About the service: Redstone House is a small home for people with learning disabilities that was providing personal and nursing care to four people at the time of the inspection.

People’s experience of using this service:

¿ Staff understanding of risk management was not sufficient to ensure people were kept safe. Staff had still not recognised or reported incidents and accidents to the appropriate authorities.

¿ Staff had not understood that restricting someone’s activities in response to that person’s behaviour was a form of institutional abuse. Two instances of one person hitting another had also not been identified as potential abuse. None of these had been notified to the relevant authorities.

¿ Concerns over how people’s monies were managed had also been raised. Purchase of take away meals and payment of activities had been done with people’s monies. These costs should have been already included in the care package paid for by the commissioners of the service, and not needed people to pay for them themselves.

¿ Guidance documents for staff to keep people safe were not adequate to minimise the risk of harm. This included staff understanding of how to respond to behaviour that may challenge, and night time fire evacuation arrangements.

¿ Staffing levels had increased, however people’s activities were still impacted by a lack of staff. Staff were working long hours to cover shifts, leaving them at risk of being tired and increasing the chance of mistakes being made.

¿ Further work was needed to ensure peoples medicines were managed and administered in a safe way.

¿ The registered manager had left the home since our inspection in December 2018. The home was being managed by two registered managers from the owner’s other homes.

¿ Some improvements had been made, and further improvements were planned, however there were still many areas identified at the previous inspection that had still not been taken care of.

¿ The management structure of the service was fragmented and confusing to the staff. Key information and support were not available to staff when they needed it. For example, documents around finances were not available at or after the inspection because the person in charge of these was unavailable. No contingency was in place for other people to be able to access the information in their absence.

Rating at last inspection:

¿ At our last inspection in December 2018 (report published February 2019) we rated the service as inadequate. At this focussed inspection we saw that some improvements had been made, and the process was ongoing, the overall rating remains the same.

Why we inspected:

¿ This focussed inspection took place as we had received concerns around the care and welfare of the people who lived here.

Follow up:

¿ We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We last carried out a comprehensive inspection of Redstone House in July 2016 where we found the registered provider was rated ‘Good’ in each of the five key questions that we ask.

This inspection took place on 06 December 2018 and was unannounced.

Redstone House 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 care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were not supported to live as ordinary a life as any citizen.

Redstone House in Redhill is registered to provide accommodation and personal care for up to four adults who have a learning disability. At the time of our inspection four people live here. The service is delivered from a two-story house in a residential area.

It is a requirement of the provider's registration that they have 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. The registered manager was present during this inspection.

This inspection had been bought forward as we had received concerning information about peoples care and support needs not being met. During the inspection we found a number of issues that needed to improve, however the care staff were seen to be kind and caring to people.

We found areas that required improvement across all five of the key questions that we ask during an inspection (Is the service safe, effective, caring responsive and well led?). In total we have identified seven breaches in the regulations.

The breaches were around managing risks to people, while minimising the impact to their independence; not having enough staff at all times to meet people’s needs; the safe management of medicines; not providing care and support that met people’s needs and preferences; not providing information in an accessible format; failing to carry out maintenance to the home environment in a timely manner; and not having quality assurance processes that promoted continuous improvement.

The provider had not ensured the home was well led. Staff were focussed on giving day to day care, however little structured and documented work had been completed to improve people’s lives. All the people who live at the home had some form of behaviour that may challenge themselves or others. This meant that they required one to one, or even two to one support at times of the day. The providers failure to promote continuous improvement meant that although these behaviours were known and documented when they happened, people had not been supported to overcome them. The records of accidents and incidents had not been reviewed to try to reduce the risk of repeat concerns arising.

The providers quality assurance processes were not effective at ensuring areas for improvement that had been identified were actioned in a timely manner. Maintenance issues such as exterior doors not being able to be locked had taken months to fix leaving people at risk as the house had not been secure.

Redstone house did not provide a consistently safe standard of care. There were risks to people’s health and safety because behaviours that may challenge had not been well managed. Although incidents had been recorded no structured approach had been taken to try to help people manage and overcome behaviours. Risk management also had an impact on people’s independence as they wer

Redstone House is owned by Oregon Care Limited. It provides accommodation for four adults with learning disabilities. At the time of the inspection four adults were resident at the service. Whilst people were unable to take part in full discussions, we were able to speak with people and observe how they interacted with 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 2008 and associated Regulations about how the service is run.

The inspection took place on 11 March 2016 and was unannounced. At our last inspection in 24 July 2013 we raised a concern about the people who use the service could not be confident that their human rights would be upheld. This was because decisions and restrictions were being made for people without their consent and without a formal assessment of the need for them under the Mental Capacity Act. Our previous inspection highlighted risks associated with leaving fire doors wedged open, leaving windows unrestricted without assessment and leaving electrical or chemical hazardous items accessible to people. The registered provider had also not always taken steps to provide care in a home that was suitably designed and adequately maintained by not providing sufficient toilets, and by allowing staff to use communal areas as an office and cloakroom. The Statement of Purpose was not up to date or accurate and did not accurately reflect the kinds of services provided or the current range of service users' needs that those services were intended to meet. Files containing information about people were not kept securely and confidentially.

The registered provider provided us with an action plan to ensure that our concerns would be actioned and completed by September 2013. This was confirmed to have been completed within the stated timeframe set out in the action plan by the registered provider during this inspection.

There was positive feedback about the home and caring nature of staff from people and relatives.

Some adaptations had been made for people with mobility needs, such as rails on stairs. The registered manager and staff worked well to keep the environment clean and feeling homely for people. The majority of people who live at the service were unable to communicate verbally with us. We therefore re non-verbal and were therefore observed their response to staff during the day and have used our observations in the report. One person who could verbally communicate said, “Staff are very nice.” A relative said, “The staff are great all of them we have no problems.”

A health care professional told us that “they had no concerns" over the care and welfare of the people who lived at Redstone House.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff holding people’s hands and sitting and talking with them. People looked relaxed and happy with the staff. We were told by one family member that they felt “People had positive relationships with their care workers” and they also felt “Confident about the service their relative received” at Redstone House.

People could have visitors from family and friends whenever they wanted.

There was a strong emphasis on key principles of care such as compassion, respect and dignity. We observed that the people who used the service were treated with kindness and that their privacy and dignity was always respected.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or t

People spoke about activities they were involved in, including going to college, shopping and trips out.

People told us they had enjoyed their meal and got enough. They also said the staff offered them choices of food and they could have a snack or a drink at any time.

We found people who use the service could not be confident that their human rights would always be upheld because decisions and restrictions were being made for people without their consent and without a formal assessment of the need for them under the Mental Capacity Act.

We saw people were supported to be able to eat and drink sufficient amounts to meet their needs and were protected from the risks of inadequate hydration and nutrition.

The provider was putting people at risk by leaving fire doors wedged open, leaving windows unrestricted without assessment and leaving electrical or chemical hazardous items accessible to people. The provider had also not always taken steps to provide care in a home that was suitably designed and adequately maintained by not providing sufficient toilets, and by allowing staff to use service users’ communal areas as an office and cloakroom.

The Statement of Purpose was not up to date or accurate and did not accurately reflect the kinds of services provided or the current range of service users’ needs that those services were intended to meet.

Files containing information about people who use the service was not kept securely and confidentially.

People who used the service responded to greetings with smiles and thumbs up.

We saw people confidently making choices and communicating them to staff in their preferred style. For example, we observed one person using sign language to communicate they wanted to a cup of tea to us and a member of staff who then supported them to make one. We also saw another person signing that they wanted to go trampolining and that staff then arranged this with them.

One person told us how they could choose what to do and liked going to college and work experience. They also told us the home was good, they liked the food, their rooms and the garden, and that some staff were nice and the others were alright.

People’s relatives told us they looked after their relative very well, and they encourage them to make choices. They told us they felt their relative was safe there.

People’s relatives told us they had no worries or complaints but felt they could talk to the manager if they did.

People’s relatives told us the staff were good and involved them in decisions about care. They said there were enough staff and the staff knew their relatives’ communication needs well.

One person’s relative told us they were kept fairly well informed about their relative’s care. They were told anything untoward immediately and contacted once a fortnight if they don’t ring themselves.

One person’s relative suggested safeguarding procedures could be improved if there was a procedure to support staff to identify when they are stressed, so their work can be changed so their feelings don’t impact on the people using the service.

Another relative told us that the home had improved a lot since the new manager took over and that there had been a lot of positive changes to keeping people informed, involved and listening to people.