Archived: Regent Hotel

Regent Hotel is a care home providing personal care and accommodation to 19 older people who may be living with dementia at the time of our inspection. The service can support up to 29 people across three floors and has lift access and bathroom facilities located on each floor.

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

People at Regent Hotel did not receive safe, quality care. People’s medicines were not always administered safely and as prescribed. Equipment used to help people transfer was not safe and appropriately maintained. Risks to people’s health, safety and wellbeing were not always identified, assessed and appropriately managed. Furthermore, guidance from safeguarding teams was not always followed. Areas of the service were not clean and there were unpleasant odours.

Staff were not recruited safely and the risk of staff working without references had not been assessed and mitigated. Staffing levels were low, which meant people’s needs were not always met in a timely manner. People who were at risk of falling did not always receive appropriate supervision. Not all staff had completed required training and did not receive appropriate supervision to ensure they were properly supported and had the required skills for their roles.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Referrals had not always been made to relevant healthcare professionals when people needed them and guidance from health professionals was not always followed. Mealtimes were a poor experience for people, as there was a lack of meal options, people were not informed what they were eating, and people were not offered the opportunity to eat at the dining table.

The provider and the registered manager continued to fail to maintain the safety of the service and improve the quality of care delivered. Shortfalls had not been identified and this included with medicines, risk management, equipment and premises safety, people’s personal hygiene, mealtime experiences, healthcare referrals, recruitment records and staff training.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 February 2023). This service has been rated requires improvement for the last two consecutive inspections and has been rated inadequate at this inspection. At this inspection we found the provider remained in breach of regulations and new breaches of regulations were also found.

At our last inspection we recommended the provider reviewed and analysed questionnaire responses and take action to implement people’s and staff’s views. The provider had not acted on the recommendation and had not made improvements.

Why we inspected

We received concerns in relation to medicine errors, staff training, staffing levels, neglect, behavioural needs of people, lack of food and fluids and falsified records. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make significant improvements. Please see the safe, effective, and well-led sections of this full report. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk management, infection prevention and control, mental capacity, staff training, staffing levels, staff recruitment, person-centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Regent Hotel is a care home providing personal care and accommodation to 22 older people who may be living with dementia at the time of our inspection. The service can support up to 29 people across three floors and has lift access and bathroom facilities located on each floor.

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

People did not always receive their medicines as prescribed and there was a lack of guidance to help staff determine when people needed their medicines.

Staff were knowledgeable about risks to people’s safety and wellbeing, though records were not always reviewed and updated following accidents, incidents or changes to people’s needs.

Quality assurance systems continued to be ineffective and all issues from the previous inspection had not been addressed. Audits had not identified shortfalls found during this inspection. Feedback from people and staff was sought but action was not always taken to improve the service.

The provider had improved the environment which supported effective cleaning and infection prevention and control. Staff recruitment was safe and staffing levels were monitored. Staff were trained in safeguarding and understood how to report concerns.

People were cared for by kind and attentive staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 February 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found there was a concern with medicines and assessing of risk, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-led.

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 not changed following this focused inspection and remains requires improvement.

Enforcement and recommendations.

We have identified breaches in relation to medicines, assessing and monitoring risk and governance of the service at this inspection. We have made a recommendation about action plans following receipt of people’s feedback.

Please see the action we have told the provider to take at the end of this report and full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Regent Hotel is a care home providing personal care and accommodation to 22 older people who may be living with dementia at the time of our inspection. The service can support up to 29 people across three floors and has lift access and bathroom facilities located on each floor.

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

Risks to people’s wellbeing and safety had not been appropriately assessed or monitored. People’s medicines were not always safely managed. Some areas of the service and equipment were not appropriately cleaned, and during the inspection areas were found to be dirty, which placed people at risk of infection.

Safe recruitment processes had not always been followed. This meant the provider could not be assured staff were suitable to work with vulnerable people. Opportunities to learn from accidents, incidents and safeguarding concerns had been missed, as there was a lack of appropriate monitoring systems in place.

Quality assurance systems were not always completed and where they were, systems had not identified shortfalls found during the inspection.

Staff were updated about changes to people’s needs and any changes to the service. The provider had sought some feedback from staff and people who used the service, although there was no analysis of the information or records of changes made in response.

People and their relatives were happy with the service. Staff worked hard and supported people in a caring manner. Staff were supported by the management team and worked closely with healthcare professionals to meet people’s needs.

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

Rating at last inspection

The last rating for this service was good (published 18 October 2018).

Why we inspected

We received concerns in relation to medicines, staffing levels and access to healthcare professionals. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, recruitment, and oversight of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff completed regular checks on people to monitor for signs and symptoms of COVID-19, this included taking people's temperatures twice daily.

Staff demonstrated a good knowledge of how to support people that had tested positive or were showing symptoms of COVID-19.

Staff breaks were taken in designated areas and restricted to one member of staff at any given time to reduce the risks of transmission. Staff were careful to maintain social distancing and wore appropriate PPE in line with current government guidance.

Staff were allocated to specific floors in the service to work to reduce the risk of transmission throughout the service.

The registered manager had used templates and guidance from best practice to appropriately assess risks to people and staff.

The registered manager had identified staff to take a lead role in infection prevention control (IPC) and they were undergoing further training to enhance their knowledge and skills.

Following the last inspection, we asked the provider to complete an action plan which they provided to show what they would do and by when to improve the key question Safe to at least good. At this inspection the provider had completed the actions on their plan and there were improvements relating to infection control with additional audits identifying where improvements were needed. The provider was now compliant with these regulations.

Regent Hotel is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 29 older people who may be living with dementia in one adapted building. There were 23 people living at the service on the day of the inspection.

At the last inspection in August 2017, the service was rated as requires improvement. At this inspection, the rating had improved to good.

There was a registered manager employed at the service who had been registered for eight months. 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.

Staff had been safely recruited and there were sufficient numbers of staff on duty to meet people’s needs in a way which met their preferences and promoted their independence. People told us they felt safe in Regent Hotel. Staff had received training in the protection of adults and knew what action they should take if they suspected or witnessed abuse.

People’s medicines were safely managed. We observed that people received their medicines wherever they felt most comfortable.

Risks to people’s health and safety had been identified with guidance for staff on how to safely meet their needs . People’s records were kept safely to maintain confidentiality.

The layout and decoration of the home met people’s needs. The environment was clean and tidy and although there were some areas for improvement to complete such as new carpets, the registered manager told us these were being arranged.

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.

People were supported by staff who were kind and caring and people felt they mattered to the staff who supported them. We saw examples of a family atmosphere with relatives, people who used the service and staff having conversations, laughing and interacting in a friendly way.

There was an effective quality monitoring system in place. Audits were completed and feedback sought through questionnaires or meetings which helped the service improve.

At the last inspection in March 2015 we were concerned that people’s nutritional and hydration needs were not being met, that staff training was out of date, that the premises were poorly maintained and that recording was inconsistent. We issued requirements in respect of Regulation 14, Regulation 15, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we saw that staff had completed training on health and safety, fire safety, safeguarding adults from abuse, and infection control during the previous 12 months. New staff were undertaking induction training and shadowing experienced staff before they worked unsupervised. The provider was no longer in breach of this regulation.

Repairs had been carried out to the premises as part of the refurbishment programme and maintenance of the fabric of the home had improved. The provider was no longer in breach of this regulation.

People told us they were happy with the choice of meals provided at the home. People’s nutritional needs were recorded and their food and fluid intake was being monitored when this was an identified area of concern. Although we saw that people were receiving sufficient to eat and drink, the recording on monitoring forms remained inconsistent.

The manager carried out audits to ensure people were receiving the care and support that they required, and to monitor that staff were following the policies, procedures and systems in place. These audits required more detail about the action taken to address any identified shortfalls.

Care planning described the person and the level of support they required. However, there were some anomalies in recording, although none of these had affected the care the person had received.

We have made a recommendation in the report about the need for recording to become more consistent.

We identified concerns about the prevention and control of infection. The systems currently in place did not fully protect people from the risk of infection.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

You can see what action we asked the provider to take at the end of the full report.

Sufficient numbers of staff were employed to make sure people received the support they needed, and those staff had been safely recruited. People told us they felt safe living at the home.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Risks to people were assessed and reduced where possible. Staff received training on safeguarding adults from abuse. They were confident when describing different types of abuse they may become aware of and the action they would take to protect people from harm.

Staff were kind, caring and patient. They encouraged people to be as independent as possible and respected their privacy and dignity. However, we were concerned that two toilets downstairs did not have locks and this compromised people’s privacy and dignity. This will be addressed outside of the inspection process.

Staff told us they were well supported through supervision and staff meetings.

Although we did not see any activities taking place on the day of the inspection, we were told that the activities coordinator worked on three days a week, and we saw a programme of activities for those days.

People understood how to express any concerns or complaints and were given the opportunity to feedback their views of the service provided.

There was a registered manager in post. They were also managing another service operated by the same provider. A new manager had been appointed and a gradual handover was taking place. The new manager told us they would be applying for registration with the Care Quality Commission (CQC) when they were fully confident in the manager role. People who lived at the home and staff reported that the service was well managed.

The Regent Hotel is a care home that is registered to provide care and accommodation for up to 29 older people. It is situated on the sea front in Bridlington, in the East Riding of Yorkshire. Accommodation is located over three floors and had a passenger lift. It has mainly single bedrooms. The home also has assisted bathrooms and shower rooms. There is a large communal room and a separate dining room.

The registered provider is required to have a registered manager in post and on the day of the inspection, there was a manager in place, although they were not registered with the Care Quality Commission (CQC) and had not yet submitted an application for registration as they had only been in post for four weeks. 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 that staff had received an induction prior to starting work within the home; however, this did not always provide staff with the required skills to carry out their roles effectively. We also found that a high number of staff had not completed refresher training in a variety of topics and they lacked some knowledge in relation to the Mental Capacity Act 2005 (MCA). This was a breach of Regulation 18. You can see what action we told the provider to take at the back of the full version of the report.

We found that people’s health needs were not always met. One person living in the home had experienced a sustained period of weight loss and although we saw that their weight was regularly monitored, no action had been taken to address the weight loss and there had been no contact made with any other professionals in relation to this. This was a breach of Regulation 14. You can see what action we told the provider to take at the back of the full version of the report.

We found the quality assurance systems in place had failed to detect issues of concern in relation to care planning, medication, staff training, the condition of some areas of the home and the monitoring of people’s weights. Record keeping within the service also needed to improve. This was a breach of Regulation 17. You can see what action we told the provider to take at the back of the full version of the report.

We found that the premises were not properly maintained. This was a breach of a Regulation 15. You can see what action we told the provider to take at the back of the full version of the report.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes.

We found that the administration of medicines was being managed appropriately at the service, although we identified some issues with the recording of medication.

The manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed. Staff did not use restraint, and this was confirmed during conversations with staff.

People told us they enjoyed the food and most people had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People told us they were well cared for. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were able to make choices and decisions regarding their care.

People were offered a variety of different activities and were supported to go out of the home to access facilities in the local community, although people did indicate they would like more outings.

People's comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were recorded and acted upon when necessary.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity and we observed caring and compassionate care by the staff. People told us they felt safe. People had their own care file and these contained an assessment of needs for example; life history events, daily living tasks, medical history, monitoring charts and contact with other professionals. This contained information about the way each person should be supported and cared for. Additional information included risk assessments to ensure people remained safe from harm.

There were activities for people to be involved in to give them stimulation and a choice about their welfare.

We saw that the service had appropriate controls in place for the safe administering of medicine. People commented, 'I take medication on a morning and a night time. If I need anything else like pain relief I just need to press the call bell and staff would assist me with this' and 'If I need any help with taking my medication the staff help me with this when they do their rounds.'

There were clear policies and procedures in place and safe and appropriate moving and handling practices were followed within the service.

The service and communal areas were pleasant, clean and hygienic.

Is the service effective?

A pre-assessment support plan was always completed with people when starting with the service. Specialist dietary and mobility needs had been identified in care files where required. Care files were checked on a four weekly basis by the manager and key worker.

A Visiting relative told us, 'My mum has put weight on since she has been here and they monitor her weight closely and she is doing well. When I take her out she always wants to come back, she believes she is in a hotel.'

We observed the lunchtime experience and staff were very responsive to people's needs and supported people during their meal. People commented, 'I always enjoy my meals and it's good to sit with my friends and chat too', 'I can choose to eat my meal anywhere I like but I prefer to have mine in the sitting room' and 'I get weighed once a week to make sure my weight is controlled.'

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were supportive and attentive to people's needs, and were professional and courteous. People commented, 'I have been here for five years and the staff are lovely, it speaks words for itself', 'Staff always ask my permission for all sorts of things and I can have what I like', 'Staff are very good they can't do enough for us' and 'It is lovely here it speaks words for itself.'

People were asked verbally by the manager about their views of the service. A person commented, 'My relative originally came here for respite care and I have nothing but praise for the staff. The manager and her husband are incredible and they push the boat out for most things.'

Special dietary requirements were recorded in some peoples' care files and when we checked with staff, they knew about these and ensured people were given the correct food during their mealtime.

Is the service responsive?

People regularly completed a range of activities in and outside the service. Different events and activities were available for people to take part in. We observed a game of bingo being played and it was well attended and people appeared to have enjoyed the session. The manager told us that they held regular 'movement to music' sessions and entertainment professionals attended the home to sing or play music to people who used the service.

Other people we spoke with told us, 'If I ring my call bell the staff always respond really quickly but I feel embarrassed by it. The staff tell me it is ok to press the call bell if I need assistance as it is their job to help me. I feel really reassured by this' and 'I hear the fire alarm being tested regularly.'

People knew how to make a complaint if they were unhappy. We looked at how these complaints had been dealt with, and found that the response had been open, thorough, and timely. People were therefore assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service had an effective quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Records we looked at included responses from people who used the service and their relatives. We saw that survey responses were received from 22 people who used the service and 19 relatives in 2013. An analysis of results was completed in 'graph form' and any concerns raised were acted on.

The staff we spoke with knew about their involvement with team meetings and supervisors and the manager observing their care activity. This meant that staff were confident and clear about their roles and their responsibilities.

Staff had a good understanding of the procedures and policies that were in place. This helped to ensure that people received a good quality service at all times.

We saw that care needs were discussed with people and/or their relatives and before people received care their consent was asked for. One person said 'They talked to me and my daughter about what my needs were'.

During our visit we saw that the home looked clean and tidy. It had a homely environment and people said they were content in the home. People told us they were well cared for. One person said 'The care is excellent, there's a lot of love and care'. Another person told us 'The manager is first class, you can talk to her, she goes out of her way to be of service when you need it'.

There were enough qualified, skilled and experienced staff to meet people's needs. Staff could tell us what they would do and who they would contact if they were concerned about abuse.

There was a complaints procedure in place at the home. The people we spoke with knew what to do if they had any concerns. The provider had systems in place to assess and monitor the quality of service that people received.