The Red House is a privately owned and managed establishment accommodating a maximum of 26 older people and people living with dementia or physical disabilities. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our visit 22 people lived at the home.

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 registered manager was at the home during the time of our inspection.

This inspection was carried out on 15 January 2019 and was unannounced.

At our last inspection in 2016 we rated the service good in all five domains. At this inspection we found significant improvements had been implemented which has increased the overall rating to outstanding.

Why the service is rated Outstanding.

People were at the heart of everything the service did. Staff had an excellent understanding of people's needs and provided person-centred care to a very high standard. The provider and registered manager demonstrated a passion to provide people with love and a life of value, regardless of their age or disability. This was reflected in the many positive comments we received about the home and its staff from the people who lived there, their relatives, and the visiting health care professionals. Everyone we spoke with told us the service gave an outstanding level of care and support to people.

The registered manager, and the provider, had a clear vision and set of values for this service. These were based on dignity and respect, and working together with a commitment to providing quality care and support. They were also focussed on getting to know the people they supported. This compassionate and clear message was clearly shared by the staff team. This had a positive impact across all five of the key questions we asked and the lives of the people who used this service.

The service strived to be known as outstanding and innovative in providing person-centred care based on best practice. The registered manager had established a culture that put people at the centre of the service. This resulted in people taking back control of their lives, either from being unwell for long periods of their life, or overcoming obstacles due to their disabilities or age. Staff were confident and knowledgeable in their ability to support and care for people. Their passion for supporting people to live a fulfilled life was evident throughout the inspection. The programme of activities and events hosted by the staff were fully based around people’s interests and enabled them to achieve lifelong goals.

This passion for innovation and leading on best practice also extended to supporting people who were at the end of their life. The staff at the home had worked closely with local hospices to develop new guidelines for ensuring people were supported in a kind and compassionate way as they neared the end of their lives. Relatives who had family members pass away at the home were thankful for the way their loved ones and themselves had been supported by staff at this most difficult time.

The staff were exceptionally kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff asking people's advice about how to proceed with tasks, or having a laugh and a joke with them. People were relaxed and happy with the staff and it was clear that caring relationships had developed between them. People's relationships with family and friends and dramatically improved due to the support and gu

The Red House is a home that is registered to accommodate up to 25 people who require personal and nursing care. The home provides care and support with physical and needs, also respite and palliative care. Accommodation is provided across two floors with access to the first floor via a passenger lift or stairs. There were 25 people living here at the time of our inspection.

There was a registered manager in post, who was present on the day of the 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.

There was positive and caring interaction between people and staff. People gave clear indications to us that they were happy living here. One person said, “Everything is just perfect. They do an excellent job.” A Relative said, “These are my family members friends, we are all going to get old and I can only hope I find a home like this for myself.” People could only praise the staff and the facilities. We observed nothing that would contradict this. Staff were all were extremely happy in their work and proud of the job they do.

People had access to a wide range of activities that met their needs. Staff also encouraged people to continue in past hobbies, and to achieve lifelong dreams. They supported people at the end of their life to achieve goals and aspirations and live their life to the fullest extent.

People were safe at The Red House because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. 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 board or the police.

In the event of an emergency people were protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. The premises provided were safe to use for their intended purpose.

Staff recruitment procedures were robust to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines. All medicines were given to people and any excess disposed of in a safe way.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People had access to drinks and snacks at any time during the day and people were able to have a cup of tea during the night if they aske

We visited The Red House to look at the care and welfare of people who used the service. We spoke with five people who lived there; one relative; four staff and the manager. We also spent time watching the interactions between staff and people who used the service.

The people that we spoke with and a relative told us they felt that they were respected by staff. One person told us “Oh yes, I do feel respected. Staff chat to me and are interested in what I am doing.” Another person said “Staff call me by my preferred name and they knock on my door before coming into my room.” A relative told us “Absolutely they respect my family member. Staff are very nice and friendly.”

We saw that assessments of people’s needs had been carried out. Care was provided that met those needs. One person told us “Overall I think my care is good.” Another person told us “They meet my needs, and I can always ask if I need anything.” A Relative told us they had been kept up to date with the care needs of their family member.

The people we spoke with told us they felt safe with the staff. Staff understood they had to report any suspicion of abuse.

We saw that the provider carried out appropriate checks when employing staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

The provider had an effective system in place for dealing with complaints. People we spoke to said they knew how to make a formal complaint.

We visited The Red House to look at the care and welfare of people who using the service. We spoke with six people who lived there. We spoke to seven staff members, including the deputy manager. We also spent time watching the interactions people had with staff and the other people who used the service.

One person told us “Staff ask if I want to do things.” And “I’m supported to do the things I want.” Another said “Staff explain things to me so I can understand what is happening.” Staff were seen to interact well with people who used the service.

We saw that decisions around consent to care had been documented. We heard staff asking people if they wanted to do things, for example taking medication, or deciding what clothes to wear.

We saw that people and their relatives had been involved in the planning of care. Risks had been identified to protect the welfare and safety of people.

We observed staff dispensing medication so that people received the right medication at the right time.

All the staff we spoke with said they felt supported to do their job.

We saw that the provider had systems in place to seek the views of people who used the service and they responded to the feedback given.

We spoke with seven people living in the home. We also spoke with some peoples carers.

Most people using the service said that they were very happy with the quality of care provided at the home with comments such as, ‘ lovely staff’, ‘very good home’ ,‘ The staff are always happy’ and they are very caring ’, excellent care’ and ‘ I am very happy with the care that I receive’.

People and their carers said that their care plan is discussed with them.

People told us that they enjoyed the activities that were provided and they spoke positively about the activities coordinator.

In the main most people felt that their needs were being met by the staffing arrangements in the home although two people said that there didn’t seem to always be enough staff at the weekends. Another person told us they felt that that was not always sufficient numbers of registered nurses.

We did not on this occasion speak to people who use the service. This was because it was not necessary for us to obtain their views in order for the service to demonstrate that they have addressed our previous concern.