Archived: Regency Nursing Home

What life is like for people using this service:

• People were kept safe from avoidable harm. Staff recognised the risks to people’s health, safety and well-being and knew how to support them safely. People received their medicines as prescribed.

• Healthcare professionals told us the staff at the service worked well with them to provide good outcomes for people.

• People were cared for by staff who were kind and caring and people’s privacy, independence and dignity were promoted.

• People received personalised care that met their needs and preferences. People chose how to spend their day and were engaged in activities that they enjoyed.

• Staff were supported in their roles. They took part in regular training and supervision. Staff told us they enjoyed working at the service and felt well supported by the registered manager and the management team.

• People knew how to raise concerns. They had confidence in the registered manager and told us they would recommend the home to others.

• A quality assurance system was in place to continually assess, monitor and improve the service.

• We found the service met the characteristics of a “Good” rating in all areas. More information is available in the full report.

Rating at last inspection: Requires Improvement (report published 14 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: There is no required follow up to this inspection, however we will continue to monitor the service through information we receive.

There was a registered manager in post. 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.

At our last inspection in June and July 2015 we found that there were not always enough staff to meet people’s needs. We made a recommendation about this. At this inspection we found there were enough staff on duty. We have, however, made a recommendation to the provider with regards to the ongoing monitoring of staffing levels.

During this inspection we found some shortfalls at the service with regard to record keeping. The provider used a range of quality assurance systems including audits; however these were not robust and did not pick up on some of the issues we found with records. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Staff told us they felt well supported by the senior team, the registered manager and the provider, however there was not a regular programme of supervision or appraisal for staff which was recorded.

People and visitors felt the service was safe. People looked comfortable, relaxed and happy and were supported by staff that knew them well. The registered manager and staff had a good understanding of how to keep people safe. All staff displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm. Risks were well managed. Accidents and incidents were recorded but were not monitored to determine if any trends were occurring. Safe recruitment processes, including pre-employment checks, had been followed. Health and safety checks on the building and equipment were regularly carried out.

Medicines were administered by trained staff. Lack of clear direction regarding as required (PRN) and topical medicines were addressed to ensure they were administered in line with people’s needs.

Staff received training that enabled them to meet the needs of people they supported and deliver effective care. Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services.

Feedback about the food on offer was positive. Where people needed support to eat, this was given in a dignified way. Food consistencies were not in line with national guidance and people did not have daily fluid intake targets recorded. The registered manager told us they had put this place following the inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Applications had been made for Deprivation of Liberty Safeguard (DoLS) authorisations, where it was considered that people would be unable to keep themselves safe if they were to leave the home unaccompanied.

Care plans in place were person-centred and included details about people's life histories and what was important to them. People’s individual needs were assessed and most people had an up to date plan of care in place.

People told us staff were friendly and caring. They told us they were treated with dignity and respect. We saw that staff knew people well, and observed positive interactions between people and staff. Visitors told us they were welcome to visit at any time.

People spoke highly of the activities on offer. There were a wide variety of stimulating activities planned within the home. The activity coordinator spent time with people on a one-to-one basis as well as planning group activities.

Complaints had been responded to in line with the provider's policy although the recording of these could be improved.

We found two breaches of the Health and Social Care Act 2008. This related to Regulation 17: Good Governance. You can see what action we told the registered provider to take at the back of the full version of this report.

We found the home had taken action to address the two compliance actions made at the last inspection.

We spoke to three people who lived at the home and to a relative of someone living at the home. We also spoke to the local authority safeguarding team about concerns raised with them. We also spoke to one of the providers and to the home's head of nursing care as well as the chef and a staff member who monitored the environment. We also spoke to the local authority fire and rescue service.

One person said they liked living at the home describing the staff as kind and helpful. Both people we spoke to said staff responded when they asked for assistance when using the call point in their rooms. However, both people said there were sometimes delays in the time it took for staff to get to them. During the inspection visit we tested the call point in one room and found staff responded promptly.

A relative we spoke to said the home's environment had improved considerably adding, 'It looks good now.'

The staff we spoke to said any disruptions caused by building works were kept to a minimum and were safely managed.

We spoke to five people who lived at the home and to two relatives of people who lived at the home. We also spoke to three staff and the manager as well as one of the providers. We also spoke to a health and social care professional about the service provided by the home.

People told us they were treated well by the home's staff and that the standard of care was good. One person said they sometimes had to wait a long time for staff to respond when they asked to be taken to the toilet. A health and social professional told us the home provided appropriate standards of nursing care.

People were supported to have a nutritious diet and to have adequate fluid intake.

At the time of the inspection building work was taking place. The home had taken steps to minimise any disruption to people and the running of the home. A number of people and staff raised issues about noise from the building works.

We found that one staff member was working in the home without adequate recruitment checks.

The home had adequate numbers of staff.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had positive experiences. The mealtime was well organised. Meals were brought promptly and staff helped people if they needed it.

We also spoke to three staff, the manager and the provider.

People told us they were treated with respect and that staff were kind. People and their relative said the home met people's care needs.

We saw each person had comprehensive assessments of need along with care plans. These showed people's views were taken account of in how they liked to be helped.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection)

tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us

to spend time watching what is going on in a service and helps us to record how people

spend their time and whether they have positive experiences. This includes looking at the

support that is given to them by the staff. We spent 40 minutes observing at lunchtime and

found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. People were treated with respect and there was warmth and humour in staff interactions with people. We did note two isolated occasions where the dignity of people was not upheld.

People and staff gave mixed views regarding the staffing levels. One person and two staff felt there were not enough staff. Staff said this had not affected the care people received. Staff told us people were well cared for.