The inspection took place on 10 and 11 October 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Regents View Care Home in October 2015, at which time the service was compliant with all regulatory standards and was rated Good. At this inspection the service remained Good.

Regents View is a care home in Hetton-le-Hole, Sunderland, providing nursing, accommodation and personal care for up to 50 older people. There were 40 people using the service at the time of our inspection, the majority of whom were living with dementia. This included a male-only area of the home, where there were currently eight people using the service.

The service had a registered manager in place. 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 protected by staff who understood specific risk assessments and care plans. Risks were reviewed and acted on with the input of external professionals where appropriate.

People and their relatives told us there were ample staff. The registered manager and some staff acknowledged the workload could be particularly challenging when there were unexpected staff absences and they were recruiting more staff in an attempt to reduce this likelihood and impact.

Staff demonstrated a good awareness of safeguarding principles and had received refresher training on the subject, as well as recent moving and handling refresher training.

The management, administration, storage and disposal of medicines was in line with the National Institute for Health and Care Excellence [NICE] guidelines.

The laundry used a ‘dirty in clean out’ two door system and was in good order. We found the home to be clean and well maintained.

Pre-employment checks were made to reduce the likelihood of employing people who were unsuitable to work with potentially vulnerable people.

Breakaway training, in order to equip staff with the skills to safely remove themselves from a physical altercation, had yet to be delivered. All other mandatory training was in place and monitored regularly. This included health and safety, fire safety, infection control, mental capacity, food hygiene and dementia awareness.

Kitchen staff demonstrated a strong awareness of people’s dietary requirements and preferences. Mealtime experiences were varied and sometimes people had to wait for their meals.

The registered manager was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). They had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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.

There were some dementia-friendly aspects to the environment, for instance wide, bright corridors with contrasting walls, tactile murals on walls. Other areas, particularly the male-only area, required refurbishing with people’s needs in mind.

Staff received consistent support through supervision and appraisal meetings, as well as staff meetings.

People who used the service, relatives and external professionals agreed staff were caring in their approach to people and we observed evidence of this during our inspection. People were treated with dignity and respect.

Care plans contained sufficient person-centred information and staff had a good knowledge of people’s needs, likes and dislikes.

The service had a full time activities co-ordinator. Weekly activities and outings were planned although more could be done to ensure people in th

Due to the physical and mental health needs of the people living at the home it was not possible to obtain some people’s views. However we used a number of different methods to help us understand the experiences of the people using the service including Short Observational Framework for Inspection (SOFI) exercise. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

We spoke to one person who told us they were “happy”. We spoke to two relatives. One told us they thought the care home was “fantastic” the staff always kept them informed and the food was good. The other person said their relative was “very settled” in the care home and the staff treated them with dignity and respect and also they knew their needs well. Both people we spoke with confirmed that they thought their relatives were safe.

We found people’s privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights. People who use the service were protected from the risk of abuse and people were cared for by suitably qualified, skilled and experienced staff. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The people who used the service and their relatives told us about their experiences when they were planning to come and live at Regents View Care Home. People we spoke with told us they were involved in the decision to come and live at Regents View, and they contributed to the assessments that were carried out by the home and also by the social workers.

People’s comments included, “I was asked to give consent for my relative’s photos to be taken which I thought was a nice thing for the staff to do. It meant they respect me and my relative”; “I have no concerns about the care I get here”, “I have been visiting this home for a long time and I know it to be a good home and that is why we chose the home”; “I made the choice of coming to live here”.

Families told us the staff kept them informed about the state of health and wellbeing of their relatives other comments included, “The staff let me know when they call the doctor out”, “We are always informed about X’s condition and staff let us know if X is not well”, “I am happy with the care here, the girls are caring and good with the residents”, “You can’t fault the care here”.

This inspection took place over two days. The first visit on 12 August 2015 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 13 August 2015.

Regents View Care home provides nursing and personal care for older people some of whom have dementia care needs. The home is registered for 50 places but there are only 48 bedrooms following the conversion of two rooms for storage. Since last inspection the provider had created a separate nine-place unit for gentlemen on the ground floor. All bedrooms in the home are single occupancy and have en-suite facilities. The home has two floors of accommodation which are served by a passenger lift. At the time of this inspection there were 39 people using the service.

The home had a new registered manager since June 2015. 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 of this care home, which was carried out on 2 and 3 December 2014, we found the provider had breached three regulations. These related to: premises shortfalls such as a poor standard of bathrooms; inadequate cleanliness of the building; and lack of staff supervision.

After the inspection on 2 and 3 December 2014 the provider wrote to us to say what they would do to meet legal requirements.

During this inspection visit we found that work had been carried out to address the premises issues, the cleanliness to the building had improved and staff had received some supervision. This meant the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations.

People were positive about the service they received. People and their relatives felt the care service was safe. Staff attended to people quickly and there were enough staff to support people with their necessary care needs. However relatives and staff felt more staff were needed to provide therapeutic care for people. Also, staffing could be arranged more effectively to meet people needs at key times of the day.

Staff were clear about how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. The provider made sure only suitable staff were employed. People were assisted with their medicines in the right way.

People, relatives and healthcare professionals felt staff were competent to meet people’s needs. Staff had the relevant training and support to care for people in the right way. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision. People’s safety was protected without compromising their rights to lead an independent lifestyle.

Any changes in people’s health needs were referred to the relevant health care services. Health care professionals said the service acted on advice and guidance, and responded to any changes in people’s well-being. People felt the quality and choices of meals was good. They were supported to eat and drink enough, and this was monitored if people were at risk of losing weight.

People and relatives felt staff were caring and kind. One person told us, “I have some canny conversations with the staff. They are very friendly.” Another person commented, “They are kind.” One person said, “They will bring you anything you want.”

People were encouraged to make their own decisions and choices wherever they could. There was a sociable atmosphere in the home and there were warm and friendly interactions between people and staff. There were opportunities for people to join in activities, events and trips out.

Staff understood what was important to each person and were familiar with their preferences. Records about people’s care needs were up to date and reflected the support each person needed.

People had information about how to make a complaint or comment and these were acted upon. People, family members and staff felt they could approach the registered manager at any time and said she was “supportive”. The provider's system for checking the quality and safety of the service was used effectively at this home.