We inspected the service on 10 & 24 January 2018. The inspection was unannounced on both days. Regency Hall 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. Regency accommodates up to 68 people in one building. On the day first day of our inspection there were 19 people and 16 on the second day living in the service, with one person was in hospital.
Regency Hall has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.
This was the first inspection of the service since they registered with the Commission in October 2016.
The service is required to have a registered manager. 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. The service did not have a registered manager. The provider did not ensure the service was managed effectively and in the best interests of people.
The provider did not have systems in place to manage the service and to ensure people’s safety. There were no systems in place to establish the number of staff or how they were deployed to keep people safe and meet their needs.
There was no process in place to ensure the control of infection. The home was visibly dirty in places and there were no process or schedule in place to keep the home clean. Care staff had to perform these duties as well as prepare meals. There was a part time chef which meant staff also had to cook meals for people taking them away from providing the care.
Risk was not effectively assessed or updated to ensure they had a reliable care plan to follow. Some accidents and incidents were recorded, but not reviewed to ensure the cause of accidents was recognised and where appropriate acted on to prevent other accidents happening again. People were left alone during breakfast without means of communication or calling for assistance.
No new staff had been recruited since the service was registered with the Commission. There was no system in place to ensure agency staff were given enough information about people to ensure their safety and welfare.
Medicine was stored and administered as prescribed although medicines due for return were not stored appropriately.
People were not consulted on how they wanted their care delivered. Daily information on people’s care was not analysed and if appropriate added to their care plan. There was no assessment process in place to re-admit people who had been in hospital. There were no communication systems in place to ensure all staff were aware of the current needs and welfare of people.
Staff were not supported or supervised appropriately to ensure their developments needs were discussed or met. There were no systems to recognise and put best practice in place. Menus were not planned in advance taking account of people needs wants and wishes.
There were no systems in place to recognise signs that the service may no longer be able to meet people’s needs. Staff had concerns about their ability to meet some people’s needs. The training provided to staff had been completed when the service was registered in September 2016 and not updated since then.
The MCA act was followed and where appropriate the local authority had been involved in determining people’s ability to make decisions about their care. Staff had some knowledge on how to safeguard people.
People’s dignity was not always promoted as people were not offered baths or showers as they wanted them. People were not involved in the planning or delivery of their care. Staff were kind in their interactions with people.
Care was not person centred and reviews were not completed in a timely manner. People were not supported to pursue their hobbies and interests. Complaints particularly regarding the cleanliness of Regency Hall and laundry services were not effectively responded to.
The provider did not ensure there was a system in place to inform CQC of incidents. Therefore there were incidents we were not informed about. Record keeping was poor and ineffective. Some records such as rotas were not dated and paperwork was not stored in a manner which offered easy access and they were not stored in a confidential manner.
There was no quality assurance process in place. This meant audits of service provision were not completed, therefore there was no way the provider could show the service was recognising and meeting people’s needs and wishes. It also meant there was no process to learn from mistakes to ensure they were not repeated.
Staff were without direction and management and only responded to immediate needs of people.
We identified the provider was in breach of six of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see the action we have taken at the end of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
You can see what action we told the provider to take at the back of the full version of the report.