This inspection took place on 2 July 2018 and was unannounced.

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 highl

This inspection took place on 12 September 2017 and was unannounced.

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 provide

We inspected the service on 14 June 2016. The inspection was unannounced. During our previous inspection on 9 November 2015 we identified two breaches 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.

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 capac

We inspected the service on 9 November 2015. The inspection was unannounced.

During our previous inspection on the 15 June 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to; the management of medicines, governance systems and processes, the quality and accuracy of care records and to ensure effective systems were in place to protect people from the risk of being unlawfully deprived of their liberty. During this inspection we checked 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 18 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 however there were still areas that needed to be improved in order to fully protect people.

Improvements had been made to care records so they were now clear and person centred. Overall the information within care records and staff’s knowledge and understanding of the people they supported facilitated the delivery of responsive care. Despite these improvements, the service could not always evidence they had mitigated risk and documentation was not always up to date to ensure staff had appropriate information to manage and monitor risk. This meant additional improvements were required to ensure the service could evidence people were safe.

People told us they felt safe living at the home. Improvements had been made to ensure incidents and accidents were robustly analysed. Processes were in place and being followed to help protect people from the risk of abuse. Improvements had been made to ensure staff acted in accordance with the relevant legal frameworks where people lacked mental capacity to make their own decisions. Improvements had been made to the procedures to help protect people from the risk of unlawful restraint

Staff received ongoing training and support to ensure they had the skills and knowledge to deliver effective care. Systems were being refined to ensure training could be managed and monitored more effectively.

A new system of care reviews was in place which provided people with the opportunity to make changes to the care they received. Formal systems were in place to obtain people’s feedback and to ensure any formal complaints were investigated and responded to. Where people provided feedback about how to improve the quality of the service this was listened to and acted upon.

We saw that staff worked in partnership with other healthcare professionals to ensure people maintained good health. We also saw that appropriate support was given to encourage people to consume an appropriate diet. We saw a choice of foods, drinks and snacks were available. People told us the food was good and there was always plenty of it available.

We saw staff were consistently kind, caring and patient when providing support. Staff were particularly skilled at communicating with and meeting the needs of people who lived with dementia. People told us they were treated with dignity and respect.

Improvements had been made to some quality assurance systems. However, the systems in place to monitor, assess and improve the quality of service provided were not always sufficiently robust; particularly the medicines management and care plan audits.

Staff worked hard to implement a philosophy of care which was person centred and adapted to the needs of people who lived with dementia. The management team provided clear leadership and promoted a positive, inclusive and open culture where opportunities to learn and improve were embraced. Staff at all levels took pride in their work, put the people who used the service first and were committed to ensuring that they provided high quality care.

We identified two breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on 15 June 2015. The inspection was unannounced.

The service is registered to provide accommodation and personal care for up to 20 people. On the day of our inspection 18 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.

Care records were not always accurate and did not always contain complete information to demonstrate that risks to people’s health and wellbeing were fully assessed, monitored and managed. Pre-admission procedures were in place. However these were not always followed when someone had to move into the home quickly. The management team had identified that care records needed updating and were working to make improvements so that everyone would have accurate, complete and person centred care records in place by the end of July 2015.

All people we spoke with told us they felt safe living at the home. No one raised any concerns regarding their relatives’ safety. Accidents and incidents were monitored and action was taken to help reduce risks. However the accident monitoring system needed refinement to ensure all relevant information was captured. Appropriate arrangements were not in place to ensure the proper and safe management of medicines.

We found the premises to be well maintained, clean and secure. Records showed periodic testing was in place to ensure the building and equipment was safely maintained. The home was decorated in a way which sought to promote the wellbeing of people who lived with dementia.

Staff demonstrated a good awareness of how to keep people safe and the correct procedures to follow in the event of an emergency. However, there were not robust procedures in place or being followed to protect people from the risk of being unlawfully deprived of their liberty.

We found sufficient numbers of staff on duty to meet people’s needs. People told us there were enough staff available to provide care and they did not experience having to wait. There were effective recruitment procedures in place which ensured people were supported by appropriately experienced and suitable staff.

Most staff were trained in key areas to enable them to provide effective support. The management team identified where there were training shortfalls and there were plans in place to ensure these were addressed. However, the lack of knowledge of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and our observations with regards to the administration of medicines indicated that ongoing competency based assessments of staff knowledge and care practices were required.

People spoke positively about the food and we saw dietary needs and preferences were catered for. Care staff provided discreet and appropriate support to encourage people to eat and drink.

People told us care staff were kind, helpful and treated them with respect. Staff demonstrated a practical awareness of how to respect people’s privacy and dignity and how to support people to retain their independence. People told us they felt involved in making decisions about their daily lives and relatives told us staff kept them well informed and they felt included. The service used a variety of ways to seek people’s feedback. These views were used to help improve the quality of care provided. When people made a complaint they were listened to and action was taken to put things right so that issues did not happen again.

People spoke positively about the new management team and liked the improvements they had made. The registered manager was committed to positively changing the culture and future direction of the service. However, they were realistic that it would take time to fully change the culture of the organisation and ensure all of their governance systems were fully embedded.

There were not robust audit systems in place to monitor, assess and improve the quality of service provided. Some audits were not recorded or were not yet in place which meant there was not a full audit trail to demonstrate they were effective in improving the quality of care. The service had not identified and acted upon the concerns identified as part of this inspection.

We identified three 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 found that the necessary improvements had been made to the internal environment of the home and the overall environment was presentable and provided a comfortable environment for people who lived at the home. We found that significant improvements had been made to bedrooms, bathrooms and the laundry room.

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.

Overall, although some processes were still being developed which meant we were unable to test their efficiency during this visit, we saw evidence of improvements. We saw evidence the provider had taken steps to improve the levels of cleanliness in the home to help ensure people were cared for in a clean and hygienic environment. For example, when we looked around the home we saw evidence the standards of cleanliness had improved.

We spoke with two people who lived at Regency Court. They told us that overall they were happy with the care and support they received. One person told us “it’s ok here, staff are pleasant and I am comfortable”. We also spoke with a relative of someone who lived at the home. They told us they were “pretty pleased” with the care their relative received. They said staff kept them informed if there were any changes in their relatives needs.

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.