This inspection took place on 11 December 2018 and was unannounced. Regent House Nursing 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.

The care home provides accommodation, nursing and personal care for up to 30 people in one detached building that is adapted for the current use. The home is situated in a residential area in Hove. Regent House Nursing Home provides support for older people living with a range of complex needs, including people living with dementia. There were 28 people living at the home at the time of our inspection.

The service had a registered manager who was present throughout the inspection. 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.

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.

The provider was working towards providing a more personalised service for people. We noted that improvements had been made, including in the person-centred detail of care plans. Staff were working with the Care Home In Reach Team (CHIRT) to seek advice and training on how to improve meaningful occupation for people living with dementia. The registered manager told us this was work in progress. Plans for improving the quality of life for people living with dementia had not yet been implemented. This was identified as an area of practice that needed to improve to ensure that people were not socially isolated and that they received the stimulation they needed.

People told us they felt safe living at Regent House Nursing Home. People were receiving their medicines safely. Risks to people were identified, assessed and managed and staff understood their responsibilities to safeguard people. Incidents and accidents were monitored and people’s care was reviewed to prevent further incidents. The home was clean and systems continued to be effective in the prevention and control of infection. There were enough suitable staff on duty and people did not have to wait longer then they should expect to have their needs met. One person told us, “When you call the bell they come quickly.” The provider’s system for recruiting staff remained safe.

People’s needs had been assessed and staff had received training and support to meet their needs. People were receiving enough to eat and drink. One person told us, “There’s a choice of meat and vegetables, plenty to drink and a nice variety.” People were supported to access the health care services they needed. Staff worked effectively with health care professionals and included their advice in care plans. Staff understood the importance of seeking consent from people. 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.

Staff were kind and caring. People spoke highly of the staff, saying, “They really look after me,” and, “I like her, she’s very caring.” Staff knew people well and had developed positive relationships with people. They supported them to be involved in decisions about their care and support. People’s privacy was protected and staff supported them to maintain their dignity and encouraged them

Regent House Nursing Home provides accommodation and nursing care for up to 30 people with age related conditions including dementia. The inspection took place on 31August 2016 and was unannounced. There were 24 people living at the home on the day of the inspection. Accommodation was provided over three floors with stairs and a passenger lift connecting all floors. The home is situated in a residential area of Hove, with a park in close proximity.

A registered manager was not in post at the time of the inspection however the person in charge had applied to be registered and was awaiting completion of the registration process. 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. Staff spoke highly of the person in charge.

People‘s care plans were not always personalised and did not give a clear sense of the person as an individual. This meant that staff did not have clear guidance about people’s wishes and preferences regarding how they wanted their care to be provided. We identified this as an area of practice that needed to improve. The person in charge told us that staff had been working with the dementia in- reach team and would be amending care plans to make them more person centred.

The provider employed an activity co-ordinator and people spoke highly of them, their comments included, “They’re marvellous,” and “They are amazing.” Not everyone was able to join in with the organised activities and we noted that some people living with dementia had little to occupy themselves. We have made a recommendation that the provider seek information about providing meaningful occupation, based upon current best practice in relation to the specialist needs of people living with dementia.

People told us they were happy with the care provided at Regent House and that they felt safe. One person said, “There is always someone around if I need help, I just push the button and someone comes.” There were enough staff on duty to keep people safe and meet their needs. Staff had a clear understanding of how to keep people safe and risks to people were assessed and managed effectively. People’s medicines were managed safely and they told us that they received the medicines they needed on time.

Staff received the training and support they needed to care for people effectively. People told us they had confidence in the skills of the staff. One person said, “I fell very well looked after, I have no complaints about the staff at all.” Staff understood their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and conditions or authorisations to deprive people of their liberty were being met.

People told us they enjoyed the food at Regent House. One person said, “The food is wonderful,” and another said, “There is a great choice, the food is very well cooked and presented.” Risks of malnutrition and dehydration were identified and managed effectively and people were supported to have enough to eat and drink. Referrals to health care services were made quickly when people’s health needs changed and staff sought advice from health care professionals in how to support people to remain in good health.

People spoke highly of the caring nature of the staff. People’s comments included, “They are absolutely first class here,” and “They are all very good.” Staff knew the people they were caring for well. One staff member said, “It really helps if you know about someone’s background because you can encourage them to talk and help them to feel comfortable when they’re being assisted with care.” People were treated with respect and their dignity was maintained. One person told us, “The staff are very careful to be respectful, I have never felt uncomfortab

A single adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that were sufficiently detailed to allow staff to deliver safe and responsive care. People told us they were happy with the care and support they received. A person who used the service said, "The carers do their work brilliantly, they are kind and patient and the nursing staff are wonderful. When I think of my disabilities I think this is the only place that enables me to be as happy as I am.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made and how to submit one.

On this inspection we looked at the arrangements in place for the management of medicines and assessed the service was safe in this regard.

Is it effective?

The provider had clear procedures to obtain consent that are followed in practice, monitored and reviewed. We were told, “At every stage we think about and document peoples consent."

Care plans were personalised and included information on the person’s life history and identity. This allowed for staff to provide care that was personalised and appropriate to that person.

We saw that there were systems in place to support staff. A member of staff said, “I love working here. It’s easy-going and a real family atmosphere. I can talk with [the manager], their door is always open.”

Is it caring?

Staff spoke with compassion and kindness for the people they supported. People were supported by committed and attentive staff. Observations of care found that people were treated with dignity and respect. We were told, “[My relative] receives very good care here. Everyone is so friendly and approachable.”

It is responsive?

People told us that they felt happy and confident approaching staff with any concerns. The staff we spoke with understood and respected people's choices and decisions.

Is it well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Quality and compliance audits were regularly conducted. Where it was required, responses to the audits findings were developed and these were recorded.

During our inspection we spoke with seven members of staff, these included the registered manager, two registered nurses, the chef and three care assistants. We also spoke with five people who used the service and a relative.

We observed the delivery of care and treatment of people who used the service. People we spoke with confirmed they were happy at Regent House Nursing Home. One person told us, “Its home from home, the staff are lovely and it’s very nice.”

We found that peoples care needs and individual risks were assessed, and care records made to meet those needs and minimise risks. We saw that care was delivered according to people's individual care records in a sensitive manner.

We found that people were provided with appropriate nutrition and had a choice in relation to their food options available. One person told us, “We get to choose and if we fancy something, they will make it for us.”

Medicines were stored safely however shortfalls were identified in relation to medication recording and risk assessments on the use of ‘as required medication’.

People were protected from unsafe or unsuitable equipment.

There were 26 people who used the service at the time of our inspection. We used a number of different methods to help us understand the views and experiences of these people, as not all of the people who used the service were able to tell of their experiences. We observed the care provided and looked at supporting documentation. We talked with three members of care staff, a trained nurse, the manager and cook. We also spoke with five people who used the service and two relatives.

Records showed that people's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. People were safe and had access to healthcare and other services as appropriate. Their every day care needs were regularly assessed and monitored.

People were cared for in a clean, hygienic environment. We looked at the physical environment and found that it was safe. We did notice that some furnishings and carpets were worn to a point where they increased the risk of injury. Since we have requested improvements, the provider has replaced fitted carpets and ordered new furnishings. This improvement has achieved compliance with legal requirement. The staff and people who used the service had sufficient equipment to meet their everyday needs.

We found that staff had a good understanding of the support needs of people who used the service. We saw staff engaged with people in a positive, confident and supportive manner. However, during the morning shift staff were very busy and this left some

people without any stimulation, particularly those with dementia care needs. People had more opportunity to engage with staff during the afternoon. Since our request for improvements, the provider has rearranged their allocation of staff to ensure that a member of staff was allocated to the lounge in the mornings. This improvement has achieved compliance with legal requirement.

During our visit we spoke with five people who were using the service, four members of staff and two visiting relatives. People who used the service and their relatives told us that they liked living at the home and that the service met their needs. People told us that staff were kind and caring and that there was always someone around to provide help and support. Comments included the following: "nursing and care staff are excellent, and, "There is nothing I would change."

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitored the quality of care that people received. We saw that there were arrangements in place to ensure that medication was stored and dispensed correctly.

Staff told us that they had received regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

People said that they had no complaints about the service and that if they did they would speak to the staff or the manager

In summary, we found that people living at Regent House were telling us that their needs were being met by a caring, committed, skilled and trained staff team. They told us that they felt every effort is made by the staff to help them maintain their independence and freedom of choice.

External agencies told us that the provider is co-operative and receptive to suggestions on improving the service and responds in a positive way to reviews undertaken when safeguarding issues are identified.

People we spoke to said they thought the service was being well managed and systems were in place to ensure that their needs were being identified and addressed and taken into account. There were opportunities for people to express their views on how the service is run. We were also able to see that people were given opportunities to express their preferences especially regarding choices in daily living and what food they ate or if they wanted to go out or join in with any activities.

We talked to many people during our visit and some said that although they were not always aware of the formal complaints processes, they did feel confident and able to raise with staff any concerns that they had. People said they felt safe and that the provider was taking appropriate steps to protect them from abuse.

People talked to us about how they were able to be involved in the running of the home and how residents meetings had been developed to make everyone feel more included. They spoke about how they were able to talk to staff about any concerns or things they wanted doing and it would happen, especially concerning menus. They also said that the Manager was approachable and helpful with new systems introduced so they could make comments about the care and service.

Suitable and effective arrangements are in place to ensure that people accommodated at Regent House receive individually assessed care and support. Wherever possible we could see that people are consulted about their care, involved in the planning processes and they are treated as individuals with their human rights respected. Care plans were seen to reflect peoples’ likes, dislikes, preferences and specific personal needs and received regular review.