This was an unannounced inspection which took place on 14 and 21 June 2018.

Regency Care Centre 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.

Regency Care Centre is registered to accommodate up to 60 people. There were three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.

The service was last inspected in April 2016 when we found it was meeting all but one of the required regulations. Although the service was rated as good overall, it was rated as requires improvement in safe, as we identified a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the staffing levels at the home. We found at this inspection improvements had been made to staffing levels at the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was no registered manager in place at Regency Care Centre. However, we were aware that the manager had applied to register with us and a fit person’s interview had been arranged. We were made aware that following the inspection the manager had been successful in registering with us.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager was present during the inspection.

The service had sufficient staffing levels in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us staff were responsive to their needs.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We found staff had been recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived at the home. We found staff were knowledgeable about support needs of people in their care.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The manager understood the requirements of the Mental Capacity Act 2005

This inspection took place on 25 and 26 April 2016 and was unannounced. We last inspected the home on 23 June 2015. At that inspection, we found the service was not meeting all the regulations in relation to sufficient staffing, confidentiality, dignity and respect and the lack of effective management systems.

At this inspection, we found that the service was meeting all the regulations apart from sufficient numbers of staff. Although improvements had been made in relation to the overall staffing arrangements for the home, on Heaton Unit we found that this was not the case.

Regency Care Centre is a purpose built home, situated on a main bus route leading to Manchester and Bury. The home is registered to care for up to 60 people and is divided into three separate units each providing either residential, nursing or dementia care. The residential unit is known as Springwater, the nursing unit as Philips and the dementia unit as Heaton. On the day of our inspection there were 44 people using the service.

The home does not have a registered manager. A registered manager is a person who has registered with 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 and associated regulations about how the service is run. A new manager was in place who had been previously registered with us at a different service. We had received an application from them to register with us as manager at Regency Care Centre. Since our last inspection, there has been a change in the organisation of the service, with a new team recently taking over the management of the service.

We found that there had been a reduction in the use of outside agency staffing, the levels of permanent staffing sickness levels had reduced and the provider was recruiting above the dependency needs. However, on Heaton Unit were people lived with dementia we found that although the number of people living there were low, their needs were high which meant additional staff were needed to support people to eat their meals and supervise the lounge at busy times when people were getting up or going to bed.

The lack of sufficient staffing was a breach of Regulation 18 Staffing.

You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us, “Staff always come when I press the buzzer,” “It’s brilliant. Staff work so hard. There are enough of them now,” “There are sometimes too many agency staff on at night. Day staff know me well” and “It varies how long it takes for staff to respond when I press my buzzer but it’s been better recently.”

We found that overall the system for managing medicines was safe. We found that appropriate risk assessments were not always in place for medicines given covertly which means without the person’s knowledge. The staff addressed this issue immediately during our inspection.

All areas of the home were clean and well maintained and procedures were in place to prevent and control the spread of infection. There was an on-going improvement plan for the redecoration of the home.

We saw that suitable arrangements were in place to help safeguard people from abuse. People told us, “I feel safe here,” “I feel safe because people can’t get in” and “I feel safe with the staff.” Staff were able to demonstrate their understanding of the whistle-blowing procedures for the reporting of unsafe and poor practice. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse.

Recruitment systems were in place to check that staff were of suitable character to work with vulnerable adults. We saw that staff received the training and supervision they needed to support people safely and effectively.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their

Regency Care Centre is a purpose built home, situated on a main bus route leading to Manchester and Bury. The home is registered to care for up to 60 people and is divided into three separate units each providing either residential, nursing or dementia care. The residential unit is known as Springwater, the nursing unit as Philips and the dementia unit as Heaton. On the day of our inspection there were 48 people using the service.

We last inspected the home on 13 and 14 August 2014. At that inspection we found the service was meeting all the regulations that we reviewed.

The home does not have a registered manager. A registered manager is a person who has registered with 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 and associated regulations about how the service is run. A manager from the company had been brought in to manage the service on a temporary basis.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We found that people’s dignity was not always protected and people were left in undignified situations. This was in relation to their continence and personal care needs.

Although we were made aware that a recruitment drive was in place we found that sufficient numbers of staff were not provided to meet the needs of the people who used the service.

We found the provider did not always adequately assess risks. This was in relation to people’s health and well-being and also safety issues within the environment.

We found that confidential information in respect of people’s care was not securely maintained.

We found the system for managing medicines was safe, however staff on Heaton Unit did not always record when a medicine had been given. The administration of doses of medicines must be recorded to ensure that staff are aware of the last time the dose was administered and to ensure they do not duplicate the dose. We have recommended the provider looks for a best practice solution to ensure staff are reminded of their responsibilities in relation to this.

Staff were able to demonstrate their understanding of the whistle-blowing procedures (the reporting of unsafe and/or poor practice). Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. We saw however that staff on Heaton Unit had recorded in a person’s care plan the existence of unexplained bruising but they had not formally notified the manager.

To ensure that people who use the service are protected we

 have recommended the provider looks for a best practice solution to ensure that all staff are reminded of their responsibility to report to management when unexplained bruising has occurred.

The people we spoke with had varying views on the abilities, kindness and attitude of the staff. Overall people were positive and told us that most of the staff worked hard, were kind to them and knew what they were doing. Comments were made however about the ability of some staff to do their jobs properly and about their lack of understanding of people’s needs.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that people were involved in the development of the menus that were being introduced.

All areas of the home were clean and well maintained and procedures were in place to prevent and control the spread of infection.

A safe system of staff recruitment was in place. This helps to help protect people from being cared for by unsuitable staff. We saw that staff received the essential training necessary to enable them to do their job effectively and care for people safely.

People’s care records contained enough information to guide staff on the care and support required. We saw that people and their relatives were involved and consulted about the development of their care plans.

We saw how the staff worked in cooperation with other health and social care professionals to ensure that people received appropriate care and treatment.

Staff we spoke with had a good understanding of the care and support that people required. Staff told us there was enough equipment available to promote people’s safety, comfort and independence.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Systems were in place to assess and monitor the quality of the service provided but they were not robust enough to identify the issues of concern we found during the inspection.

During our visit to the home we spoke with five people using the service, four relatives and five staff.

People using the service were asked if they felt they were being looked after properly. Comments made included; “The carers do a good job and they are all very nice”, “All very kind” and “I do enjoy being in here”.

One relative spoken with told us, “It is absolutely excellent and we could not get better care”. Another relative said, “We have not found any negatives, there is nothing to worry about”.

People's care records were kept secure and contained enough information to show how they were to be supported and cared for. They also showed that people gave consent to their care and treatment.

Systems were in place to protect people who lacked the capacity to make decisions about their own care and support.

People were cared for by a sufficient number of staff that were properly trained, supported and supervised. Some people did express concerns that at times there were not always enough staff on duty. Comments made included; “ I can be kept waiting when I press my buzzer” and “Some staff come quickly when I ring and others come when they feel like it, but most staff are good”. Other people told us, “I feel there is enough staff around” and "We have never had a problem".

Regular monitoring of the services and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

During our visit to Regency Care Centre we spoke with six people using the service. They were complimentary about the staff and the care provided. We were told the staff were kind, they were given their medicines when they needed them and the food was good. Some of their comments were:

“We are well looked after”.

“Everything is fine”.

“Happy to be here”.

“They are all very nice”.

“The food is good”.

“We have plenty to eat and always have a choice”.

On the day of our unannounced inspection the manager was not available. We therefore returned the following day to complete the inspection.

We spoke with the registered manager, deputy manager, staff and people living at the home. We looked at six people's care records. Other records we looked at included complaints, staff training, personnel files and quality assurance documents.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found:

Is the service safe?

Care records and our observation of staff provided evidence of good practice in applying the least restrictive options to promote and maintain an individual’s independence. Equipment was well maintained and regularly checked to ensure it was safe.

The home was visibly clean. There was a cleaning schedule in place for all areas and this was monitored.

We saw there were systems in place to make sure staff learned from events such as complaints and concerns. This reduced risks to people and helped the service to continually improve.

A recruitment policy was followed when recruiting new staff members and all necessary pre-employment checks were carried out to ensure the suitability of new staff.

Is the service effective?

We saw that people’s care plans were person-centred and care was delivered in a way they preferred. Care plans were reviewed at least monthly and amended where people’s needs had changed.

The manager followed a programme of audits. We saw action plans were in place where improvements could be made. These were monitored.

Is the service caring?

People's care needs were assessed by the staff. People and their families where appropriate, had been involved in the assessments. We saw records reflected people’s current needs and were up to date.

We observed care workers providing support when it was required or requested.

Is the service responsive?

All complaints and concerns made verbally or in writing were recorded and investigated. Guidance was sought when required and necessary changes to practice were made and disseminated to staff.

Other medical and care professionals were consulted appropriately and were involved in the care of people living in the home. Where a person had to attend an appointment outside the home, or was taken to hospital in an emergency, a care worker accompanied them and took all relevant documentation with them.

Is the service well-led?

Staff were clear about their roles and responsibilities. The manager and deputy manager held meetings with staff to ensure they knew about changes or updates. A nurse led each of the three units and senior care workers had recently been employed to provide guidance to more junior staff.