The inspection took place on 15 and 28 August 2018. It was unannounced on day one but we arranged with the registered manager to return on day two. At the last inspection in August 2017 there was a breach of Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because infection control and prevention was not managed well and this had not been identified by the registered manager in audits.

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.

Regent Hotel is a care home that accommodates up to 29 older people, some of whom may be living with dementia. The home is situated on the sea front in Bridlington, a seaside town in the East Riding of Yorkshire. Bedrooms are located on the ground, first and second floors and there is a passenger lift to reach the first and second floors. On the day of the inspection there were 25 people living at the home, including five people who were having respite care.

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 program

This inspection took place on 19 May 2016 and was unannounced. At our last inspection of the service on 22 April 2014, the registered provider was compliant with all of the regulations in force at that time.

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 supporte

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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 used a number of different methods to help us understand the experiences of people who used the service. During the day we sat with the people who used the service and observed their daily activities including the lunchtime meal. We also observed their interactions with staff. We spoke with people who used the service and with members of staff. We reviewed documentation including three care plans.

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.

We spoke with two people who lived at the home and we asked them about the decisions they made. They told us that they could decide what time to get up, what time to go to bed and where to spend the day.

People told us that staff assisted them with personal care in a sensitive way that respected their privacy and dignity. They said that staff always spoke with them in a nice way and that they felt comfortable in their presence. Comments from the people we spoke with included, “we get looked after properly”, “the food is good - there is plenty and always a choice” and “I feel I belong”.

People told us that staff gave them their medication when they needed it. One person said, “They are very efficient with medication. I get mine as soon as I get up – about 8 am”.

One person said that the staff seemed to be well trained and said, “I just ask if I need anything”. Both of the people that we spoke with said that they would not hesitate to speak to staff if they had any concerns and that staff were friendly and pleasant.

We spoke with three care staff and they told us that they undertook recognised induction training when they commenced work at the home and that this included information about respecting a person’s privacy and dignity.

We did not speak to people living at the home during this inspection.

People told us they were well looked after and the staff assisted them as and when they needed. Comments were, 'you can't get better looked after' and 'you can't fault the staff - if you want anything you only have to ask'.

People told us that the staff were polite and friendly, 'the girls are lovely, and they always help you'.

People told us that they completed surveys about the home and they had resident's meetings at which to express their views.

People spoken with told us they were happy with the care they received and their privacy and dignity was respected.

They told us they were able to make choices and decisions about aspects of their daily lives.

Staff were described as kind and caring and answered calls for assistance quickly.

Some people were happy with the activities and occupations on offer but others would like to have more to do and to be consulted more about the running of the home.