Regent House provides accommodation without nursing for up to 23 people with mental health needs whose primary needs are for emotional support and care.

Our previous inspection of 7 June 2016 found that the service required improvement. Improvements were required to ensure that all risks to people were assessed and guidance was provided to staff about how the risks were reduced. Improvements were also required around the auditing of medicines and ‘as and when required’ medicines (PRN) to ensure that people received their medicines safely. Some staff had not had any recent training in the Mental Capacity Act 2005 (MCA) and lacked awareness of what the Mental Capacity Act meant for people. Improvements were needed to ensure that staff received regular supervision and effective appraisal of their performance.

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You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Regent House on our website at www.cqc.org.uk. This comprehensive inspection was undertaken to check that further improvements had been made.

This was an unannounced inspection. At the time of our inspection there were 18 people living at the service.

Whilst this inspection was carried out to review improvements, it was prompted in part by notification of an incident following which a person using the service was involved in an altercation with another person using the service was injured and later died. The incident is subject to an on-going police investigation.

The Commission made further enquiries into the circumstances leading up to the person’s death to consider whether the incident was avoidable and whether it should take further action under its criminal enforcement powers. The Commission has reported to a coroner and considers the incident was not as a result of unsafe care and treatment, avoidable harm or a significant risk of avoidable harm. We are however continuing to liase with the Coroner, Police and Local Authority on this matter.

A safeguarding investigation was undertaken by the local mental health safeguarding team. The health and welfare of people using the service were reviewed and it was concluded that people were happy and well cared for and Regent House was a comfortable and caring home.

At this inspection we found that although improvements had been made following our last inspection, further improvement was still required in relation to risk assessments to ensure they included sufficient detail to guide staff on how to minimise any identified risk or potential risk.

Appropriate arrangements were in place to ensure people’s medicines were obtained and stored safely.

People received care that was personalised to them and met their individual needs and wishes. Staff were knowledgeable about people’s choices, views and preferences and acted on what they said.

Systems were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. Procedures and processes guided staff on how to ensure the safety of people. There were sufficient numbers of staff employed who had the knowledge and skills to meet people’s needs.

The service was up to date with the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). Staff sought consent from people before supporting them with their care.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People’s nutritional needs were assessed and they were supported to eat and drink sufficiently.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

The management team were approachable and there was an open culture in the service. Quality assurance processes were used to

Regent House provides accommodation without nursing for up to 23 people with mental health needs whose primary needs are for emotional support and care.

There were 21 people living in the service when we inspected on 7 June 2016. This was an unannounced inspection.

There was a registered manager in post. 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.

People were not always supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) Some staff had not had any recent training and lacked awareness of what the Mental Capacity Act meant for people. Where one person had fluctuating capacity, it was not clear what support they required and where decisions had been made in their best interests.

Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised. However, improvements were needed to ensure that all the risks in people’s daily living were assessed and these assessments provide staff with information about how the risks are minimised.

People received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. The atmosphere in the service was friendly and welcoming.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. However, improvements were needed to ensure that staff receive regular supervision and effective appraisal of their performance.

People were provided with their medicines when they needed them and in a safe manner. However, improvements were required around the auditing of medicines and as and when required medicines.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Care and support was based on the assessed needs of each person. People’s care records contained information about how they communicated and their ability to make decisions. People were encouraged to pursue their hobbies and interests.

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There were processes in place that encouraged feedback from people who used the service. People, or their representatives, were involved in making decisions about their care and support. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

There was an open and transparent culture in the service. Quality assurance surveys were used to identify shortfalls and drive improvement in the service. However, audits required further development to ensure that they highlighted all areas for improvement, For example, medicines and care plans.

Staff knew people well and they were able to tell us about their specific needs. We saw that there were respectful interactions between members of staff and people who lived in the home. Staff listened to people and provided support in ways that met their needs and took into account their individual preferences.

People were provided with nutritious food that they enjoyed. One person said: “You couldn’t get better food.” Another person told us: “X (the cook) should have Michelin stars, the food is so good.”

There were systems in place to supervise and support staff and provide them with the training they needed. This ensured that they had the skills and knowledge to provide safe and effective care.

Regent House was well run by a competent management team and there were effective processes to monitor the quality of the service. They listened to people and took their views into account to make improvements.

There were procedures in place to update and maintain records so that they contained the information staff needed to deliver care safely.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

During our inspection we spoke with people who said they liked living at Regent House. We saw that people spoke confidently with members of staff and made them aware of their needs and wishes. Staff showed a good understanding of people’s needs and preferences and we noted that people received good care and staff treated them with respect.

We found that systems to recruit staff were appropriate and staff received the training they needed to provide care and support safely.

People living in the home completed feedback questionnaires as part of the home’s quality assurance system and we saw positive comments about the standard of care provided at Regent House. One person said the staff were “Excellent” and “I always have a laugh and joke with them and when it’s serious they listen to me.” Another person stated “Staff are there when you need help and they sit with you as well.”

We saw that there was a relaxed atmosphere in the home and that people chose how they spent their time. One person told us they liked to go into town every day and it did not matter if it was raining because it was only a short walk.

During our visit on 13 May 2011 we saw that people were being well cared for and treated with respect. One person told us it was their birthday and they were having a buffet tea that evening.

People with whom we spoke told us they got on well with staff and that staff treated them well. On the day of the visit we saw that people were relaxed, confident and comfortable with staff. We also saw that there were good interactions between members of staff and people living in the home.

We were told by people with whom we spoke that they liked their rooms and they liked living at Regent House.

We were also told by people living in the home that staff ask them what they want to do. We saw that people living in the home were confident in expressing opinions and telling staff what they liked or wanted.