The Care Quality Commission
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Archived: Regency Residential Care Home

Overall: Inadequate read more about inspection ratings

Regency Residential Care Home, 41 Torrs Park, Ilfracombe, Devon, EX34 8AZ (01271) 862369

Provided and run by:
Norma Martin Care Homes Limited

All Inspections

20, 21 & 26 October 2015

During a routine inspection

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.

13 and 16 March 2015

During a routine inspection

This inspection was undertaken on 13 and 16 March 2015 and was unannounced.

At the last inspection on 2 April 2014 we found that the service was meeting all the legal requirements and regulations associated with the Health and Social Care Act 2008.

The Regency is registered to provide accommodation for 14 older people who require personal care. There were 13 people living at the home at the time of the inspection. The service works in partnership with local health professionals to provide a rehabilitation service. This service also offers respite for people, which may prevent hospital admissions.

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.

Prior to the inspection we received concerns from the local authority about the management of medicines within the service. As a result of the concerns Devon County Council implemented a safeguarding process. Placements to the home had been temporarily suspended on 5 March 2015. The service was monitored through a combination of visits by social services staff, and the community nurse team, as well as multidisciplinary safeguarding strategy meetings. The suspension of placements was lifted by the local authority in 2 April 2015. The safeguarding process was closed on 2 April 2015 as the multidisciplinary safeguarding meeting concluded that actions had been taken at the service to keep people safe.

Appropriate arrangements were not in place for the safe administration of all medicines. One person had not received their prescribed medicines which resulted in them experiencing discomfort.

People using the service and their relatives were very positive about the service provided, although some people said there was little in the way of daytime activities and that sometimes they did not have enough to keep them occupied. However, some people said they enjoyed a number of independent activities outside of the service and staff supported and promoted their independence in and outside the service.

The daily records of care provided did not show the full level of care and support provided. There was little information about how effective some medicines or treatments had been. For example, there was no evaluation of pain management to confirm whether pain relief was effective.

People said they felt safe and were well cared for. Comments included, “I feel safe here. The staff are a great help to me” and “I am quite safe and they (staff) keep an eye on me.” Relatives comments included, “Mum is safe here. She is happy and healthier since moving here”; “Things couldn’t be better.”

Staff treated people with respect and ensured their privacy and dignity was promoted. People were supported and encourage to maintain their independence and to make choices about their daily lives. Care records were personalised and contained relevant information to help staff provide person-centred care and support.

Systems were in place to protect people from the risk of abuse. Staff had received training and all were aware of their responsibility to report any concerns. The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

Positive comments were received about the food served, including, ’The food is always good’ and “I like all the food served here…It’s all very tasty.” All staff including the cook had a good knowledge of people’s likes and dislikes as well as any specific dietary requirements people had. There were measures in place to ensure that people’s nutritional needs were monitored and actions taken where required.

Staff had opportunities for regular training and professional development to enhance their skills and knowledge of working with people in the service. Staff said the training provided them with the skills and knowledge they needed to do their jobs. Care staff understood their role and what was expected of them. Staff said they enjoyed their work and were happy working at the service. Visiting professionals described the manager and staff as being ‘caring, enthusiastic, keen to learn, helpful and receptive’.

Staffing levels were sufficient to meet people’s needs and staff had gone through appropriate recruitment checks to ensure they were suitable and safe to work at the home.

Some aspects of the environment needed to be improved and the service had a refurbishment and redecoration programme in place to address this.

Systems to monitor and review the quality of the service were in place and the manager maintained an overview of the service by being involved in people’s care. People felt confident to raise any concerns with the manager although people said they had no cause to complain. People using the service, their relatives and staff had an opportunity to influence the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

2 April 2014

During a routine inspection

Our inspection was unannounced, and lasted seven hours. During our visit, we inspected five outcome areas, which were all judged as compliant.

There were 12 people living at the home. We spoke and spent time with seven people; some of whom were able to comment directly on their care. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for. We spoke with three staff members and the registered manager.

They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. We saw risks to people’s health and well-being were monitored and regularly assessed.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. Recruitment practice is safe and thorough.

Is the service effective?

People told us they were happy living at the home and we saw people looked relaxed and at ease in their surroundings. People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by friendly and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person commented about the staff, “They are so welcoming and they put you at ease”. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People using the service, their relatives, friends and other professionals involved with the service could influence how care was delivered. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

We looked at people’s care plans and we saw the registered manager contacted health and social professionals appropriately when people’s needs changed.

We looked at how these complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

20, 27 November 2013

During an inspection looking at part of the service

Our inspection was unannounced, took place over two days and in total lasted ten hours. During our visit, we inspected four outcome areas, which had been judged non-compliant in inspections in May and July 2013. We also inspected a further two outcomes because of information and observations during the inspection.

There were 12 people living at the home. We spoke and spent time with seven people living at The Regency Care Home; some of whom were able to comment directly on their care. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for. We spoke with three staff members and the registered manager. We looked at a selection of care records, and focussed on risks which had been identified by staff for each individual. We completed a tour of the home with the manager to check on the work to improve the environment.

Improvement was needed to ensure people’s privacy and dignity was maintained and a compliance action was made. We repeated a compliance action regarding the management of people’s care and welfare. We also identified further work was needed to ensure the activities on offer met people’s individual interests. Work had taken place to improve the home’s environment. Changes to the numbers of people living at the home and the layout of bedrooms had resulted in the staffing levels being appropriate for people’s current needs.

Complaints were responded to in a timely manner, although a repeated compliance action was made for this outcome as further improvements were needed to improve recording about complaints and how they were managed. We also made a compliance action for the outcome for quality assurance as identified risks were poorly managed. This had the potential to put people’s safety at risk. We will be meeting with the manager, who is also the owner, to discuss our concerns regarding the level of non- compliance and the repeated compliance actions.

11 September 2013

During an inspection looking at part of the service

Our pharmacist inspector checked the handling and management of medicines to follow up on concerns found at our previous inspection, and to check the compliance with a warning notice that we issued to the provider.

We found that there have been improvements made to the way medicines are looked after and managed. We saw that medicines were administered safely and in a caring way. We spoke with one person who told us they were happy with the way they received their medicines from staff.

26 July 2013

During an inspection looking at part of the service

Our inspection was unannounced and lasted over five hours. There were 12 people living at the home and also one person on a respite stay. We met with ten people and we spoke with six people about their experiences of living at The Regency Care Home. We also spoke with care staff and the registered manager, who was also the owner. After the inspection, we spoke with two district nurses and contacted a GP surgery with patients at the care home. We have spoken with the local safeguarding team and we also contacted the local commissioning team from Devon County Council about the outcome of the inspection.

We looked at a selection of care records, complaints records (sent prior to this inspection) and medication records. This was a responsive inspection to follow up on compliance actions made in May 2013 regarding the environment and the management of complaints. We had also planned to look at people’s health and welfare as a result of a safeguarding alert. However, because of our observations on the day of the inspection, we also looked at the management of one person’s medication and staffing levels.

Six people told us they thought the care was good at the home. However, we have made compliance actions in all of the outcomes we inspected. This meant improvement was needed in meeting people’s social and emotional needs, as well as the management of assessed risk. Medication for one person was poorly recorded and managed. The environment still needed improvement to make the home a safe and suitable place to live. Staffing levels did not meet the social and emotional needs of people. And a new approach to complaints still needed to be demonstrated.

14 May 2013

During an inspection in response to concerns

There were 13 people living at The Regency at the time of this inspection. We spoke with, and observed staff interacting with seven people. We also spoke with four staff. After our visit we spoke with the provider (who is also the registered manager) on the telephone.

The inspection was unannounced and was in response to concerns we had received including staffing arrangements, food supplies, and how some people had been spoken to by the provider.

We found that people’s personal care needs were being met. However, we also found that where people had raised concerns or complaints there were no records of and investigations carried out, liaison with other professionals, or actions taken to address the matters that had been raised. This meant that some people did not feel confident that their complaints and concerns had been adequately addressed.

Food supplies were satisfactory. Menus were varied and met people’s nutritional needs. People told us they enjoyed the meals and there was always plenty of choice.

People told us there were always sufficient staff available in the home to meet their needs.

Some areas of the home had been decorated and maintained to a good standard. However, a programme of redecoration and improvement of the home had not been completed, leaving other areas in need of decoration and maintenance. The provider told us that they planned to resume the programme of decoration and maintenance in the near future.

14 February 2013

During a routine inspection

There were 14 people living at the Regency. We spoke with seven people, four care workers, two relatives, two professionals and the provider. Some people were unable to comment directly on the care they received. So we spent time in communal areas observing their experiences.

People’s food met their needs and help with eating and drinking was given in a caring way. People told us the food and drinks were good, for example one person told us they “know exactly what I like and dislike”. People had the help they needed at mealtimes and with gentle prompting had a good intake of food and drinks.

We looked at some key documents including care plans, risk assessments and quality assurance records. This helped us make a judgement about how well the home was being run.

Care was being planned and people were involved in making decisions about their care and treatment and activities of daily living. Where people did not have capacity to make important decisions there was clear guidance for care workers about how to promote this, which was followed.

People lived in comfortable accommodation, with appropriate and well maintained equipment.

Everyone we spoke with made positive comments about the running of the home and opportunities available to them. These included “I get plenty of attention and it’s all good” and “The owner comes up to see me often to see how I am and if there’s anything I need”. Relatives told us their relation was “very contented”.

During an inspection looking at part of the service

We carried out a review on 29th March 2012. The purpose of this review was to decide whether the provider was compliant with assessing and monitoring the quality of the service.

We did not speak to anyone using this service. The provider sent us a satisfactory improvement plan. This tells us that the quality of the service people experience with regard to the management of risks to their health, welfare and safety had been monitored more closely and action taken to address gaps seen at the last inspection.

Systems for monitoring supervision, training, policy and practice in the kitchen had been put in place and were being monitored. Additionally, we received information from the environmental health department showing that the legal notice issued had been complied with.

28 October 2011

During an inspection in response to concerns

We carried out this responsive review in response to concerning information. This focused on key themes, which highlighted that the home may not:

' Ensure people have choice regarding the drinks or the time they get up or go to bed.

' Protect people living in the home from potential abuse.

' Have experienced and skilled care workers in sufficient numbers to meet the needs of people.

' Provide care workers with appropriate support.

' Be managed in a professional manner.

We carried out an unannounced inspection to the Regency on 28th October 2011 and because of the concerns we looked the key outcomes 1, 4, 7, 14 and 16. The purpose of this review was to check compliance in these key outcome groups for people currently living in the home.

We looked at the records of four people in detail; and where possible we spoke to the individual and or their carer. We observed other people being attended to whilst we were visiting.

An expert by experience also spoke with 10 people living at the home. The expert by experience expressed the view 'Overall I feel that the home is definitely fit for purpose and the owner and staff are respectful, caring, accommodating and efficient. I did not receive any negative comments from the resident's, they were all very happy, content and pleased to be living in the home. The home is in the process of refurbishment and I am sure that when it is finished it will be first class in every way'

People we spoke to said that their needs were being met, with comments like 'I have no complaints, I'm well looked after'. Care workers were described as being 'excellent and very patient with people'. An area people thought could be improved was around outings.

We found that improvements are needed to quality assurance systems so that gaps in supervision, training, policy and practice in the kitchen are identified and addressed in future.