We carried out an unannounced comprehensive inspection of this service on 13 October 2016.

The home is registered to provide accommodation and personal care for adults. A maximum of 37 people can live at the home. There were 34 people living at home on the day of the inspection. At the time of our inspection there was manager in post who had recently been appointed and since the inspection has been registered with us. 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 the last inspection on 10 August 2015, the provider needed to make improvements in supporting staff knowledge of the Mental Capacity Act 2005 (MCA) and to the home environment and this action has been completed.

People told us that they felt safe in the home and felt the staff helped to keep them safe. People were confident about the care staff and care staff told us about how they kept people safe. During our inspection staff were available for people and were able to support them by offering guidance or care when needed. People told us they received their medicines and senior care staff looked after people’s medicines and administered them as needed. People told us there were enough staff to support them and they did not have to wait for care to be provided.

People told us care staff knew them and their care needs and looked after them well. Staff felt their training reflected the needs of people who lived at the home. Care staff had supervision which they said supported and helped them in providing care to people who lived at the home. People’s rights and freedoms were respected by staff who listened and responded to people’s decisions. People were supported to eat and drink enough to keep them healthy. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us that care staff made sure they remained independent and they were encouraged to be involved in their care. People knew the care staff well and had developed positive relationships with them. Care staff were considerate when talking about people and knew it was important to maintain a person’s privacy and dignity when in their home proving personal care.

Where people had not been able to be involved in the planning of their care due to their capacity to make decisions, relatives and care staff were involved and asked for their opinions and input. People told us they had limited abilities and chose not to maintain their hobbies and interests. However, staff offered encouragement and supported people to read or join in group activities and outings. People we spoke with told us they were confident to approach the manager if they were not happy with their care. The manager had reviewed and responded to all concerns raised.

People felt involved in their home and had opportunities to make suggestions that were listened to and actioned with the regular meetings held. Management and staff had implemented recent improvements and these were regularly reviewed to ensure people’s care and support needs continued to be met. The management team were approachable and visible within the home which people liked.

The inspection was unannounced and took place 10 August 2015.

Regents Court is registered to provide accommodation and personal care for adults who may have a dementia related illness for a maximum of 37 people. There were 32 people living at home on the day of the inspection. There was a manager in place however they had not been registered with us. A 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 told us they felt safe and staff were available to them and spent with them. Staff told us about how they kept people safe from the potential risk of abuse and were provided with medicines as required. People told us they liked the staff and felt they knew how to look after them and made day to day choices about their care and support. People gave their consent to care and treatment or were supported to have decisions made in their best interests.

Staff were provided with training, however they told us they would like further training and awareness in understanding the Mental Capacity Act. People’s consent to care and treatment would be better supported from staff that had more knowledge in this area. The provider told us they would ensure training was arranged to support staff.

People enjoyed their meals food and had choices regarding their meals. Where people wanted a particular choice this would be arranged. People had been supported to maintain access with other health and social care professionals. People were helped to contact and arrange appointments with services which were not available within the home. They had regular visits from their GP when needed and were supported by staff to attend appointments in hospital.

Staff knew people’s care needs and people felt involved in their care and treatment. Staff were able to tell us about the care needs of people. People’s privacy and dignity were respected and staff were kind to them. People had been involved in the planning of their care and relatives were involved in supporting their family members care.

The manager was available, approachable and known by people and relatives. Staff also felt confident to raise any concerns of behalf of people. The management team had kept their knowledge current and they led by example. The management team were approachable and visible within the home and people knew them well. The provider ensured regular checks were completed to monitor the quality of the care delivered.

People had been supported with things to do during the day and live in an environment that supported their needs. People and relatives felt that staff were approachable and listen to their requests in the care of their family member.

We saw that some communal rooms were being used as storage or were not being used. The manager was looking at how best to make these more accessible to people. The manager felt that people would enjoy using these rooms with support. The provider and manager had made regular checks to monitor the quality of the care that people received and look at where improvements may be needed. The staff team were approachable and visible within the home which people and relatives liked.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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, their relatives, 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 told us they felt safe. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

Systems had been in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans due to their conditions. The provider had also considered information and involvement from relatives, other health professionals and staff. People we spoke were not aware of what was in their care plans but told us they were happy with the care they had received. One person told us: “I don’t worry about the paper, I like it here and they look after me well”. Specialist dietary needs had been assessed and included.

Visitors confirmed that they were able to see people in private and that visiting times were flexible and the home were accommodating and welcoming.

The staff had received training that they felt met the needs of the people. They also told us their training was kept current and were told when courses were due to be attended. This meant that staff were trained and supported to ensure that people’s needs had been met.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us: “I am able to do a lot on my own and they let me get on with it” and: “They look after me, some things I need help with. I am very happy here”. A relative said, “I visit regularly and I am confident that X (person’s name) is very well looked after”.

Is the service responsive?

People completed a range of activities in and outside the service regularly and the provider had staff dedicated to arranging and supporting people to attend these activities.

The views of people and relatives had been recorded in meetings held at the home. We saw that these views had been considered. For example, communal areas had been redecorated and the home was looking to recruit a gardener. This meant that the provider considered the views of people in running the home.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. Staff told us that they felt the quality of the service had continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

When we carried out this inspection 31 people were using the service.

We spoke with the registered manager and five members of staff. At the end of the inspection we spoke briefly with one of the providers. During our inspection we spoke with people who used the service and one visitor. One person commented: “We are pleased with what they (the staff) are doing”. Another person described the staff as: “Helpful and kind”.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner.

From our observations we saw that people were provided care that met their individual care needs. We saw equipment was used to prevent people who used the service from getting sore.

We found that appropriate arrangements were not in place that ensured the safe use and management of medicines.

A recent reduction in staffing levels during the afternoon was re-instated at the time of our inspection in order that people’s needs could be better met.

We found that accurate records in respect of people who had used the service were not always maintained to show how care needs were to be met. We saw occasions where these records had not provided appropriate information to guide staff on how they should have meet people’s needs.

When we inspected Regents Court 32 people were using the service. During our inspection we spent time with people who used the service while they were in the dining room and in the lounge.

We found that relatives had raised concerns following a recent reduction in the number of care workers employed on each shift. Although staff were aware of people’s needs we saw times when people were not sufficiently supported in order to have their needs meet. When care workers were supporting people we found that choice was offered and their dignity respected.

We saw three recorded entries of incidents between people who used the service. The registered manager was not aware of these events and no referral to safeguarding had taken place.

During this inspection we saw that systems were in place to manage the prevention and control of infection within the home.

The new provider had systems in place to assess and monitor the quality of care provided and as a means to identify any improvements needed. Further systems were to be introduced.