Archived: Regent House Rest Home

During this inspection, we looked at the outcomes relating to cleanliness and infection control and medicines management. We looked at medicines as we identified concerns with the management of creams and eye drops during the inspection. We considered the evidence we had gathered under the outcomes we inspected. We spoke with four people who used the service, two staff and the manager. We reviewed infection control and medicines' administration records.

This is a summary of what we found:

Is the service safe?

The arrangement and systems to manage the prevention and control of infection had not been developed. The environment was not clean and appropriate processes were lacking in order to facilitate the prevention and control of infections. This may put people at risk of cross infection and strategies for the prevention and spread of infection were not followed.

People were receiving their oral medicines safely. However the arrangement for people's prescribed creams, ointments and eye drops were not safely managed. Staff had not followed procedures to ensure the creams and eye drops were used according to the manufacture's recommendations.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of infection control and medicines.

Is the service well-led?

There were some audits for infection control. However this was not always effective as shortfalls were not identified for action to be taken. The quality improvement system did not evidence how improvements would be sustained and embedded in practice.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led

This is a summary of what we found.

Is the service safe?

We found that not all aspects of the service were safe. People were cared for by staff who were knowledgeable about their needs and had the skills to provide the support people required. However, we found the home was not clean and although there were systems in place to monitor the cleanliness and hygiene of home, these systems were not effective. Everyone we spoke with said they were happy with the way their care needs were met but raised concerns about the timing of their care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control.

There were enough qualified, skilled and experienced staff to meet people's needs. The staff we spoke with confirmed they had received induction training before commencing work within the home.

The staff we spoke with were clear about their role and responsibilities in respect of providing care and meeting people's needs.

There were two people living at the home who were subject to Deprivation of Liberty Safeguards (DoLS) authorisations. We looked at the paper work for these people and saw it had been completed correctly and recorded in the person's care plan..

Is the service effective?

The care plans we looked at were personalised to reflect the individual needs and people's likes and dislikes. The people we spoke with told us they were happy with the care they were receiving and their needs had been met. It was clear from our observations and from speaking with the staff that they had a good understanding of the people's care and support needs and they knew them well. A person we spoke with said 'the staff are good to us'. A visitor told us staff understood their relative's needs and added 'I am happy she has been really cared for here'.

Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists. Therefore arrangements were in place to meet their healthcare needs.

Staff received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and attentive staff. People said they had no concerns over how they were treated and they felt their privacy and dignity were respected. The records we looked at showed the staff took account of people's individual wishes and these were respected, when providing care.

We observed part of the lunch time meal and saw that staff were available to support people if they were needed. One person told us 'the staff don't rush me, I can take as long as I need'

Is the service responsive?

People's care plans were reviewed regularly and updated to meet people's changing needs. During our inspection we saw one visitor, who was the responsible persons for a friend, reviewing changes to their friend's care plan.

There were arrangements in place to respond to short term staff absences, which were managed through the use of overtime and the manager.

Staff received specific training to meet the needs of people living at the home. This included medication, person centred care, dementia awareness and mental capacity act. Discussions with staff showed they were aware of how to use the training they had received for the benefit of people.

We saw there was an effective compliments and complaints policy in place, which was published in the service users' guide. The manager showed us their complaints file and told us they had not received any formal complaints during the last year. The people and visitors we spoke with told us they knew how to complain but had not needed to do so.

Is the service well-led?

There was a clear management structure. There were also procedures in place to monitor the quality of service provided with audits. These included, care planning medication, activities and infection control audits. However, the quality assurance process currently in place was not robust enough to identify all areas of concern, such as those found during our inspection.

A survey questionnaire was given out to people and their families, on an ad hoc basis, seeking their views on the service provided. We saw the results of the completed questionnaires which were all positive.

There was a staff meeting structure, where staff could raise any issues or concerns. The manager told us that because it was a small team they only held staff meetings on an ad hoc basis, 'when there was an issue or a new resident'. Staff told us they received regular supervisions where they could raise any issues or concerns.

During our previous inspection on 8 July 2013 we identified the provider did not have effective systems in place to ensure that notifications affecting people using the service were sent to the Care Quality Commission (CQC) without delay. We set a compliance action and the provider wrote to us, telling us how they would become compliant.

During this inspection we found the provider now had a system in place to notify the commission when an incident occurred. The manager explained the process and was able to demonstrate an understanding of the requirements under the health and social care legislation.

Medicines management was organised and we saw the home procedures were followed. Equipment had been obtained and was in place for meeting people's needs.The manager had revised the recruitment process and checks before employment were in place. Staff training and support was provided from induction and staff had recently received training on fire matters ,moving and handling and dementia . Work on the quality assurance process had taken place and monitoring of the service had increased through a wider range of audits. There was evidence of the service responding to complaints.

The provider had failed to ensure that notifications were sent to us about reportable incidents detailing action they had taken for example following the death of one person and when a safeguarding matter was raised.

Although risk assessments had been reviewed insufficient action had been taken to demonstrate thorough risk management was embedded in the service. We found areas such as fire checks had not identified problems with intumescent strips. We found problems with a vent in a toilet had not been identified and action taken to minimise risk to people. Temperature checks of the hot water were incomplete and action taken to reduce risks not documented. The provider had not ensured the monitoring procedures in the home demonstrated how all risks were minimised.

Overall, improvements were seen but more time was needed to ensure these improvements continue.

Effective recruitment procedures were not in place meaning that people living in the home were at risk of receiving care from staff who had not been properly vetted. The provider had not taken effective measures to ensure that people living in the home were sufficiently protected against the risks of unsafe care because the quality of the service and systems for identifying risks were not effective.