued to people that used the service, relatives and health care professionals and meetings were used to obtain people’s views. There was an effective system in place for checking the quality of the service and this had been used to check that mental capacity regulations were being followed.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered with the Commission for the last five months, but had been managing the service for the last year. A registered manager is a person who has 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.

People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury or harm.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support people. We found that the management of medi

Red House is a care home that is registered to provide care and accommodation for older people. The home has two units, with one specialising in support for people with dementia related conditions. The home is located in Bridlington, a seaside town in East Yorkshire.

We carried out this inspection to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit one. This helped to ensure people would be safeguarded as required.

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose. The doorways to bedrooms, communal spaces and toilet/bathing facilities were wide enough for wheelchairs or people with walking frames to mobilise comfortably through them. People who used the service were pleased with the facilities offered by the service. One person told us “I have a lovely room and the staff keep it nice and clean.”

People were protected from unsafe or unsuitable equipment because the provider had ensured the equipment used in the service was serviced and maintained and service certificates were available for inspection.

Care files and associated care records were stored securely within the service and detailed policies and procedures were in place with regard to record keeping and retention. Staff had received training on data protection. This meant people could be assured that information about them was kept confidential.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. There was limited evidence of people being involved in assessments of their needs and planning of their care. However, people said they could discuss their care with the staff or manager and on the whole felt well supported and cared for. One person told us “The staff are lovely. They treat you with respect and listen to you when you want to talk about your care. I like to do things my own way and the staff support me to be as independent as possible."

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living. The equipment used in the service was serviced and maintained and service certificates were available for inspection. One person told us “I have every confidence in the staff when they help me with my care and support, they are competent and know how to use the various aids and pieces of equipment I use in my everyday life”.

Is the service caring?

We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives.

We saw that people asked for drinks and assistance with personal care and these requests were promptly responded to. Staff were respectful and patient with individuals.

All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations. People who spoke with us said “The staff look after us” and “The food is lovely and there is always a choice of meals.” A third person told us “You sometimes have to wait for staff to see to you, but they always do come though”.

When we spoke with staff it was clear they genuinely cared for the people they supported. However, we observed that staff were sometimes task orientated and did not recognise when people needed additional help. Discussion with the registered manager indicated this was something they had recognised and were taking action on.

Is the service responsive?

People had access to information about the service and what it offered. The manager informed us that on admission the people who used the service were provided with copies of the Statement of Purpose and Service User Guide. In addition to these documents people and relatives were given the provider's ‘Living well with dementia’ brochure. These documents gave people information about the service in a large, clear print format with plenty of photographs illustrating examples of what people could expect from the service.

People had access to a range of activities in the service. Two people said they had played bowls and attended an exercise class the day before our visit and three others said they enjoyed pastimes such as reading their newspapers, watching television and reading.

People were supported by the staff to fulfil their spiritual needs. People accessed church services in the community and were given support from staff to attend if needed. Visits from clergy could be arranged on request.

People we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems.

Is the service well led?

The service had an effective quality assurance system, which indicated the quality of the service was continually monitored. The records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Feedback from these individuals was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was analysed by the provider and where necessary action was taken to make changes or improvements to the service.

The service had an open door policy so staff were able to discuss any concerns with the manager. Regular staff meetings were held so that people could talk about any work issues. This meant that staff were able to provide feedback to their managers and their knowledge and experience was recognised and taken into account.

At our last inspection in August 2013 we found concerns with the arrangements for handling medicines. Following our visit the provider wrote to us and told us that they had taken action to address the concerns. At this visit we saw that this action plan was being acted upon and medicine handling had improved.

We visited Red House on 7 August 2013. This visit was a scheduled annual inspection.

People who used the service who we spoke with told us they were satisfied with their care and treatment. One person told us “They are very good, of course they are”. A relative of a person told us “They are pretty good, we cannot grumble at all”.

A visiting health worker told us that they were satisfied with the support their patients were receiving. They told us that staff had been quick to respond to a person whose deteriorating health had led to a pressure area. They explained that all appropriate action had been taken as soon as the risk had been identified.

We found that people were supported to maintain an adequate diet and that catering staff and care staff worked collaboratively to ensure people’s nutritional needs were met.

We checked the management of medicines. We found two people had not received their medicines as prescribed.

Staff told us they felt they had the knowledge and skills required to do their job. Staff felt supported by the manager and were confident that they could go to them if they had any concerns regarding the care and welfare of the people who used the service and that these would be addressed.

The provider had a robust quality assurance process in place that was responsive to feedback regarding the experience of people who used the service.

Because people were not able to communicate with us verbally, we spent time observing the interaction between staff and people who lived at the home. We saw that staff made every effort to obtain consent from people before they assisted them with eating, drinking, personal care or other activities, and that they did this in a sensitive and encouraging manner.

We saw that assessment, risk assessment and care planning information included sufficient detail to inform staff how the person wished to be assisted or supported. This information had been reviewed on a regular basis to ensure that it remained up to date. We saw that health care professionals had been consulted appropriately.

Staff had undertaken training on safeguarding adult's from abuse and any incidents that had occurred at the home had been investigated appropriately. There was a complaints procedure in place and records of any complaints made evidenced that a thorough investigation had taken place.

There were sufficient staff on duty although staff felt that there were occasions when an extra member of staff had been needed.

We observed that the home had been maintained in a clean and hygienic condition.

People told us that staff respected their privacy and dignity and that they were able to make choices about their day to day lives, including what time to get up and go to bed, how to spend their day and what to have for meals.

People told us that they were assisted with personal care in a sensitive manner. One person said that staff listened to them if they had any concerns and that staff were polite when they spoke to them. Another said, “We are taken good care of”. People told us that they felt safe living at the home.

People told us that they always got enough to eat and drink. They said that there was a good varied menu and that the food was always served at the right temperature.

They said that there was enough to eat and drink and drinks were served to them in the way they liked them. All of the people we spoke with said that they liked the food and would not change anything about it.

People told us that staff at the home were kind and helpful but some people said that they ‘always seemed rushed’. However, they did say that this had not affected the care they received.

We carried out this inspection on 8 and 9 October 2015. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was unannounced; which meant that the staff and registered provider did not know that we would be visiting.

The last inspection was carried out on 16 April 2014; at that inspection Red House Care home was found to be compliant with the regulations we looked at.

Red House is a care home that is registered to provide care and accommodation for up to 48 older people. The home is divided into two units, ‘Burlington' which provides support for people who require residential care and who may have a mild cognitive impairment and 'Bayle’ which specialises in support for people with more complex dementia related conditions. On the day of the inspection there were 40 people living at the home which is located in Bridlington, a seaside town in East Yorkshire.

The home is required to have a registered manager in post. On the day of the inspection there was a manager in post who was registered with the registered provider at another location. At the time of the inspection the manager had submitted an application to the Care Quality Commission (CQC), to change the location of their registration to Red House. A registered manager is a person who has registered with 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.

We found there were insufficient numbers of staff to effectively meet the needs of the people living in the home during traditionally busy times of the day, including the morning when people required the highest levels of support with personal care and also at mealtimes. This was a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

We found that Mental Capacity Act (MCA) (2005) guidelines had not always been followed. We saw that when decisions were made on people’s behalf these a capacity assessment had not always been completed and the decision had not been taken at a best interest meeting. This was a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

We found the registered provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support. However we found that these were not always effective. This was a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

People told us that the staff were caring and they felt well looked after. We saw people were treated with respect and dignity and saw examples of positive interactions between the staff and people living in the home. However, these were too infrequent to provide enough stimuli for people. We made a recommendation regarding the levels and type of interactions between staff and people living in the home.

We found that people were offered some activities and that activity coordinators were employed. However, staff, relatives and people living in the home all told us that there was not enough activities. We have made a recommendation around the homes activity programme.

We found that the recording of some documentation including food, fluid and repositioning charts was inconsistent. We have made a recommendation regarding the homes recording of charts.

People told us they felt safe and we found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. We found that effective recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

We found assessments of risk had been completed for each person and plans had been put in place. Incidents and accidents in the home were accurately recorded and monitored monthly. The home had a system in place for ordering, administering and disposing of medicines and this helped to ensure that people received their medicines as prescribed.

Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty; a standard authorisation application for each person had been completed and these were being reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.

People’s nutritional needs were met. People told us they enjoyed the food, were given a good choice of meals and they received enough to eat and drink. However the meal time experience for people across the home was inconsistent due to insufficient staff numbers.

Staff told us they were well trained. We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as safeguarding, moving and handling and infection control and also home specific training such as dementia awareness.

Peoples health needs were met. People were supported to maintain good health and had access to healthcare professionals and services. People were encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments when necessary.

We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

We found that peoples comments and complaints had not always been responded to appropriately, however since the new manager had been appointed this had improved. We saw that systems were now in place to seek feedback from people and relatives about the service. We saw that any comments, suggestions or complaints were now appropriately actioned.

There was a new manager in post and people told us they were able to approach them with any concerns they may have. People told us they felt the home had improved since their appointment and were confident that the improvements made so far would continue.