Regency Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Regency Retirement Home accommodates people in one adapted building and is registered for up to 14 people. There were 12 people at the home at the time of this inspection.

There was a registered manager in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run

The previous inspection was completed in January 2017. There were two breaches of regulation at that time. At our previous inspection the service was rated as Requires Improvement. At this inspection we found significant improvements had been made to ensure the service was working within the principles of the MCA and people’s care plans had improved. At this inspection we rated the service as Good.

Staff had received training appropriate to their role. Staff had received training around safeguarding and were confident to raise any concerns relating to potential abuse or neglect. Staff received regular supervision from the management team. The administration and management of medicines was safe. There were sufficient numbers of staff working at Regency Retirement Home. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, action had been taken to ensure the on-going safety of the person.

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 encouraged to make choices about their day to day lives. People were supported to access health professionals. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans had improved and were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team. People’s feedback and the views of relatives and staff were sought to make improvements to their experience of the service.

People were supported to take their medicines safely as prescribed. Care and support plans gave staff guidance on how people preferred to take their medication. All relatives were happy with medicine arrangements. The registered manager was reviewing records and current best practice guidelines to show when people with ‘as and when required’ medication needed it.

The registered manager of the service was due to retire, there was no specific timescale for this. Two acting deputy managers had been employed to implement the transition and in time into applying to become joint registered managers. The registered manager told us they fel

The inspection took place on 3 January 2017 and was unannounced. The last inspection took place in July 2013 and no breaches of regulation were found at this time.

The service provides care and accommodation for up to 14 older people. At the time of our inspection there were 12 people living in the home.

There was a registered manager at the home. 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.

People who used the service were positive about the care they received and talked positively about the staff who supported them. However we did find shortfalls in some areas of the service. There were care plans in place to guide staff; however these did not fully describe people’s needs or describe the strategies required to support the individual. There were risk assessments in place but these were not fully effective in identifying risks or stating the measures needed to ensure people’s safety.

Staff training and supervision was not sufficient to ensure staff had the knowledge and skills to make sure people’s needs were met and their rights respected. There were long gaps between staff’s supervision sessions and training did not cover all relevant aspects of the service provided, particular in relation to the Mental Capacity Act 2005. This lack of knowledge impacted on people in the home because it was not always recognised when mental capacity assessments needed to be carried out and when a best interest decision might be required.

There were systems in place to monitor the quality of the service; however these were not fully effective in identifying shortfalls. The monthly care plan audit for example, had not identified gaps in the care plans or that the principles of the Mental Capacity Act had not been fully applied.

People experienced caring and respectful relationships with staff. Comments we received included, “I’m well looked after”. “I like it here, I feel part of a family” and “Staff are more like friends than staff”. Visiting health professionals that we spoke with told us that the people they visited always appeared happy and content. People’s independence was promoted and they were treated with respect. However, we did observe time when people’s privacy may be compromised due to staff discussing people’s care in close proximity to the lounge where people could potentially overhear.

People received safe support with their medicines, these were stored and administered appropriately. Staff were trained in safeguarding vulnerable adults and confident that they would be able to recognise and report any potential signs of abuse. People told us they felt safe living at the home and there were sufficient staff to meet their needs.

Staff were knowledgeable about the people they supported and told us about the ways in which they met their individual needs. People were involved in planning their own care and their opinions about the service were sought through surveys and meetings. Family and friends were welcomed to the home without restriction and this enabled people to maintain relationships with people that were important to them.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see the action we took at the end of our full report.

We spoke with four people that lived in the home. They made the following comments;

"Lunch was lovely", "There are always enough staff", "We get to go out, recently we went to Gloucester Cathedral", "I've been on a boat trip", "It's alright here", "I didn't want to come here but I don't dislike it", "Staff are nice", "There's no place like home but it's good here", "It's very laid back", "They (staff) do their best for us", "We can come and go as we like", "The owners are good, they do everything for us".

Staff commented;

"It's generally very relaxed, how you've found us today is how we are", "Care plans are much better, they actually reflect what peoples needs are", "I get the opportunity to update care plans", "People do crosswords, bingo and have day trips out", "There is lots of family involvement", "It's a settled team here".

Speaking with the owner and people living at the home they spoke about a "race day" they had recently where they people dressed up with hats, dresses and flowers. People told us it had been a lovely day that they had really enjoyed it.

Observations while we were at the home showed that staff knew the people they supported well. The atmosphere was relaxed and unhurried and staff were able to spend time talking with people. The decoration around the communal areas of the home that we saw was a good standard and was homely.

This was the first inspection that the home had received following their registration with the Care Quality Commission in 2010. The manager and staff had recently received a quality monitoring visit conducted by the Gloucestershire quality assurance team which had highlighted areas that would need improvement.

The manager and staff were quite clear that they wanted to improve the services they provided and welcomed assistance and guidance from local support teams and CQC.

Although moderate concerns had been identified at this inspection it was evident that the manager and staff wanted what was best for people in their care. In some aspects people were receiving good individualised support that promoted independence, choice and respect, that protected their rights.

People living at the home were happy with the care and support they received. They told us that staff were kind, respectful and supportive. They welcomed us to their home and enjoyed telling us about their experiences.

All staff were open and honest about what they did and did not know. They shared with us some good examples about the quality of support people received. They also told us about how they felt they could improve the services provided including additional training, using the guidance for compliance the Essential Standards of Quality and Safety and having access to a computer and internet services.