Regency Hall

Updated 18 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by 2 inspectors.

Service and service type

Regency Hall is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Regency Hall is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, there was a manager who was in the process of registering.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, including feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 8 people who lived at Regency Hall and 3 relatives who were visiting, about the care received. People were able to give differing levels of feedback and so we also observed care in communal areas. One relative also provided written feedback. We spoke with 13 members of staff including care staff, catering and cleaning staff and the manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received written feedback from a further 2 members of staff.

We reviewed a variety of care records to ensure people received safe care including 6 care plans and a number of medicines administration records. We also checked 2 staff files to ensure they were safely recruited and a number of management oversight records such as audits.

Updated 18 March 2023

About the service

Regency Hall is a residential care home providing personal care for to up to 68 people. The service provides support to a range of people including some who are living with dementia. At the time of our inspection there were 46 people using the service. Care was provided across 2 floors which were organised around 3 communal lounges. The provider was not providing care on a third floor and kept this decision under review. There was a large garden for people to enjoy.

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

People were supported by kind and caring staff who understood risks to their health and wellbeing. There were enough staff to meet people’s needs and they were safely recruited and trained. Medicines were administered as prescribed and safely managed to reduce the risks associated with them. Staff adhered to infection prevention and control procedures in line with legislative requirements and recognised best practice guidelines. Safeguarding systems were effective and regularly reviewed and analysed.

There was a new registered manager in post since the last inspection, who was committed to continuous improvement of the service to make a difference in people's lives. Systems such as audits were well managed to ensure a culture of safety and continuous improvement. Community links were being strengthened to ensure people retained connections and interests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 March 2020). There was a breach in regulation relating to medicines management. 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 regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and prompted in part due to concerns received about a safeguarding incident. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

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 Requires Improvement to Good based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Regency Hall on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.