Regency Court

Regency Court is a residential care home providing personal care to up to 22 people in one adapted building. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 9 people using the service.

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

Significant improvements had been made since the last inspection. Recruitment checks were carried out before new staff started work. However, the accuracy of application forms, employment history and verification of references needed to be more robust. We have made a recommendation that the provider reviews their recruitment process.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

There were enough staff to meet people’s needs and keep them safe. Staff received the training and support they required to carry out their roles. Medicines were managed safely.

People felt safe in the service. Safeguarding events, accidents and incidents were reported, recorded and acted upon appropriately. Risks to people were assessed and managed well by staff. One relative said, “[Family member] is safe here, they have been in 2 other homes but they are much happier here.”

The environment was well maintained and clean. Safe infection prevention and control procedures were followed. 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.

People received person-centred care. Care records had improved although some further minor improvements were identified. People and relatives were happy with the care provided and were involved in planning and reviewing care. People and relatives praised the staff for their kindness and compassion. We saw staff treated people with respect and maintained their privacy and dignity. Activities were taking place. People had access to healthcare services. People were provided with a choice of food and drinks and enjoyed their meals.

There had been a lack of consistent leadership over the last couple of years but this had improved. Relatives and staff spoke highly of the current manager and acknowledged the improvements they had made since starting in post. The provider had secured additional support from an external consultant. Effective quality assurance systems had been implemented and issues were actioned and verified by the consultant and provider. An action plan was in place to make sure improvements were sustained and developed further.

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 inadequate (published 19 September 2022) and there were breaches of regulations. 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.

This service has been in Special Measures since November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Recommendations

We have made a recommendation in relation to recruitment at this inspection.

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.

Regency Court is a residential care home providing personal care to up to 22 people in one adapted building. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 13 people using the service.

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

People were not always safe. Actions had not been taken to safeguard people from abuse. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks. Accidents and incidents were not always appropriately recorded. Medicines were not managed safely.

There were not always enough staff to meet people’s needs and keep them safe. Recruitment processes were not robust in checking people were safe and suitable to work in the service.

People did not always receive person-centred care and care records did not fully reflect their needs. People were not always treated with dignity and respect and their experience of care varied. Some staff were kind and caring, however others interacted very little with people. There were few activities taking place and there was little to occupy and interest people. People’s dignity was not always respected.

Infection control procedures were not followed on the first day as staff were not wearing masks correctly though this had improved on the second day.

There was a lack of effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level.

People’s nutritional needs were met although the recording of people’s food and fluid intake needed to improve. Staff training and support had improved. Training was up to date and staff were receiving supervision. People were supported to keep in touch with family and friends. People had access to healthcare services. Relatives were satisfied with the service provided.

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.

The manager and provider were responsive to the inspection findings and responded during and after the inspection to address the issues we found..

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 inadequate (published 30 November 2021) and there were breaches of regulations. 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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

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.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, recruitment, person-centred care, privacy and dignity 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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Regency Court is a residential care home providing personal care for up to 22 older people, some of who may be living with dementia. At the time of the inspection there were 18 people using the service. Accommodation is provided in single and double rooms on two floors with stairlift access between floors. Communal areas including a lounge, dining room and conservatory are located on the ground floor.

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

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks. Government guidance on the prevention and control of infection was not always followed which meant people were put at increased risk. Regular COVID-19 tests were not being carried out on staff or people living in the home. This was put in place after the first day of the inspection.

People did not receive person-centred care and care records did not fully reflect their needs. Medicines were not managed safely. People’s nutritional needs were not met.

People were not always treated with respect by staff or had their privacy and dignity maintained. Although some staff were kind, caring and compassionate and treated people well, other staff were task focussed and did not respond appropriately to people's needs. There were few activities taking place and there was little to occupy and interest people.

Staff were not fully checked before starting work in the home. Staff did not receive the induction, training and support they needed for their roles. There were not enough staff on duty to meet people’s needs, although staffing levels were increased following the first day of inspection.

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.

There was a lack of consistent and effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level.

People were supported to keep in touch with family and friends through video, phone calls and indoor visits. People had access to healthcare services. Overall people and relatives were satisfied with the service provided.

The manager and provider were responsive to the inspection findings, took action during and after the inspection and shared plans to improve their systems and processes.

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

Rating at last inspection

The last rating for this service was good (published 13 August 2019).

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection control, staffing, care provision and risk management. 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. We inspected and found other concerns, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions.

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.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from good to inadequate. This is based on the findings at 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 Regency Court 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 safe care and treatment, staffing, recruitment, nutrition, personal care, need for consent, dignity and respect and good governance 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.

Special Measures:

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.

We found the following examples of good practice.

The premises looked clean and staff were observed cleaning touchpoints. Hand sanitisers and PPE stations were situated throughout the building.

Staff were observed wearing appropriate PPE.

One member of staff used public transport and they were getting to and from work via taxi; this was paid for by the provider.

Further information is in the detailed findings below.

Regency Court is a residential care home providing personal care for up to 22 people in one adapted building. At the time of the inspection There were 17 older people and people living with dementia using the service.

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

Staff understood how to keep people in their care safe from harm. Where risks to individuals had been identified measures had been put in place to reduce or eliminate those risks. Safe systems were in place to ensure people got their medicines at the right times. The home was clean and checks were in place to ensure the environment was safe. Staff had been recruited safely and there were enough staff to provide people with timely care and support.

Staff were trained and were supported by the manager. Improvements to the environment were ongoing. People liked their rooms and they had easy access to a safe outside patio area. Staff made sure people’s nutrition, hydration and healthcare needs were met. People said the meals were good.

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.

Staff were kind and caring and feedback from people using the service and relatives was very positive. Staff were warm and welcoming, and visitors were able to visit at any time.

People’s care needs were assessed before a place at the home was offered, to make sure staff would be able to meet their needs. Care plans were developed to make sure staff knew what they needed to do to meet those needs. This meant people received person centred care. Activities were on offer to keep people occupied and stimulated. Trips out were also organised on a group and individual basis. The manager had an ‘open door’ policy and people were encouraged to bring any concerns to their attention. Any concerns which had been raised had been dealt with and resolved.

A new manager had been recruited since the last inspection. They were held in high regard by people using the service, relatives and staff. This was because the changes they had implemented had made Regency Court a better place to live, visit and work. The audits and quality checks which were in place were effective in identifying areas for improvement. The manager acted upon advice from other agencies to continually improve the service. People told us they would now recommend the home as a place to live or work.

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 (report published 16 August 2018) and there was one breach of regulation identified. 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.

Regency Court is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 20 older people and older people living with dementia in one adapted building. Accommodation is provided over two floors.

On the day of inspection there were 15 people using the service and one person was in hospital.

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.

Our last inspection took place on 12 September 2017 and at that time we found the service was not meeting three of the regulations we looked at. These related to safe care and treatment, fit and proper persons employed and good governance. The service was rated ‘Inadequate’ and was placed in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and if the service should be taken out of ‘Special Measures.’

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded some improvements had been made. More improvements needed to be made to make sure people consistently received safe, effective and responsive care and treatment. This is reflected in the overall rating for the service which is now ‘Requires Improvement.'

Staff were being recruited safely and there were enough staff to take care of people. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were not always up to date. However, people told us they got the care and support they wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was clean and tidy. Some redecoration and refurbishment had taken place since the last inspection which had improved some areas of the home. We found improvements needed to be made to the security and maintenance of the premises.

Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the registered manager and said they were approachable and supportive.

The provider had systems in place to monitor the quality of the service which was being provided. These systems needed further development and needed to be tested over time to make sure they were effective.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The service is registered to provide accommodation and personal care for up to 20 people. On the day of our inspection 18 people were living at the home. People who use the service are predominantly older people who live with dementia. The home is situated two miles from the town of Keighley.

There was a registered manager in post who was working half their week at Regency Court and the other half at another care home. A registered manager is a person who has registered with the Care Quality Commission (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.

When we inspected the service in November 2015 we identified two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were on-going breaches from our inspection in June 2015. Due to the continuation of these breaches we issued warning notices to the provider and the registered manager in relation to the management of medicines and governance systems and processes.

Another inspection took place in June 2016 when we found some improvements with the management of medicines had been made, but improvements still needed to be made regarding the application and recording of topical creams and lotions. We found the service had made improvements to governance systems. At this inspection in September 2017, we found there were still issues with the management of topical creams and lotions, issues with the environment and once again, issues with the governance systems.

When we looked around the home we found it was in need of general redecoration and refurbishment. Lighting levels were poor and we identified some issues in relation to fire safety. Since our visit the fire officer has visited the home to check the fire safety and has told the provider they must make improvements by 29 January 2018.

Staff were not being recruited safely and the service’s own recruitment policy was not being followed.

We saw staff were kind and caring and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Staff knew about people’s dietary needs and preferences, there was a choice of meals available and people told us the food was good. Appropriate weighing scales needed to be available at the home and we would recommend records of people’s food and fluid intake need to be maintained, for those who are nutritionally at risk.

Activities were on offer to provide people with occupation.

We found the service was working within the principles of the Mental Capacity Act and Deprivation of Liberty. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

All of the people we spoke with spoke highly of the manager and told us they would recommend the service as a place to be cared for or as a place to work.

Quality assurance systems were in place, however, they were not effective in identifying areas which required improvement such as medicines management. The provider had employed the services of some external consultants to help them identify issues and make improvements.

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 registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During this inspection we checked to see if improvements had been made in these areas and re-rated the quality of the service provided.

The service is registered to provide accommodation and personal care for up to 20 people. On the day of our inspection 19 people lived at the home. People who use the service are predominantly older people who live with dementia. The home is situated two miles from the town of Keighley.

The service had a registered manager in place. 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.

We found the service had made some improvements to the way medicines were managed which meant the service had complied with the warning notice. However further improvements were needed to achieve full compliance . We found the service had made improvements to the governance systems which meant they had complied with the warning notice issued in this regard.

Most of the issues with managing medicines identified on our previous inspection had improved and we observed some areas of outstanding practice. However, some documentation was inconsistent and some care plans lacked detail. The provider needed to make further improvements regarding documentation of “when needed” medicines, recording of maximum and minimum fridge temperatures and application of creams.

Risks to people’s health, safety and welfare were identified and managed. Accidents and incidents were analysed and action was taken to reduce the risk of repeat incidents. Improvements had been made to the level of detail within care records to ensure staff were provided with appropriate information to enable them to manage, monitor and mitigate risk. However, risk assessments were not always accurately completed which meant the level of risk was not always accurate. Although staff had a good understanding of the level of risk and risk reduction strategies.

Staff were aware of action they should take if they were concerned someone was at risk of abuse. We found safeguarding concerns were being referred to the local safeguarding team but the Commission was not always being notified about them.

Our discussions with people and observations throughout the day showed there were enough staff on duty to make sure people were safe and received the care and support they needed in a timely way.

Many people told us they enjoyed the animals which were kept in the gardens. However, we saw the animals had access to the smoking shelter, which meant people who smoked did not have a choice about whether to spend their time with the animals.

Overall we found the building to be clean and tidy with no unpleasant odours. However, some areas required more attention to detail to ensure appropriate standards of cleanliness were consistently maintained.

We concluded the care manager was taking action to implement an effective system of staff training, however improvements were required to ensure all staff had the appropriate skills, competence and knowledge to deliver safe and effective care.

Where appropriate staff made referrals and worked with other health and social care professionals to ensure people maintained good health.

Applications had been made to ensure the rights of people with limited mental capacity were protected in line with the legal framework of the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). We found the information within people’s care files could have been improved to demonstrate what authorised DoLS meant in practice. However most of the staff we spoke with were able to explain their role in protecting the rights of people with limited mental capacity and in keeping people with an authorised DoLS safe.

People were supported to have an adequate dietary intake. Some people told us the food could be “Plain,” however we saw menus were discussed and planned with people who used the service on a regular basis. Appropriate action was being taken to monitor and manage nutritional risk and people’s weights were regularly checked to ensure any changes could be promptly identified and acted upon.

Feedback from people about the service, staff and standard of care provided was consistently positive. Our observations and discussions with people who used the service led us to conclude that staff treated people with kindness, respect and were consistently mindful to preserve people’s privacy and dignity.

A system of quality assurance was in place to ensure the provider and registered manager monitored the standard of care provided. We saw examples to show that these audits were effective in identifying areas for improvement and improving the quality of care provided.

The provider used a variety of methods to seek the views of people who used the service, such as care reviews, quality questionnaires and residents meetings. We saw evidence to show people’s feedback was used to shape future development of the service and improve the quality of care provided.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We also found improvements had been made to care records and people's support plans. Support plans were person centred and easy to understand. Care files we also set out in a logical order and key information was easy to find. We spoke with three people who used the service during the inspection; one person said they were found things to be "Okay" and another person didn't have any complaints about the home. A third person we spoke with said they were "Well looked after" and "The food was okay". We also briefly spoke with two visiting community nurses and they had no concerns about the care and/or leadership that was provided.

People told us they received support from staff when they needed it and that they didn't have to wait long for someone to come and help them if they required assistance. One relative told us the staff were 'there if you needed them'. However, they said there was 'not a lot going on' in the home.

Despite the positive comments people made we found evidence that care and treatment was not planned and delivered in a way which ensured people's welfare and safety. We also found evidence that people were not cared for in a clean, hygienic environment and people were not protected against the risks of unsafe or unsuitable premises.