This inspection took place on 4 and 5 October 2018. It was an unannounced visit to the service.

The Red House Nursing Home is a care home with nursing. It is registered to provide support to older people living with dementia, mental health and or physical disability. It can accommodate 32 people. At the time of our inspection 24 people lived at the home. The care home is in a rural village in north Buckinghamshire. Accommodation was over three floors. People had access to a small dining room and had a choice of two communal seating areas.

At our last inspection we rated the service good. However, we made a recommendation about ensuring people received effective care and records relating to care were accurately recorded. At this inspection we found some improvements had been made. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

At this inspection we found the service remained Good.

People gave us positive feedback about their experience of the home. Comments included, “The staff here are lovely and [Name of person] is always very well looked after" and ”They are very caring here and their approach is good" and "The good staff are fun as well as doing a good job.”

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. We found some improvement were required to ensure decisions made for people who lacked capacity were made in line with the code of practise of the Mental Capacity Act 2005. We have made a recommendation about this in the report.

Risks to people had been assessed and many actions required to minimise risks were made. However, the provider did not always make recommended changes in a timely way. We have made a recommendation about responding to action plans following the completion of risk assessments.

Improvements could be made to the senior managerial oversight of the service. No service improvement action plan was in place. We have made a recommendation about this in the report.

People were supported by staff who had been recruitment safely. Staff were supported to keep their skills and knowledge up to date.

People could be confident they would receive their medicines when required. Medicines were stored safely.

People were supported by staff who knew how to recognise signs of abuse and knew what to do in the event of a concern being raised.

People’s dignity was respected and people were encouraged to be independent.

Further information is in the detailed findings below.

This inspection took place on 16 and 17 February 2016. It was an unannounced visit to the service.

The Red house is a care home for older adults, some of whom may have a physical disability or are living with dementia. It is registered to provide accommodation for 32 people who have nursing needs. At the time of our inspection 29 people lived at The Red house.

We previously inspected the service on 11 February 2014.The service was meeting the requirements of the regulations at that time.

The service had 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 Red House is located in a Buckinghamshire village, it has developed good links with the local community and people are encouraged to join in ‘dementia friendly’ activities in the community.

Risks to people are recorded, and plans are put in place to reduce risks. However care plans are not always evaluated with up to date information. This meant that staff were sometimes unaware of what care and treatment was required.

People are protected from harm and staff had a good understanding of how to recognise abuse and take appropriate action should a safeguarding concern be raised.

The service had a very stable workforce, this contributed to the knowledge the staff had about people they cared for. Positive relationships had developed with staff and people living at The Red House.

The service had a clear vision to provide a high quality service. Staff felt supported by the management and feedback was sought from people and their relatives.

The service was open to driving up improvement and engaged with external parties. It had agreed to be part of a clinical trial in medicine.

Where required the service ensured that onward referrals were made to external health care professional.

We have made a recommendation about training for staff on care planning and reviewing.

We looked at the personal care or treatment records of people who use services, carried out on a visit on 11th February 2014, observed how people were cared for and talked to staff and relatives.

People’s needs were assessed and care plans were clear and individualised, reflecting the needs of people who use services. Risk assessments were undertaken to manage people’s choices and safety. Staff plan activities and arrangements were made to take people regularly to a local national trust home and gardens.

Staff provided a healthy balance and choice of food that was cooked on the premises. People were provided with home made cakes in the afternoons. Dietary needs were met and staff were properly trained in food hygiene. Specialist dietary advice was followed in the management of people’s medical needs.

Clear systems were in place for the management of medicines and staff were trained to ensure medicines were handled safely, securely and appropriately.

Staff were trained to care for people who used the service and staff demonstrated a good understanding of the needs of those people. Planning of staff rostas and strategies for coping with shortfalls in staffing were in place.

The home had assurances in place to assess and monitor the quality of services.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they are still a Registered Manager on our register at the time.

People who currently use the service require dementia care and had limited communication skills, so we used observation wherever we could, to help us understand their experiences.

We saw that the routines of the service were unrushed and that staff respected people's wishes to be in their rooms.

We saw that people's privacy and dignity were promoted through mostly single occupancy bedrooms and staff carrying out personal care in private areas of the building.

The atmosphere was relaxed with people interacting with each other and with staff in a kind and appropriate manner.

We observed that staff had a good understanding of peoples needs when they weren’t able to express their wishes verbally.

We saw lunch being served to people who needed extra help with feeding. Staff were observed to be sensitive in their approach to people and were seen to encourage individuals to eat in an appropriate manner.

We observed that staff communicated with people using the service to let them know what was happening, for example that lunch was ready.

One person did not want the meal offered for lunch and we saw that an alternative meal was provided.

We saw that one person who needed full assistance from staff had their meal interrupted on several occasions because the staff member had to keep getting up and providing support to other people.

On the day of the visit the home was observed to be clean and tidy and there were no unpleasant odours.

Our discussions with staff confirmed good procedures were in place to ensure the home remained clean and hygienic.

Staff were aware of their duty of care and responsibilities in relation to the prevention and control of infection. They said that plastic gloves, aprons and hand gels were readily available to them. We saw staff use these as they went about their work.

We saw staff administering medication properly to make sure people receive their medicines safely.

Many people using the service had dementia and as such found it difficult to express their views and experiences about what it was like living at the home. Two people we spoke with in private told us the staff were polite, respectful, and encouraged them to do us as much they could for themselves.

During our visit we saw that staff assisted people who lived at the home in a kind and compassionate way. We found people were treated with dignity and respect. We joined people in the dining room during lunch time. We observed staff offering people choices of food and provided discreet assistance to those who needed help. People were not rushed and enabled to eat their lunch at their own pace.

People’s needs had been assessed before a placement at the home had begun. This ensured their needs could be met appropriately. A pre admission assessment was undertaken and included risk and needs assessments. Care plans addressed people's individual needs, were detailed, reviewed and updated regularly.

Daily activities were provided to those who wished to take part. These included one to one activities and group activities.

The provider had systems in place to monitor and regularly assess the quality of service that people received.