This inspection site visit took place on 14 December 2017 and was unannounced. We announced we would return to complete our inspection on 18 December 2017.

Regent Residential Care 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.

Regent Residential Care Home accommodates up to 64 people in one adapted building, with areas for people to spend time together or more privately as they choose. Accommodation and care is provided to older people, including those living with dementia. There were 62 people living at the home at the time of our inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

We found people living at the home were supported to remain safe. Staff understood people’s individual risks and knew what actions to take if they had any concerns around people’s safety. Staff took action to reassure people when needed and ensured people had the equipment they needed to remain as independent and well as possible. There were enough staff to care for people in the ways they preferred and to spend time with them so they did not become isolated. People received regular support from competent staff to have the medicines they needed to remain well and pain free.

People benefited from living in a home where there were systems in place to reduce the risk of infections and to manage their safety. This included checks on the environment they lived in, and processes for identifying if there was any learning after safety incidents.

Staff assessed people’s care needs and involved people who knew them prior to people moving into the home. By doing this, staff could be sure they could meet people’s needs. People received care from staff with the experience and skills to meet their needs. People were supported to choose what they wanted to eat and to obtain support from other health and social care professionals so they would remain well. 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 had built strong and trusting relationships with the staff that cared for them, and enjoyed spending time with staff. Staff took communicated with people in the ways they preferred and people had access to written information in different styles to meet their needs. People were encouraged to make their own day to day choices about their care, with support from staff when they wanted this. Staff provided care in ways which promoted people’s right to independence and dignity and took action to support their right to privacy.

People’s care had been planned by taking their individual wishes, histories and needs into account. Staff communicated information regularly with other staff and relatives, so people’s care would be varied to meet their changing needs. People and their relatives knew how to raise any concerns or complaints they may have and were confident these would be addressed. Staff knew how to support people if they wished to raise any concerns or complaints.

People and their relatives were complimentary about the way the home was managed and found senior staff to be approachable. The registered manager had supported staff so they understand how they were to care for people, so people would enjoy life at the home. The provider and the registered manager checked on the quality of the care provided to people, so they would be assured people enjoyed a good quality of life. The registered manager listened to the views of relatives and staff when developing people’s care and the home further. This included refurbishment of areas of the home and adaptation of the gardens to meet people’s sensory needs. Senior staff had built eff

This inspection took place on 9 September 2015 and was unannounced. Regent Care Home provides accommodation and personal care for up to 64 older people. There were 59 people who were living at Regent Care Home on the day of our visit.

The home has 64 bedrooms and people have their own en-suite facilities. The communal areas of the home consisted of lounges, dining rooms and a quiet lounge that can be used for private visits and events.

There is one unit on the ground floor which provides personal care and accommodation called St Clement’s. Two units are located on the first floor, St Michael’s and St David’s. St Michael’s provides personal care and accommodation. St David’s provides support to people living with dementia.

There was a registered manager in place at the time of our 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.

People lived in a safe environment as staff knew how to protect people from the risk of harm. Staff were aware of the signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

People told us there were enough staff on duty to meet their needs and help them when they needed assistance. People told us that they knew the staff team well. People’s medicines were administered and managed in a safe way. We found that medicines were handled and stored in a safe way. People received care and support in a way that met their preferences and needs and we saw people smiling when staff approached them. Care and support was provided to people with their consent and agreement.

We found people were encouraged to eat and drink enough to keep them healthy, and that dietary requirements and people’s preferences were taken into account. People told us that they enjoyed the food and drinks provided.

We found that people had access to healthcare professionals, such as the district and practice nurses and their doctor when they needed them, and we saw that staff took action if people required medical care.

We saw that people were involved in the planning around their care when they wanted to be. People’s views and decisions they had made about their care were listened to and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

We found that people and their relatives knew how to raise concerns and that these had been responded to. No formal complaints had been made about the service, but we saw that information was available to tell people and their relatives how they could do this if they needed to.

The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant that people received care in a way that meet their needs and wishes. We also found that communication had been encouraged between people, relatives, staff and the management team, which improved the effectiveness and responsiveness of the care provided to people.

We found that the checks the provider completed looked at people’s experience of care, and that people, relatives and staff were encouraged to suggest improvements that could be made, and we saw that suggestions made were acted upon. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practice.

Concerns had been raised to us around the care and welfare of the people who lived in the home. We visited the home to check the people who lived there were kept safe and that their care and welfare needs were being met. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

We spoke with six people who lived in the home and one relative. We spoke with four members of staff and the registered manager.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private. They also told us the staff were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions and acted upon them.

Is the service caring?

We asked people for their opinions about the staff that supported them. What people told us was positive.

People were supported by staff who demonstrated a clear understanding of their needs and preferences. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people’s preferences and interests and found that care and support had been provided in accordance with people’s wishes. We saw that the care people received reflected what we read in their care records.

We spent time at the home watching to see how staff supported people, and talking with people about life at Regent Care Home. We spoke with four people living at the home and three relatives in passing. We also looked at records, and spoke with staff and the manager.

People who lived in the home that we spoke with told us that staff respected their privacy and dignity whilst assisting them with their daily routines. For example, one person told us that staff: ''Always knock my door'' before they entered and they could close their door whenever they wished.

During our inspection we saw staff provided assistance and support with meals to people who needed it, which was done at each person's own pace. Other people were encouraged to be as independent as possible by having adapted cutlery to eat their meals with dignity.

Several of the people and the relative of another person that we spoke with told us the meals looked good and they were happy with the meals provided.

We spoke with two people who looked after their medicines. One person told us ‘’I can take my painkillers when I need it for pain. I much prefer having that control’’.

We found that arrangements were in place to ensure that medicines were managed safely.

People said if they were not happy they would tell the manager or staff. We saw that the provider had systems in place to monitor and review people’s complaints to ensure that these were resolved to each person’s satisfaction.

Following our inspection in February 2012, we set compliance actions in two outcome areas where we had concerns. These were mainly about the storage and auditing of medicines and the accuracy of reflecting people’s needs within their care plans at all times.

At this inspection we found that progress had been made in all of the outcome areas where we had previously had concerns and improvements had been made.

Our inspection was unannounced; no one knew we would be visiting. We spoke with three people and six staff which included the management team to find out their views about the service provided at the home.

People were very positive about life at the home. One person said "I am really happy here and would never want to leave" and another told us "all the staff are kind and I cannot fault any of the care.”

The arrangements for boxed medicines needed to be improved. We found by counting some people’s medicines we could not tell whether people were always receiving their medicines at the right time, as prescribed to meet their health needs.

People said that they felt safe at the home. The regional manager was able to demonstrate that systems for monitoring the quality of the service were effective.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We carried out this visit to review any improvements that had been made since November 2011 and to see if the provider had complied with the Warning Notice we issued on 23 December 2011 about safeguarding people who used the service from abuse.

When we visited Regent Care Home we spoke with people who used the service, senior managers and staff. People told us they were “very comfortable here” and that it was also “very nice here”.

We spent time observing how staff interacted with the people who used the service. We saw that staff treated people with dignity and respect. People were spoken to by staff in a gentle way and gave them time to respond. Staff used peoples’ preferred names when addressing them. We found that significant improvements had taken place and people who used the service were now being treated with respect, staff were promoting choice and their dignity was being maintained.

We pathway tracked the care of three people and looked at how their care was provided and managed. We found that people were now receiving effective and appropriate care, treatment and support to meet their personal needs.

Our last visit to the home in November 2011 identified that Regent Care Home were failing to safeguard people from abuse. An investigation led by the Local Safeguarding Authority had taken place and found that the allegations of neglect of care of two people who used the service were found to be true.

We issued a Warning Notice in December 2011 as the provider failed to safeguard people from abuse. We found that appropriate action had been taken since our last visit to safeguard people from abuse.

Improvements had been made to the management of medicines since our last visit. Some further improvements were still required in relation to stock control and storage of medicines.

Our last visit identified that staff did not have the skills and competencies to manage the care of people with behaviour difficulties. This had been addressed by the provider through developing and implementing a training programme specific to the needs of the home. We found that staff had been given training and supervision to ensure they had the correct skills and competencies to meet peoples’ health and welfare needs and protect people from any unacceptable risk of harm.

The provider had put into place an improvement plan following the last inspection. They had continued to measure their progress towards meeting their improvements and had shared this information with us and the Local Safeguarding Team. We found that systems for auditing the quality of the service were in place to make sure that information was used to improve the quality of care and treatment for people at Regent Care Home.

There had been a significant improvement in the quality of the information available in the care records. The care records were individualised and overall gave care staff good information about peoples’ needs to make sure that they knew the care that was needed. We did identify some minor improvements that needed addressing.

We spoke with people who use the service and asked them if staff respected their privacy and maintained their dignity. One person told us “absolutely, they always knock on the door and they stay out of the room if I am showering”. People told us they had a choice of food at mealtimes and where they ate their meals. People told us they chose not to join in with any activities that took place in the home but were aware of any that took place. One person told us that they managed their own medication and that was their choice. They told us that they had not seen their care plan and it had not been discussed with them.

We found that people's privacy and dignity were generally respected at the home, but there were shortfalls in the way in which some aspects of dignity were managed.

When we visited the home we spoke with people who lived there. People made the following comments to us about their care; “not bad”. “Pretty good”. “When you ask them to do anything you have to wait”. “I have a bath when I want one”. “You can’t lock your door at night, they will not allow it, I do not like being checked at night”.

We looked at the care records for two people who lived at the home and found information was missing and the care records were not up to date. This means people may not receive their care in a consistent manner.

People told us they felt safe living at Regent. People told us if they had any concerns they would speak to the lead care staff. People told us you “can complain if you want” and they were “not afraid to speak their mind”. One person told us that they had complained about an issue and it had been dealt with by the service.

We spoke with people about the staff who worked at the service and they told us staff were “very kind and helpful”, “alright”, “you can’t say anything against them”. We found that further training and supervision of staff was needed to ensure that staff are competent to provide care and treatment to the people who use the service.

We found that systems for assessing and monitoring the quality of the services provided needed to be more thorough, as people were not protected from the risk of inappropriate or unsafe care and treatment.

We spoke with people who used the service and asked them if staff respected their

privacy and maintained their dignity. People told us that staff respected their privacy whilst supporting them with personal care and they knocked on their door before they came in. One person said the staff ‘treat her with respect’ and that they managed their own medication and that was their choice.

We found that there were still shortfalls in respecting people, as people who used the service were not always being treated with respect. Staff were not promoting peoples’ choice and their dignity was not being maintained at all times.

When we visited the home we spoke with people who lived there. One person told

us ‘if I need any help I ask and I get it’. They told us the staff were ‘all very nice and very kind’.

We found that people who used the service remained at risk of potential harm through the risk of receiving inappropriate care and support as a result of inaccurate assessments, poor communication and care planning. We found that people were not being safeguarded from harm and were being placed at risk of receiving unsafe and inappropriate care through lack of staff training and supervision. Please refer to section 7 (Safeguarding people who use services from abuse), section 14 (Supporting staff) and section 16 (Assessing and monitoring the quality of service provision).

The management of medication was looked at by a pharmacist inspector and we found that people were not fully protected against the risks associated with the unsafe use and management of medicines by means of making appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines.

We found that people who used the service were being placed at risk because there were inadequate systems in place to monitor and assure the quality of the care that was provided.