Archived: Regent House

Regent House is a residential care home providing accommodation and personal care for up 23 people with mental health needs. At the time of the inspection 7 people needed support with personal care.

Regent House is made of 3 floors, on the ground floor you will find living spaces such as two lounges, kitchen, dining room and office, with a courtyard garden. Bedrooms and bathrooms can be found on the first and second floor.

People’s experience of using this service and what we found

People were put at risk of harm due to the lack of safeguarding processes and effective systems in place to implement improvements where risks had been identified.

Care plans and risk assessments did not always correlate and identify fundamental information to ensure people were supported in a safe way.

People did not always receive their medicines in line with the prescribers’ instructions. There was a lack of staff trained to administer medicines, which had an impact on delivery of care.

People did not always get the dedicated support when needed. This meant people were not always provided with safe support and were unable to experience new things or meet their aspirations.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not receive support that was person-centred and gave them autonomy in their life. Support did not focus on people's quality of life or follow best practice.

Staff told us and records confirmed staff did not have adequate training which meant there was not enough appropriately skilled staff to meet people's needs.

The management team did not always offer the support and leadership required for the staff. Staff felt there was a lack of communication between staff and management.

The management team did not have robust governance system in place, some spot checks were in place, however, these were not effective and did not identify the issues we found.

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 good (published July 2017)

Why we inspected

We received concerns in relation to safe care and treatment of people and ensuring there was enough skilled staff to meet people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, lack of person-centred care, inadequately skilled staff, poor environment and lack of governance systems and management oversight.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added at the bottom of the report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Our previous inspection of 7 June 2016 found that the service required improvement. Improvements were required to ensure that all risks to people were assessed and guidance was provided to staff about how the risks were reduced. Improvements were also required around the auditing of medicines and ‘as and when required’ medicines (PRN) to ensure that people received their medicines safely. Some staff had not had any recent training in the Mental Capacity Act 2005 (MCA) and lacked awareness of what the Mental Capacity Act meant for people. Improvements were needed to ensure that staff received regular supervision and effective appraisal of their performance.

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You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Regent House on our website at www.cqc.org.uk. This comprehensive inspection was undertaken to check that further improvements had been made.

This was an unannounced inspection. At the time of our inspection there were 18 people living at the service.

Whilst this inspection was carried out to review improvements, it was prompted in part by notification of an incident following which a person using the service was involved in an altercation with another person using the service was injured and later died. The incident is subject to an on-going police investigation.

The Commission made further enquiries into the circumstances leading up to the person’s death to consider whether the incident was avoidable and whether it should take further action under its criminal enforcement powers. The Commission has reported to a coroner and considers the incident was not as a result of unsafe care and treatment, avoidable harm or a significant risk of avoidable harm. We are however continuing to liase with the Coroner, Police and Local Authority on this matter.

A safeguarding investigation was undertaken by the local mental health safeguarding team. The health and welfare of people using the service were reviewed and it was concluded that people were happy and well cared for and Regent House was a comfortable and caring home.

At this inspection we found that although improvements had been made following our last inspection, further improvement was still required in relation to risk assessments to ensure they included sufficient detail to guide staff on how to minimise any identified risk or potential risk.

Appropriate arrangements were in place to ensure people’s medicines were obtained and stored safely.

People received care that was personalised to them and met their individual needs and wishes. Staff were knowledgeable about people’s choices, views and preferences and acted on what they said.

Systems were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. Procedures and processes guided staff on how to ensure the safety of people. There were sufficient numbers of staff employed who had the knowledge and skills to meet people’s needs.

The service was up to date with the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). Staff sought consent from people before supporting them with their care.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People’s nutritional needs were assessed and they were supported to eat and drink sufficiently.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

The management team were approachable and there was an open culture in the service. Quality assurance processes were used to identify shortfalls and address them and as a result the service continued to improve.

We have made a recommendation about the management of medicines.

There were 21 people living in the service when we inspected on 7 June 2016. This was an unannounced inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were not always supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) Some staff had not had any recent training and lacked awareness of what the Mental Capacity Act meant for people. Where one person had fluctuating capacity, it was not clear what support they required and where decisions had been made in their best interests.

Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised. However, improvements were needed to ensure that all the risks in people’s daily living were assessed and these assessments provide staff with information about how the risks are minimised.

People received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. The atmosphere in the service was friendly and welcoming.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. However, improvements were needed to ensure that staff receive regular supervision and effective appraisal of their performance.

People were provided with their medicines when they needed them and in a safe manner. However, improvements were required around the auditing of medicines and as and when required medicines.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Care and support was based on the assessed needs of each person. People’s care records contained information about how they communicated and their ability to make decisions. People were encouraged to pursue their hobbies and interests.

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There were processes in place that encouraged feedback from people who used the service. People, or their representatives, were involved in making decisions about their care and support. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

There was an open and transparent culture in the service. Quality assurance surveys were used to identify shortfalls and drive improvement in the service. However, audits required further development to ensure that they highlighted all areas for improvement, For example, medicines and care plans.

People were provided with nutritious food that they enjoyed. One person said: 'You couldn't get better food.' Another person told us: 'X (the cook) should have Michelin stars, the food is so good.'

There were systems in place to supervise and support staff and provide them with the training they needed. This ensured that they had the skills and knowledge to provide safe and effective care.

Regent House was well run by a competent management team and there were effective processes to monitor the quality of the service. They listened to people and took their views into account to make improvements.

There were procedures in place to update and maintain records so that they contained the information staff needed to deliver care safely.

During our inspection we spoke with people who said they liked living at Regent House. We saw that people spoke confidently with members of staff and made them aware of their needs and wishes. Staff showed a good understanding of people's needs and preferences and we noted that people received good care and staff treated them with respect.

We found that systems to recruit staff were appropriate and staff received the training they needed to provide care and support safely.

People living in the home completed feedback questionnaires as part of the home's quality assurance system and we saw positive comments about the standard of care provided at Regent House. One person said the staff were 'Excellent' and 'I always have a laugh and joke with them and when it's serious they listen to me.' Another person stated 'Staff are there when you need help and they sit with you as well.'

We saw that there was a relaxed atmosphere in the home and that people chose how they spent their time. One person told us they liked to go into town every day and it did not matter if it was raining because it was only a short walk.