We carried out a review of the data available to us about Redlands Acre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Redlands Acre, you can give feedback on this service.
We found the following examples of good practice.
¿ The provider and manager had set up a visiting ‘pod’ in accordance with recognised safe visiting guidance. Additionally, alternative ways, including the use of technology, had supported people’s ability to remain in contact with their relatives.
¿ Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection.
¿ People’s health and wellbeing was monitored. People were observed for symptoms of COVID-19 and other potential infections. Healthcare professionals had continued to provide clinical support to people as this was required.
¿ Action had been taken to reduce the risk of infection spreading which had included the correct use of personal protective equipment (PPE). Staff had received training and support in relation to infection control and COVID-19. The manager observed staff practice ensuring they were following the correct use of PPE. The provider provided frequent guidance for staff to review and staff ensured they prompted and assisted their colleagues with PPE.
¿ The manager and provider had plans in relation to the isolation of people affected by COVID-19 and the cohorting of staff to reduce the spread of infection. The service did not use agency staff, which reduced the risk of COVID-19 entering the service.
¿ People and staff were tested in line with national guidance for care homes. The home had touch free temperature recording systems which staff and residents could use.
¿ As part of full infection control measures laundry and waste arrangements had been correctly implemented to reduce the spread of infection.
¿ Cleaning schedules had been enhanced and were followed by housekeeping staff and care staff. This included the additional cleaning of frequently touched surfaces to reduce the risk of infection spreading.
¿ The provider’s policy for managing COVID-19 and related infection prevention and control procedures had been reviewed and kept up to date. COVID-19 guidance was also kept up to date for staff reference.
¿ Staff and people were supported to socially distance. The home had a range of communal areas where social distancing could be supported, including during activities. Some people chose to be supported in their own room. The manager and staff ensured people received engagement to promote their wellbeing.
¿ The provider team had provided support and guidance to the home’s management throughout the COVID-19 pandemic. This included support in relation to ensuring the appropriate resources and equipment were in place.
Redlands Acre is a residential home which provides personal care for up to 33 older people and people living with dementia. The home consists 25 bedrooms, a large conservatory area, and eight self-contained care suites at the rear of the home. At the time of our inspection 25 people were living in Redlands Acre.
People’s experience of using this service and what we found
The provider had made improvements to their fire safety arrangements and medicine management systems since our last inspection. Quality monitoring systems had been fully embedded and used to ensure appropriate action was taken when shortfalls had been identified. The registered manager had ensured that improvements which had been made before the last inspection, were now embedded and consistently operated.
People felt safe living at Redlands Acre. People’s risks were known by care staff. Care staff were fully aware of their responsibilities to raise concerns and the registered manager and provider ensured lessons were learnt from any incidents or accidents.
The provider and register manager ensured the home was safe, well maintained and free from infection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 16 August 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Redlands Acre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Redlands Acre is a residential home which provides personal care to 33 older people and people living with dementia. The home consists of a home containing 25 bedrooms, a large conservatory area, and eight self-contained care suites at the rear of the home. At the time of our inspection 29 people were living in Redlands Acre.
People’s experience of using this service and what we found
People could not be assured that they would be safe if an emergency evacuation was required. Fire evacuation practices had not taken place regularly and people’s personal evacuation plans were out of date. Improvements had been made to the management of people’s medicines, however care staff were not always following systems set by the provider in relation to the management of people's prescribed medicines.
While quality monitoring systems had improved, further improvement and time were needed to ensure systems were effective in identifying shortfalls and driving improvement. Where incidents and accidents had occurred, the service had taken appropriate action, however systems in relation to the people’s care plans and the management of people’s prescribed medicines had not always been operated effectively.
People and their relatives felt Redlands was a safe place. People’s relatives had peace of mind received appropriate care and treatment. People’s risks were known by care staff. Care staff were fully aware of their responsibilities to raise concerns and the registered manager and provider ensured lessons were learnt from any incidents or accidents.
People and their relatives felt staff were well trained and had the skills to meet people’s needs. Staff had access to training, support and continued professional development. People received effective care and treatment. The service worked alongside healthcare professionals to ensure people’s health and wellbeing were maintained. A GP who covered the home spoke positively about the care people received.
People told us care staff were kind, caring and compassionate. Staff knew people and their needs well. People were treated with dignity and respect. Where possible, people were involved in their care and their individuality was promoted.
People received care which was personalised to their needs. Where people’s needs changed or their health deteriorated, care staff took appropriate and effective action to ensure their health and wellbeing. People enjoyed their life at Redlands Acre. The provider ensured people’s views were acted upon.
People and their relatives told us Redlands Acre was well led. During the inspection there was a change of management in the home, a new manager who was registered with CQC at another home operated by the provider was actively in post during the inspection. The provider and new manager had clear plans to further improve the service and increase the pace of these improvements. Staff spoke proudly about working at the home and were looking forward to working under the new manager.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 6 March 2019) and we identified multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the ‘Is the service Safe?’ and ‘Is the service Well-led?’ key question sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.
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.
The provider confirmed that they would carry out audits to make sure these recruitment and selection procedures were being followed. Appropriate checks were undertaken before staff began work.
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 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 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.
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".
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.