Regency Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This was the first assessment of this newly registered service. This assessment considered the following 4 quality statements: Learning culture; Involving people to manage risk; Safe environments; Infection prevention and control. Risks to people were not always managed or mitigated effectively. We identified shortfalls in the management of skin integrity, falls prevention and fluid monitoring. Risks associated with the environment had not been clearly documented. There were no recorded risk assessments for the stairwells or free-standing radiators is people’s bedrooms. These presented a potential risk of harm. We noted that some equipment, including bed rail protectors and toilet surrounds were damaged. This could lead to injury and would also make equipment difficult to clean effectively. We identified improvements needed to ensure the flow of laundry and to minimise the risk of contamination. Processes in place to identify learning and drive improvement were not fully in place or effective. This meant avoidable risks to people may not be identified and opportunities for improvement might be missed. At this inspection there was no evidence of closed cultures. Staff were able to raise issues and felt listened to and supported. The registered manager was open to feedback and demonstrated a willingness to develop and improve the service. The service was registered in October 2023 and systems and processes were still being developed and embedded. This assessment did not include sufficient quality statements to provide a rating for the service under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 28 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives expressed they wished to be more involved in people’s care. They told us they were not involved in regular care plan reviews and said they often needed to raise the same issue more than once. One relative told us, “I still must remind staff to make sure her hearing aids have batteries in despite raising it so many times.” Another relative told us they had not been informed as to why their loved one had a bandage on their leg. A third said they had suggested family meetings but had not received feedback on this. The provider told us a new clinical lead and director of care had been appointed and they anticipated this would improve communication with people and their relatives/representatives.

Staff indicated they felt able to raise concerns or put their hand up if they had made a mistake. The registered manager shared information about recent incidents. We identified the response and follow-up to incidents was not consistent, meaning opportunities to learn lessons and implement improvements may have been missed.

Processes were not in place to undertake timely reviews and to analyse incidents. This meant learning had not been identified and associated improvements had not taken place. For example, staff had not been completing post-fall monitoring of people to help identify injury or signs of deterioration. This was not in line with the provider’s policy and had not been identified due to the lack of review. Where incidents had occurred, there was a lack of action to prevent reoccurrence. We noted one person, who was noted to be at high risk of falls, had walked down two flights of stairs. There was no action recorded in relation to the lack of staff response to their movement alert mat, nor to the risk of the person falling down the stairs. This placed the person, and potentially other people, at risk of avoidable harm. Some incidents that indicated safeguarding concerns, for example a report of missing money, had not been identified as such and had consequently not been referred appropriately. In response to an external complaint, the registered manager had completed an incident review. This was comprehensive and identified areas of learning as well as good practice. Following the visit, the provider told us they had boosted training in falls management and updated guidance for staff on the action that was expected of them.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people spoke well of the service and told us they felt safe. Relatives spoke of measures in place to minimise risk, for example a relative said, “Mum has thickened drinks and they are provided to prevent her choking.” We received mixed feedback with regard to moving and handling support. One person said, “I need a hoist and there are always two staff who use it.” Another told us, “They (care staff) sometimes use a slide sheet when moving me, but other times pull me by my hands to get me up the bed.” The registered manager was shocked to hear this feedback. Following the visit, she told us discussions had been held with the staff team and that face to face moving and handling training was booked during March 2024.

Staff expressed some concern over their ability to monitor people at risk of falls, particularly in the early morning and evening. They told us this was due to staff supporting people in their rooms and some people being more anxious in the evening. Staff were unable to provide assurance on how certain risks were mitigated. For example, some people had guidance in place to return to bed after a certain amount of time sitting in a chair (to minimise the risk of skin breakdown). Staff told us they adhered to these timings but there did not appear to be a formal or systematic approach to provide assurance people received consistent support. Staff told us they had received appropriate training and they felt confident in their skills and ability to support people. Staff shared they felt comfortable raising any concerns or issues they encountered in their work with the registered manager.

On both days of our visit, we observed people standing or trying to stand. Although staff were present in the communal areas, they were occupied and did not always notice people attempting to stand. We discussed the possibility of movement alert equipment with the registered manager, to support staff in knowing when a person had stood up to enable them to offer prompt support thus reducing the risk of falls. Following our visit, the provider informed us they had increased their staffing level in the morning in response to staff feedback and to improve the monitoring in communal areas. We observed topical creams in people’s bedrooms and ensuite bathrooms. None of the tubs or tubes had been dated on opening, meaning there was a risk these would be used beyond the safe to use date. We observed appropriate use of moving and handling equipment within communal areas.

Risks to people were not always managed or mitigated effectively. To minimise the risk of skin breakdown, some people had pressure relieving mattresses. We found these were not always set appropriately to the person’s weight. This placed people’s skin integrity at risk. The system in place for staff to record the date topical creams were opened was not effective, or not enforced. This presented a risk creams could be used beyond the safe to use date. Some people had been identified as at risk of dehydration and were placed on ‘fluid watch’. Records did not evidence they had drunk enough. In one record, 0ml of intake recorded against a target of 1500ml in 24 hours. There was no evidence staff had noted this lack of recorded intake or raised concerns. Where people required thickener to safely manage their drinks, care plans with clear guidance for staff were in place. On the first day we visited, we noted thickener was not stored safely. This was addressed by the second day of our visit. When people had fallen, there was little evidence of post-fall monitoring or of neurological observations if a person had bumped their head. Individual incidents had not been reviewed meaning this shortfall had not been identified. There was no system in place to review accidents and incidents to identify patterns and to drive improvement. The failure to ensure assess and mitigate risks in people’s care was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the visit, the provider told us they had boosted training in falls management and updated guidance for staff on the action that was expected of them. They advised people’s weights had been integrated to their digital system so staff could easily cross reference the person’s weight and appropriate mattress setting. Risks relating to wound care, catheter care and specific conditions including Diabetes were assessed, with appropriate guidance in place.

On the first day we visited, the lift was out of order. This meant some people were unable to come downstairs and were being supported by staff in their rooms. On the second day we visited, the lift was working. We observed people appeared happier and were enjoying the opportunity to meet with others and chat with staff in the communal areas. We noticed marks on one person’s arm and asked if they had hurt themselves. They told us, “I keep catching it on the bedside here and the bed table has a rough bit on it.” We saw the bed rails did not have a cover or protection and the table was seen to have a rough edge on it. We informed the registered manager of this.

Staff told us they had plenty of equipment available to support people, including wheelchairs and a hoist on each floor. Staff were able to describe the action they would take in the event of the fire alarm sounding.

We observed a number of hazards during our visit. There were free-standing radiators in some bedrooms which were uncovered and hot to the touch. There were also trailing wires which could present a trip hazard. Fuse/wiring boxes on the landings and sluice rooms were unsecured. We shared our concerns with the registered manager who took prompt action, for example by the second day of our visit, the fuse/wiring boxes were equipped with combination-coded bolts. We noted that some equipment, including bed rail protectors and toilet surrounds were damaged. This could lead to injury and would also make equipment difficult to clean effectively. Following the visit, the provider told us they had updated their inventory of equipment and were continuing to remove and replace damaged items.

Risks associated with the environment had not been clearly documented. There were no recorded risk assessments for the stairwells or free-standing radiators in people’s bedrooms. These presented a potential risk of harm from falls and burns. Where checks were in place, these were not always effective. For example, water temperatures had been checked and documented. The temperatures recorded were high but this had not been identified, meaning no action had been taken to ensure people were protected from the risk of scalds. The failure to ensure the premises were safe for use was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager advised the safe temperature range would be added to their monitoring forms to ensure any divergence was identified and addressed in a timely way. Following our visit, the provider told us action had been taken and Thermostatic Mixing Valves (TMVs) within the home had been checked and installed where necessary by a plumber. We saw records of room safety checks from November 2023, but the intended frequency of these checks was unclear. During our visit, we observed some equipment (bed rail covers, toilet surrounds) that was damaged and areas (ensuite bathroom window frames) that required deep cleaning. We also identified that one person’s call bell was not working. Following the visit, the provider advised they had checked the call bell system and completed an inventory of equipment with a view to removing and replacing damaged items. There was a process to ensure equipment, including hoists and gas appliances, was serviced as required. This information was on a spreadsheet monitored by the Registered Manager. Fire safety training for staff and checks on alarms and emergency lighting were in place.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and family members told us they felt the home was kept clean and the cleaners did a good job.

Staff told us they had access to personal protective equipment (PPE). They told us the housekeeping team were supportive, for example if there had been a spillage this would be addressed promptly. Housekeeping staff described their work, including daily tasks and monthly deep cleans of bedrooms. They told us they had sufficient equipment and supplies to complete their work. Staff confirmed they had completed training in infection prevention and control.

On the first day we visited, areas of the home appeared dirty. On this visit, the lift was broken and staff were responding to this challenge and supporting more people in their rooms. On the second day of our visit the home was clean. In the laundry room, we observed the flow of dirty to clean laundry required improvement. For example, we observed dirty laundry being handled over a basket of clean laundry meaning contamination could occur. There was one sink in the laundry area which was being used to soak heavily soiled items. This meant there were no handwashing facilities available to staff in the room. In the ground floor sluice room, the handwashing sink was full of items making it difficult for staff to wash their hands and giving the room a cluttered appearance. We noted that some equipment, including bed rail protectors and toilet surrounds were damaged. This would make it difficult to clean equipment effectively. We observed some staff with long false nails. This was not in line with best practice or the provider’s policy. Clinical waste was stored appropriately outside the property, with separate access for contractors to come and collect.

The provider had clear policies in place with regard to infection prevention and control. We noted, however, that elements of this were not enforced. For example, on the first day we visited, some staff were noted to have long, false nails. Best practice advises short, clean fingernails without nail polish or false nails to enable effective cleaning of hands. The system to ensure the flow of dirty to clean laundry required improvement to minimise the risk of contamination. The provider told us they had spoken with staff and reinforced the flow of dirty to clean items with additional signage. They told us investment was planned, including rearranging the laundry room to facilitate the flow of items, a new handwashing sink, new machines and cupboards. There was no process to keep records of infections each month. This could help identify patterns or trends and prompt improvements in practice. The registered manager acted immediately on this feedback and this was in place by the second day of our visit. Mattress audits were in place. This included staff checking for stains, cleanliness of the mattress and bed frame and signs of wear and tear.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.