Regency Hall

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent to care.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments of people’s health, care and well-being did not always contain consistent or accurate information. For example, a moving and handling risk assessment did not reference the use of a stand aid for one person who used this equipment. We found where risks were identified in one aspect of a person’s care and support, it was not considered how this impacted other needs. For example, where a person displayed anxiety around continence care, this was not reflected in their mental health care plan. One relative shared they had requested information to be added into their loved ones care plan, but this had not been done.

However, most people and relatives confirmed they had been involved in regular care plan and assessment reviews. One relative told us, “Yes [relative] has a care plan. I was involved. There are regular reviews, and they always invite me to take part.”

Nationally recognised tools were used to support the delivery of care. This included tools to assess malnutrition and skin integrity risk. Overall, records showed that people received care in line with their assessed needs, such as regular re-positioning where a high risk of skin breakdown had been identified. Weights were routinely monitored, and referrals were made to relevant professionals where concerns about weight loss were identified. Kitchen staff demonstrated a good understanding of people’s dietary requirements, and how to modify diets in line with evidence-based practice, such as when a person had swallowing difficulties.

The mealtime experience was observed to be calm. Staff encouraged people to eat where appropriate. People had access to drinks throughout the day, but these were not all dated so we could not confirm how fresh the drinks were. A snack trolley was available in the afternoon. One person told us, “The food is okay, it’s not exceptional but I've gained weight since I came here. There are usually two options, if its ever something I'm not that keen on they will find me something else.” And, “The food is absolutely gorgeous. They come round and tell me the choices. They will make me sandwiches if it’s not something I like.”

As care plans, risk assessments and training did not ensure staff had sufficient knowledge of people’s needs we could not be fully assured staff had access to the information they needed to appropriately support people. Additionally, staff shared that sometimes the handheld devices used to record information did not always connect, impacting on the ability to record and review information. The manager was aware of this and monitoring closely. Systems were in place to ensure updates and changes in people’s needs were shared with staff, such as handover and staff meetings.

Overall staff reported effective communication and collaboration within the staff team, and external partners. A visiting professional told us, “The manager has always taken my calls, replied to my email in a prompt and efficient way. The communication from the home has always been excellent.” A relative shared, “Staff work well together and they work well with me.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. For example, care plans did not provide details on signs and symptoms of deterioration for diagnosed health conditions such as diabetes, or infection of catheter and stoma sites and how to manage and escalate concerns.

Some relatives felt improvements could be made to ensure people were supported to exercise, or efforts made to improve well-being. One said, “[Person] never comes out of their room, it would be nice if someone came and chat with them, boost their mental health.”

However, referrals to appropriate professionals were made as required. This included the GP, district nurses, dietician and other relevant healthcare professionals. One person told us, “I get to see the doctor.” Another relative confirmed, “I think they work well with other health professionals. They work with the local GP practice.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves. Improvements were required in the completion of monitoring charts, such as food, fluid and personal care charts to ensure effective monitoring of people’s health and well-being. Manager reviews of care plans did not check daily records and therefore could not demonstrate how these were monitored.

The registered manager informed us staff had been booked to attend training to support in the monitoring of and recognising of deterioration of people’s needs.

Where people lacked the mental capacity to make decisions about their care and treatment, only 1 mental capacity assessment was in place which looked at whether people could consent to living in a locked environment. This did not follow the principles of the Mental Capacity Act (2005), which states that assessments of capacity need to be decision specific. This meant there were no mental capacity assessments in place for decisions regarding medicine administration, including the administration of covert medicines and care and treatment related decisions. Furthermore, the mental capacity assessments reviewed did not contain adequate details to demonstrate a person had been fully supported to try and make the decision themselves. For example, no details were recorded to show consideration had been made to people’s past and present wishes. This meant people’s rights had not always been fully protected.