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Inspection carried out on 12 March 2019

During a routine inspection

About the service: The Regent provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. There were nine people using the service at the time of our inspection.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways [promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

People’s experience of using this service: People were happy with the care provided and told us staff were kind, helpful and promoted their independence.

Staff were appropriately vetted before starting work to ensure they were suitable to work with potentially vulnerable people. Staff had received training in the safeguarding of vulnerable adults.

We received mixed views about staffing. Some relatives told us there had been a high turnover of staff and there was a small number of vacancies at the time of the inspection. Recruitment was ongoing, and people said they continued to receive the care they needed in a timely manner by staff they were familiar with.

Staff received regular training relevant to their role to support them to care for people effectively.

The privacy and dignity of people was promoted and protected, and staff were aware of the importance of equality, diversity and human rights needs being supported.

At this inspection, staff were clearer about the remit of a supported living service and people were encouraged to be as independent as possible.

Improvements had been made to care planning and person-centred plans were in place which meant people’s physical, social and emotional needs were considered when planning care and support.

Improvements had been made to systems to help the provider monitor the quality and safety of the service.

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: Requires Improvement. Published (14 March 2018).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected: This was a planned inspection which was based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 7 February 2018

During a routine inspection

This inspection took place on 7 and 9 February 2018 and was announced. We announced the inspection because the service is a supported living service and we needed to be sure there would be staff in the office when we called. A previous inspection in August and September 2017 had found multiple breaches of regulations and rated the services as inadequate overall and placed it in special measures. As the service was in special measures we returned within six months to check improvements had been made. At this inspection we looked at the areas of concern previously found at the service. We did not look in detail at areas where we had previously found the service to be compliant with regulations.

At the last inspection in August and September 2017 we asked the provider to take action to make improvements with regard to managing safeguarding, staff training, staff supervisions and appraisals, supporting people with their finances and medicines, completing assessments of people’s capacity under the MCA, improving risk assessments, improving care planning, dignity and respect and improving audits and checks on the service. The provider sent us an action plan of the improvements they were intending to make to the service. At this inspection we found the provider and staff team had worked hard since the inspection in 2017. We found actions had been taken and, although further improvements were still required in some areas, the service was no longer inadequate or in special measures.

The Regent provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of the inspection there were nine people being supported by The Regent. Each person lived in their own flat within a single and larger complex of flats. Staff visited people in their own flats to assists them with personal care needs or to support them to access the local community.

At the time of the inspection there was a registered manager registered for the service, however they were absent from the service on a long term basis. The deputy manager had been overseeing the service in the interim, with support from senior managers in the provider’s organisation. On both days of the inspection the deputy manager was away on sick leave. A registered manager is a person who has registered with the 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.

We found Improvements had been made to the way the service dealt with safeguarding issues. Any safeguarding concerns had been reported to the local authority and notifications had been sent to the CQC, as providers are legally required to do. Staff had received additional training with regard safeguarding vulnerable adults and were able to describe the action they would take if they had any concerns.

Risk assessments with regards to people’s care had been reviewed and updated. We found some of these assessments still lacked detail or did not cover other important aspects of care.

People were now supported to manage their finances as independently as possible. They had ready access to their money, which was now kept securely in their own flat, rather than in the service office. Regular checks were made on people’s money to ensure it was safe and any discrepancies were reported to senior managers for further investigation. The provider had developed a new policy to support people to manage their own finances, where possible.

People’s medicines were now kept securely in their own flats, rather than in the services main office. Management of medicines had improved, par

Inspection carried out on 15 August 2017

During a routine inspection

This inspection took place on 16 and 29 August and 26 September 2017. This inspection was announced. The provider was given notice of the inspection because they provide community services and we needed to be sure that someone would be in.

At our last inspection of The Regent, the service was compliant with the Regulations in force at that time.

The Regent provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The service provides support to people with physical or learning disabilities (aged 18 and above). The service operates 24 hours per day, seven days per week. At the time of our inspection there were nine people using this service, all of whom lived in their own flat.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

The human and legal rights of people who used this service were not protected because staff did not have a good working knowledge of the principles of the Mental Capacity Act 2005. Staff had not been provided with appropriate training and therefore did not have the skills and knowledge required in order to support people safely. Quality assurance systems had not fully identified and addressed the impact on the wellbeing and continued safety of people who used the service.

People who used the service and their relatives told us that their support workers were friendly and caring. No one that we spoke with during the inspection, raised concerns about their support worker. However, people were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

Most people had care plans and risk assessments in place, but these were not up to date and did not reflect current support needs or strategies to help staff manage risks appropriately. People had been involved in the development of their plans. However, they had not been provided with information or an explanation, in a way that they could understand as to why these documents were important.

There were limited opportunities for people to comment on the standard and quality of the service they received.

There were systems in place for people to raise concerns and complaints if they wished to. The people we spoke with were clear about who they would talk to about concerns. During our inspection no one raised any major issues with us.

At this inspection we found seven breaches of the Regulations. These related to person centred care, consent, safeguarding people from abuse, safe care and treatment, dignity and respect, staff training and competency and the governance of the service.

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, 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

Inspection carried out on 16th March 2015

During a routine inspection

This announced inspection took place on the 16th March 2015. The provider was given 48 hours’ notice of the inspection visit because the location provides personal care and support to people in their own homes. As the people who use this service often accessed community activities we needed to make sure people were available to speak to us. The Regent provides personal care to people who have a learning disability or other complex needs.

During our previous inspection visit on the 13th December 2013 we found the service met all the national standards we looked at. Since then there have been no incidents or concerns raised that needed investigation. At the time of our inspection The Regent provided personal care and support to seven people.

There was a registered manager in post on the day of our visit. 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 2008 and associated Regulations about how the service is run.

The inspection team consisted of one adult social care inspector.

We found that people who used this service were safe. The support workers had completed training in the protection of vulnerable people and were aware of their responsibility to keep people safe and free from harm. Staff knew how to report incidents that gave them cause for concern and were confident the management team would listen to them.

There were good systems to ensure people knew the staff that supported them. Staff rosters ensured there was consistency within the staff team and the people we spoke to knew the support workers well.

The provider had robust recruitment policies and procedures in place which ensured only suitable people were employed to care for vulnerable people with complex needs. Records evidenced that all the appropriate checks were completed before people started work at the regency.

We found that the service worked well with external agencies such as social services, other care providers and mental health professionals to provide appropriate care to meet people’s physical and emotional needs.

We saw that medicines were administered safety and all the records were up date and checked regularly. All staff had completed training in the safe handling of medicines.

We saw people were encouraged to take part in a variety of activities in the community including work placements, holidays and outings.

The service followed the requirements of the Mental Capacity Act 2005 Code of Practice. This helped to protect the rights of people who were not able to make important decisions themselves.

We saw that professional advice from adult care social workers, the learning disability nurse and other health care advisors was accessed as and when necessary. Health care needs were met through people’s own GP practice.

Personalised care plans were in place in a format that was suitable through pictures and symbols as well as writing.

There was an appropriate internal quality monitoring procedure in place. Checks or audits were completed in respect of personal finances, medicines management, care plans, health and safety and equality and diversity. These checks ensured people were cared for and supported in the way they wanted to be.

Leonard Cheshire, the registered provider, also had formal methods for monitoring and assessing the quality of the services it provided. Annual survey questionnaires were sent to people who used the service asking for their feedback on the care and support they received. The results of the surveys were used to make any changes that may be needed to improve the service provision.

Inspection carried out on 13 December 2013

During a routine inspection

We spoke in private with four people who used the supported living service. They told us that they had been included in agreeing to the support provided by this service. People told us they could refuse any aspect of their planned care if they wished. They said the support staff respected the decisions they made about their care.

Everyone we spoke with said they felt safe with the care provided by this service and with the staff who supported them.

People told us the support they received had helped them to gain greater independence including following a range of activities in the local community. One person told us they had developed increased independence and said that this had improved their quality of life and given them greater confidence.

People told us the service was responsive to their needs. One person said, �They [support staff] fit in around what I�m doing each day�.