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Archived: Regency Residential Care Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 23 December 2015

This inspection was undertaken on 20, 21 & 26 October 2015 and was unannounced. We brought this inspection forward because we received concerning information about the health and welfare of people at the home. This information suggested that people's health needs were not being managed appropriately.

The Regency is registered to provide accommodation for 15 older people who require personal care. There were 14 people living at the home at the time of the inspection.

There was a registered manager in post at the service. 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.

We last inspected this service in March 2015 and the service was rated as ‘requires improvement’. We found the provider was not meeting one regulation in relation to the safe management of medicines. The need for improvement was identified in relation to meaningful occupation and stimulation, as there were limited opportunities for people to take part in activities. We also found that care records did not always reflect whether care and support had been effective.

CQC received an action plan from the provider on 8 June 2015. This contained information about the action the provider would take to address the issues we raised at the last inspection. During this inspection we found improvements had been made in respect of the safe management of medicines. However little or no improvements had been achieved in relation to activities or care records.

Devon County Council implemented a safeguarding process in August 2015 following concerns raised with them about one person. During their investigations additional concerns about the care and welfare of people at the service were found. Placements to the home were suspended by commissioners on 8 October 2015 as a result of the safeguarding concerns. The provider had agreed to suspend the admission of privately funded people until the conclusion of the safeguarding process.

During the safeguarding process the service is being monitored through a combination of visits by social services staff and the community nursing team, as well as regular multidisciplinary safeguarding strategy meetings.

The Commission had also been made aware of an incident that had occurred at the service which was being investigated by the police. We will continue to liaise with the provider, police and safeguarding strategy meetings on this matter. Part of this inspection considered matters arising from that incident to see if people using the service were receiving safe and effective care.

This inspection found that although people and their relatives told us they were happy with the service, there were significant concerns about how the service was being run and managed. Improvements were needed in several areas where the provider was not meeting the requirements of regulations.

Management and staff in the service had failed to recognise poor practices and had not made referrals to the appropriate agencies, such as the local authority safeguarding teams, when this was needed. This had left people at risk and had not protected them from harm.

Due to staffing levels, practices within the service had become ‘institutional’ and not person centred or person led. This meant that some people were not always given meaningful choices in relation to their daily routines.

The environment had not been maintained to a high standard. Health and safety risks were not adequately assessed and account had not been fully taken of how the environment should meet the needs of people using the service.

Risks to people using the service were not always identified and some risk assessments were not detailed. They did not contain the information required for care staff to know how best to support the person.

Health professionals were consulted about people’s health needs. However records were not always clear about the recommended interventions. This meant there was an increased risk people might not be getting the care and treatment, based on their current needs and professional advice.

Care plans were not always being followed, and were not up to date. Some care plans were not person centred and contained minimal information about the person’s support needs, life history and their preferences about care and daily life. This meant care and support might not be provided in line with people’s needs and wishes. People did not have access to regular meaningful stimulation or activity.

A lack of effective governance meant the service had failed to independently recognise and remedy problems identified by CQC and the local authority investigations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We are considering taking further action in relation to this provider and will report on this when it is completed.

Since the inspection, the provider has submitted an application to cancel their registration of this service and this is being processed by CQC. All of the people living at the service were assisted to find suitable alternative accommodation and care and support, and all were safely moved from The Regency by 20 November 2015.

During our inspection, we found breaches in nine areas of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection areas

Safe

Inadequate

Updated 23 December 2015

The service was not safe.

Incidents of abuse were not always referred to appropriate authorities and acted upon accordingly which meant people were exposed to further risk of harm.

Risk was not always well managed at the service, particularly those relating to weight loss and choking.

There were not enough staff to meet people’s needs and preference which put them at risk of not receiving assistance when they needed it.

Not all areas of the service were clean and hygienic and parts of the environment had not been well maintained.

Suitable arrangements were in place for the safe management of medicines.

Effective

Inadequate

Updated 23 December 2015

The service was not effective.

Where a person did not have capacity to consent to specific decisions, the service did not act in accordance with the Mental Capacity Act 2005. This meant it was difficult to confirm if decisions made were always in people’s best interests.

Health professionals were consulted about people’s health needs. However records were not always clear about the recommended interventions.

People’s dietary preferences and needs were not always met.

Caring

Requires improvement

Updated 23 December 2015

Some aspects of the service were not caring.

People were not always treated with dignity and respect. Some people’s basic care needs were not being maintained to a high standard. We saw some people looked unkempt in their personal appearance.

Staff were kind and polite, however the delivery of care and support did not focus on or promote individual preferences.

Responsive

Requires improvement

Updated 23 December 2015

The service was not responsive.

Although some staff were friendly and supportive towards people, care was

sometimes task based as opposed to meeting the personalised needs of people. This did not support people’s choices or dignity.

Some people’s care plans were not comprehensive or person centred to ensure individual care needs could be met.

There was a lack of stimulation and interaction available for people. Some people displayed behaviours which indicated boredom and withdrawal.

Complaints and concerns were not always well managed.

Well-led

Inadequate

Updated 23 December 2015

The service was not consistently well led.

The registered manager was not managing the service effectively; as a result we found a number of breaches of regulations.

Monitoring systems were not effective and had not identified shortfalls in the service.

Although people’s views had been obtained, action had not been taken as a result of people’s feedback to improve the service.