This inspection took place on 15 January 2019 and was unannounced. We last inspected the service in August 2016. At that inspection we found the service met all the fundamental standards and attained a rating of Good.

At this inspection, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment; staffing; and governance. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009. The overall rating for the service is now Requires Improvement.

Redlands Acre is a care home without nursing that provides a service to up to 33 older people, some of whom may be living with dementia or a physical disability. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection, there were 28 people living at the service.

There was a registered manager in post, who was present during our inspection. 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.

Medicines were not always stored securely. Although medication audits were in place, these were not up-to-date. The audits did not include people's prescribed creams, which meant shortfalls in this area had not been identified.

Where incidents and accidents had occurred in the home, these had not always been reported. Staff had not always alerted management to allegations of harm or abuse, which had delayed action being taken to protect people.

Investigations into incidents at the home were not always thorough, with necessary actions to prevent a reoccurrence missing; the provider had re-opened two investigations at the time of our inspection.

Training the provider deemed as mandatory for staff was sometimes out of date, or had not been completed at all. Although this had been identified, a clear and targeted action plan was not in place.

The registered provider had not ensured all notifiable events had been reported to the Care Quality Commission, as required to by law.

Although there were quality assurance measures in place to assess and monitor the quality and safety of care provided, these had not been effective in identifying shortfalls, such as in weight monitoring and accuracy in people's 'as required' medicine protocols.

People enjoyed positive relationships with staff, and staff knew people well as individuals. People's independence was promoted, and there was a 'no locked door' policy at the home.

People were supported with their communication needs, and to maintain contact with loved ones.

Care plans were person-centred and were kept under review to make sure they reflected any changes in people's health or wellbeing. People were able to enjoy their hobbies and interests.

Complaints and feedback were considered, acted on and responded to, and used to make improvements to the service.

Staff felt valued in their roles and spoke enthusiastically about working at Redlands Acre. There was a calm, relaxed and happy atmosphere at the home, with sufficient staff to meet people's needs and spend time with them.

People were protected from the risk of infection. A safe recruitment process was in place.

You can see what action we told the provider to take at the back of the full version of the report.

This was an unannounced inspection which took place over two days on the 16 and 17 August 2016. Redlands Acre provides accommodation and personal care for up to 35 people. Facilities can be provided for people who wish to live together. People have access to two lounges and a dining area, en-suite bedrooms, and assisted bathrooms. Accommodation was also provided in eight bungalows offering people a more independent style of living whilst also having access to staff. At the time of our inspection 24 people were living at Redlands Acre. There were five people residing there who had been diagnosed as living with dementia.

The home had a registered manager. 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.

At the last comprehensive inspection in October 2014 we rated this service as requires improvement in the key questions safe, caring, responsive and well-led. This related to staffing levels, people’s perception of the attitude of some staff, the lack of meaningful activities, ineffective quality assurance auditing and not recognising the needs of people living with dementia. Action had been taken to address these and had improved people’s experience of their care and support.

People’s care and support reflected their individual needs, wishes and aspirations. They had positive relationships with staff who understood them well and supported them with care, kindness and compassion. When people were distressed staff reacted quickly offering reassurance when needed. People made choices about their care and support and about their daily lifestyle. People were involved in their care and support and their changing needs were responded to keeping them safe and well. When necessary social and health care professionals were contacted and staff worked closely with them to make sure their recommendations were carried out. When people had accidents and incidents these were closely monitored to reduce the risks of them happening again.

People were supported by staff who were checked thoroughly prior to appointment to make sure they had the skills and aptitude to carry out the work. Training was provided from induction and staff were encouraged to develop professionally. They felt supported in their role and said they worked well as a team and communicated well with each other. They would raise concerns about people’s health and well-being and were confident the appropriate action would be taken. People were supported by staff to participate in a range of activities both inside and outside of their home. Staff spent time with people sharing light hearted moments, talking, laughing and just being there for them.

People expressed their views about the service they received in a variety of ways. They attended residents’ meetings where they discussed menus, activities and the environment. Each year they could respond to a formal survey as well as giving feedback at reviews of their care with their keyworkers. Quality assurance audits identified where improvements could be made and provided evidence when any actions had been implemented. The registered manager worked closely with health care professionals and local organisations keeping up to date with changes in legislation and current best practice.

This inspection took place on 21 and 22 October 2014 and was unannounced.

Redlands Acre provides personal care and accommodation for 40 people some of whom were living with dementia. At the time of our visits there were 29 people living at the home two of whom were living with dementia. Redlands Acre provides accommodation on the ground and first floor of the home and in eight self contained bungalows. People living in the bungalows have the opportunity to be more independent whilst also receiving personal care from staff. 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 and associated Regulations about how the service is run.

Staff were kept busy meeting the individual needs of people as well as providing activities and preparing the evening meal. At times the care and support they provided focussed on the task in hand without having a meaningful interaction with people.

People raised concerns with us about the attitude and behaviour of some staff. Despite this being raised previously with the registered manager in January 2014 and action taken with staff, some people still felt some staff were “rude and bad tempered.”

People had limited opportunity for stimulation and occupation due to the poor and inconsistent provision of activities. People enjoyed music and movement sessions, the occasional film show or quiz however there was no programme in place for day to day activities. Staff met people’s needs in a task centred way with little social engagement. When they had time to sit and chat with people the atmosphere was lifted and people could be heard laughing. People living with dementia did not receive a service which reflected their individual needs. For example there was inadequate signage to help them find their way around the home.

Quality assurance processes had identified where improvements to the service could be made such as reviewing the provision of activities and staffing levels. The experience of people living in the home had not improved by the provider as a result of this feedback. However some minor improvements had been made in response to comments from people and their relatives. People and their relatives said the registered manager was approachable and accessible and concerns would be dealt with promptly.

People could see a range of health care professionals to maintain their health and wellbeing. People were supported by staff who had the experience to meet their individual needs. Staff said they were supported and were able to update their skills and knowledge. Staff conduct was monitored and when needed action had been taken to address poor performance. The registered manager had worked with external agencies to keep people safe when dealing with safeguarding concerns. People were supported to take risks to maintain their independence as safely as possible. Some people managed their own medicines. Effective systems were in place to manage people’s medicines.

People were supported to make choices and decisions about their day to day lives. People said they enjoyed their meals and were offered choices about what to eat and drink. Where people had specific dietary needs these were catered for. Staff supported people with kindness, patience and sensitivity.

We made three recommendations for the provider to consider how improvements can be made to the service people receive.  We recommend that the service explores the relevant guidance on how to make the service provided to people living with dementia more dementia friendly. We recommend that the service considers how people can live well in a setting which promotes their mental health, wellbeing and their interests. We recommend that the service considers the relevant guidance about monitoring quality and how to listen, improve and respond to people’s views.

We spoke with eight people living in the home, a visitor and four members of staff. People told us, "it's marvellous" and "it's a good home". Staff told us they enjoyed working at the home. We observed them treating people sensitively, politely and with good humour. People told us "staff are all really lovely" and "everyone's polite and helpful".

The planning and delivery of care ensured that people's individual needs were met. Their safety and well-being were promoted.

People were offered a choice of suitable and nutritious food and drink. People told us, "the food is alright, it varies a bit" and "the food is good, there is too much for me".

One person told us "it's a good home, I'm comfortable here". We found that people could access most areas of the home and gardens. Maintenance plans were in place and some areas had been identified for long term improvements. Equipment was provided where appropriate to encourage people to retain their independence.

Recruitment procedures did not safeguard people from potential harm. The provider was not obtaining all records and information about new staff prior to them starting work.

We haven't spoken with people who were living in the home as part of this follow up inspection to check on compliance with two outcomes. We gathered evidence of people's experiences of the service by reviewing their care records and discussing these with staff.

We looked at the care records for four people who were living in the home. Where they had falls or had returned from hospital their care records were updated to reflect their changing needs. Staff were being responsive to accidents and incidents minimising the risks of further risks to people. Where needed people were referred to health care professionals for advice and support.

We found that people's personal records were being kept up to date. They provided an accurate record in respect of each person's care and support. The provider had put audits in place to monitor and review records to make sure they maintained compliance with this standard.

We spoke with six people using the service they told us they were happy living at the home. One person told us staff talked to them about their care needs. Another person said they were unsure if this happened. We spoke with three staff who had a good understanding of people's needs.

We found that the care plans of one person had not been amended to reflect their changing needs. Their key worker had noted changes in their cirumstances when reviewing the care plans but no alterations had been made to these records. Accident and incident records stated that one person had three falls out of bed in October 2012. Staff had made changes to their sleeping arrangements but there was no evidence of a referral for an assessment by an occupational therapist to provide equipment to safeguard them from harm. We found they were not meeting this standard.

We noted that care records were being reviewed inconsistently. Some were being reviewed each month whereas others were being reviewed at differing intervals. There was evidence that some people were involved in discussions about their care but this was not recorded consistently. Weight and fluid monitoring charts were not always being fully completed. This could potentially put people at risk of inappropriate care or treatment. The provider told us they would conduct audits of care records and ensure that action plans would be put in place to address any shortfalls. There was no evidence that these were taking place.

We talked with seven people using the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specfic way of observing care to help us understand the experience of people who could not talk with us.

Five people told us that staff discussed their care plans with them and had a good understanding of their needs. One person told us, "I have nothing bad to say about the home". Another person said, "I visit with people who stay in their rooms and can say they have no problems at all".

We spoke with people about how staff supported them. People told us "staff are alright", "staff always have time for me" and "staff are very good". One person said, "staff treat me respectfully. They are very caring here". Another person told us, "staff are fine".

We asked people if they knew how to make a complaint. All of the people we spoke with told us they did not have any concerns at the time of our visit. A person told us, "I think I picked a good home, there is very little to complain about". Another person said, "the manager is accessible and keeps an eye on things".

An expert by experience visited the home with us. An expert by experience has personal experience of using or caring for someone who uses a social care service. Their observations and discussions with people have been used in this report.

People told us, "all staff are good no one is miserable or nasty", "staff are very good, nothing is too much of a problem" and "they are all very good to us."

Another person told us, they recently spent seven weeks in hospital, they said " I missed this place, I was glad they let me back because I have heard some places don't."

One person said "there is nothing to do here, I used to do lots of things but I don't do anything here." Another said "there is always someone to talk to but never anything to do." A visitor we spoke to said lack of activity was their main concern about the home, they said their relative was very low and they wished the home could do more activities for them. The visitor spoke about a trip out in the minibus that their relative had enjoyed and said they wished they did more trips.

We observed that there was very little interaction between residents at meal time and staff only spoke when serving and collecting plates. The manager told us staff often had their breaks in communal areas spending time chatting to people. Staff confirmed this. People told us they were happy with the staff. They also said staff were very busy.