We carried out an unannounced inspection of the service on 10 and 11 April 2018. Redcote Residential Home is a ‘care home’. People in care homes receive accommodation and 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.

Redcote Residential Home is registered to accommodate up to 28 older people in one building. Some of these people were living with dementia. At the time of the inspection, 26 people were using the service.

A registered manager was present during the inspection. 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.

During the home’s previous inspection on 20 August 2015, we rated the home overall as ‘Good’ although the service was rated as ‘Requires Improvement’ for the question, ‘Is the service safe?’ During this inspection, we found some areas of concern and the overall rating has now changed to ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

People felt safe living at the home. Staff understood the processes for protecting people from avoidable harm. People’s medicines were managed safely however, protocols for the consistent administration of ‘as needed medicines’ were not always in place. The risks to people’s safety had been assessed and care plans were in place to support people safely. There were enough staff to keep people safe, however the staff were not always deployed appropriately, which could place people at risk. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager. The home was clean and tidy.

People’s physical, mental health and social needs were assessed and provided in line with current legislation and best practice guidelines, although guidance for some conditions such as Parkinson’s disease was needed. People were supported by trained staff who had their performance regularly assessed. However, few staff had received an annual appraisal of their work. Staff felt supported by the registered manager. People spoke positively about the food; however, the lunchtime experienced was unorganised with some people waiting longer for their meals than others.

The registered manager had built effective relationships with external health and social care organisations and people’s health was regularly monitored. However, information for people within the home about their health conditions was limited. The environment had been adapted to ensure people who had mental or physical disabilities were able to lead fulfilling lives. However, more directional signage was needed to support people living with dementia to orientate themselves independently around the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice, although some assessments of people’s capacity to make decisions required more detail.

People and relatives liked the staff and found them to be kind, caring and respectful. Staff treated people with dignity and respected their privacy. People felt able to make decisions about their care and felt the staff respected those decisions. People were encouraged to lead as independent a life as possible. People were provided with access to an independent advocate if they needed one, although information about how to do so independently was not available.

People’s care records were person centred and guidance was provided for staff on how each person would like to be cared for. Some records required older information t

This inspection took place on 20 August 2015 and was unannounced. Redcote Residential Home provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 28 people who require personal and nursing care. At the time of our inspection there were 27 people living at the home.

At the time of our 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

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff were able to tell us about how to keep people safe. The provider had systems and processes in place to keep people safe.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and GP and were supported to eat enough to keep them healthy. People had access to drinks and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were usually sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered.

Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision, however they had not received appraisals.

We saw that staff obtained people’s consent before providing care to them. People had access to activities and community facilities.

Staff felt able to raise concerns and issues with management. Relatives were clear about the process for raising concerns and were confident that they would be listened to. The complaints process was on display.

Regular audits were carried out and action plans put in place to address any issues which were identified. Audits were in place for areas such as medicines, health and safety and infection control. There were cross infection issues which had not been identified by the infection control audit.

Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

A single inspector carried out this inspection. At the last inspection in October 2013, the provider was asked to take action to ensure there was an accurate record for each person using the service, including appropriate information and documents in relation to the care and treatment provided each person. At this inspection we found these issues had been addressed.

We talked with five of the 27 people using the service and three relatives. We looked at five people's care records and observed care being provided. We talked with three care staff, the cook, two housekeepers and the manager. We examined four staff records and the documentation related to quality audits.

This helped us to answer the questions below:

Is the service safe?

We found there were appropriate standards of hygiene and cleanliness and staff were conversant in procedures necessary for the prevention and control of infection.

Safe procedures were in place for the ordering, storage and administration of medicines.

Is the service effective?

Care was planned in conjunction with the person using the service or their relatives. Care plans had been reviewed regularly and updated as necessary. Care plans were therefore accurate and reflected people's needs.

Specialist equipment needs had been identified and required equipment was in place.

Visitors we talked with confirmed they were able to visit at any time and could see their relative in private if they wished.

Is the service caring?

All the people we talked with told us all the staff were kind and caring. A relative of a person using the service said, "They try their hardest to encourage (the person) to eat and will prepare anything (the person) fancies even though they eat very little of it."

People's preferences had been recorded and care and support was provided in accordance with their wishes.

Is the service responsive?

People were encouraged to provide feedback on the care provided and issues identified were addressed.

People told us staff listened to them and said, "If you want anything at all, you only have to ask. The carers will do anything for you."

The service cooperated and collaborated with other care professionals to ensure people had access to specialist support when required.

Is the service well led?

People using the service and the staff told us the manager was always available for them to talk to and acted on issues raised.

There were a range of quality audits in place to assess and monitor the quality of the service provided.

Care records and staff records were maintained and stored appropriately.