This inspection took place on 28 June 2018 and 3 July 2018 and was unannounced.

Redstacks is a privately-owned care home in a residential area of Hessle. 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. The home is registered to provide personal care and accommodation for up to 14 older people, including those with dementia related conditions. At the time of our inspection 13 people were receiving a service.

At our last inspection in February 2016, we rated the service overall good. At this inspection, we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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

Medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this. We found staff had been recruited safely and training was provided to meet the needs of people. Staff received regular supervision and appraisal and told us they felt supported in their roles.

Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Accidents and incidents were responded to appropriately and monitored by the management team. The service was clean and infection control measures were in place. People and relatives spoke positively about the clean and well-maintained environment.

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.

People’s nutrition and hydration needs were catered for. A choice of meals were offered and drinks and snacks were made readily available throughout the day.

There was a positive caring culture within the service and we observed people were treated with dignity and respect. People’s wider support needs were catered for through the provision of activities provided by care staff and visiting entertainers.

There was a complaints policy and procedure made available to people who received a service and their relatives. All complaints were acknowledged and responded to quickly and efficiently. The service sought feedback from people who received a service; feedback was positive.

There was a range of quality audits in place completed by the management team. These were up-to-date and completed on a regular basis. All of the people we spoke with told us they felt the service was well-led; they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the service and enjoyed their jobs. People spoke highly of the provider who was heavily involved with the day to day running of the service

Further information is in the detailed findings below.

The inspection of Redstacks took place on 14 January 2016 and was unannounced. At the last inspection on 22 May 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Redstacks is a residential care home that provides accommodation and support to a maximum of 14 older people who may be living with dementia. The service is in the residential town of Hessle within the boundary of East Yorkshire. The property is a detached house in its own grounds. There is car parking for seven vehicles and on extra parking is found on-street. People that use the service also have access in and out of Hull via public transport.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager that had been registered and in post for the last three and a half years. 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.

The registered manager also managed a separate service under a separately registered company, which was part of a family group of businesses. They were not present for the whole of the inspection, but we were assisted by a person that was to be the next registered manager. This person was in the process of completing a Diploma in Management and had made an application to the CQC to become the new registered manager. There was also a deputy manager who had been assisting with managing the service for several years.

We found that 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 of harm at all costs.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the people that were on duty. We saw that recruitment policies, procedures and practices were carefully followed to ensure staff were ‘fit’ to care for and support vulnerable people. We found that the management of medication was safely carried out.

We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and received appraisal regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitable for providing care to older people and while there were no adverse effects to people living with dementia, the environment was not quite as conducive to their needs as it could have been in terms of floor covering and signage. We made a recommendation to the provider about this.

We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected a

Our inspector visited the service and assessed six essential standards of quality and safety which helped us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 using the service and the staff supporting 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?

We found that people were having their care and welfare needs met by staff who provided support to them in a safe way. Care plans included assessments of need and an action plan to instruct staff on how best to care for people. We found that staff followed the instructions of the care plans.

People that used the service experienced safe practices with the handling and administering of their medication because staff followed the procedures in place and accurately recorded when medicines had been administered, stored or disposed of.

We found that the premises were safe and suitable for providing care and accommodation to older people who may have a dementia type condition.

Is the service effective?

We found that people received effective care because they had care plans in place to inform staff on how best to meet peoples' needs. Staff understood peoples' individual preferences and accessed health care support when necessary to ensure peoples' health care needs were effectively met.

Staff had been appropriately trained to care for older people and so they used their skills effectively to ensure peoples' needs were met.

Is the service caring?

People were treated kindly and with respect. We observed and heard staff being patient and understanding and we found that people were given the time they needed to do things at their own pace. Staff were caring and encouraging.

Is the service responsive?

We saw that staff responded to people whenever they requested support and offered assistance at strategic times to ensure people were comfortable and their needs were met. People were listened to regarding their complaints and action was taken to remedy any concerns relatives may have had. The service was responsive to peoples' wishes and requests.

Is the service well led?

There was a suitable quality monitoring and assurance system in place which enable the provider to identify any shortfalls in the service and to address them to improve on the quality of service provision.

People who lived in the home, relatives and a visiting professional told us that they felt people’s needs were met. However people who lived in the home told us there were no activities as there were not enough staff. One person told us that as no staff were available they walked to the bathroom and back several times a day for physical exercise.

We observed that staff were polite with people who lived in the home and people told us that staff were “Polite and kind”. We saw that people’s choices were recorded in their care files, staff were able to evidence how they supported people to make choices.

There was a care planning system in place to support people with meeting their needs. However not all of these were up to date. We saw that the home liaised with other professionals, for example GP’s to help ensure that people’s needs were met.

The manager informed us that a large amount of the people who lived in the home required support with dementia needs. However, we found that staff had not undertaken training in this or other specialised areas and had not completed training over the last year.

When we looked at staffing levels there were three care staff on duty each morning, although one of these was allocated to undertake domestic duties. There was not an activities person employed in the home.

There were quality assurance system to help check that people’s needs were being met and these included surveys of people who lived in the home; audits of all recorded accidents, staff meetings and up to date maintenance of the home.

We carried out this inspection as part of our routine reviews of the service and also to check on some outstanding compliance actions from the last inspection, the improvement plan for which had not yet expired.

We spoke with three people that used the service and with two relatives visiting on the day of our visit.

People that used the service told us they were satisfied with the care they received, that they had good relationships with the staff and that their needs were well met.

The visitors told us they thought their relatives were settled and safe. They praised the staff and commented that the activities being carried out were a welcome distraction and a pleasure to be involved in.

People did not raise any concerns and were happy in the home.

People told us they had been well cared for, felt respected and had made their own decisions where possible. They said they would have preferred to stay at home, but had received the care and support they needed.

They said they had been satisfied with the medication and financial arrangements in place, had been well fed and nourished and felt safe and protected from harm.

People said they had liked their bedrooms and been satisfied with the cleanliness of the home. They had had their needs met with the use of appropriate equipment although one person had found the lifting hoist to be uncomfortable. They said no one had had any cause to complain, but that they all knew who to complain to if necessary.