Care Home: Regency Residential Home

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What the care home does well The residents are treated as individuals and their wishes and preferences are respected. They are consulted on all aspects of life in the home and are encouraged to make their own decisions and to get involved in the daily routine in the home. The residents are well supported by an effective staff team with a skill mix that benefits residents. Members of staff interacted well with the residents and readily assisted those residents who needed help. All the members of staff assist with activities. Equality and diversity are clearly demonstrated in this service. The home caters for residents from diverse backgrounds. Some members of staff are able to communicate with residents whose language is not English. The service encourages and provides cultural dishes to those residents who preferred them and in terms of social entertainment, the television programmes are arranged in the resident`s own native language with unlimited access. Two recent admissions had the privacy of their own bedroom during their prayer time. Residents and visitors spoken to gave very positive feedback about the care and service provided. Comments received included: "The staff are very nice." "They are helpful and kind." "They give me what I want. I usually have tea and toast for breakfast." "The food is quite good." "I have a choice of hot food. There is a choice of drinks. I prefer orange juice. I have plenty to eat." "The staff seemed very confident. They seemed warm and nice. I see them talking to the residents." "I come regularly to see my clients. The care seemed very good. The staff are polite and helpful." What has improved since the last inspection? Since the last inspection six months ago, the new provider for this service has completed their first-stage development plan. Many of the facilities and decor of the premises have been completed. New equipment, including commodes and zimmer frames replaced the old ones to the benefit of the residents. Additional facilities included two new hoists and a wheelchair and there is now an assisted shower facility for residents. There is an additional office for staff. Since the last inspection, the service has employed a deputy manager with NVQ4, some experienced care workers with NVQ2 and NVQ3 and a professional chef withexperience of international cuisine. One of the directors is currently managing the home. What the care home could do better: The pre-admission documents have been revised to a more user-friendly format and the pre-admission assessment process that is being carried out by management is now more thorough to ensure that the home admits only people whose care needs can be met appropriately. Senior management staff are being trained to ensure that the newly designed person-centred care plans are in use. This ensures that those who are looking after the residents have the required information to deliver the personal, social and healthcare needs of the people living in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Regency Residential Home 6-8 Rosslyn Road Watford Hertfordshire WD18 0JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 2 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Regency Residential Home 6-8 Rosslyn Road Watford Hertfordshire WD18 0JY 01923244130 01923816325 sudera@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : RNJ Care Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Additional conditions: 0 The Registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Regency Residential Home is a care home registered for 30 people in the Old Age category. It had a new provider, RJN Care Limited, registered with the Commission since June 2008. The home is situated in Watford close to the main shopping centre. There is a car park to the rear of the building. The two storey Edwardian building was once a hotel. All floors are served by a lift. The communal rooms are all on the ground floor, including the lounges, the dining room, the kitchen, the laundry room and the two administrative offices. There is a smaller lounge designated the TV room. Next to this is a small conservatory overlooking the car park, situated to the back of the building. Care Homes for Older People Page 4 of 27 2 8 1 1 2 0 0 8 Brief description of the care home There are bedrooms on every floor and they are of varying size. There are two double bedrooms. The bathroom, shower room and toilet facilities are nearby. All the bedrooms have a washbasin and 12 of them have en suite toilet facilities. The home is managed and staffed by a multicultural team. The back garden consists of a lawn and a border of mature plants. The garden has garden furniture and seating for the service users. The garden is wheelchair accessible. The home charges £425 - £450 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service User Guide. A copy of these and the most recent inspection report are available in the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the second key inspection since the service was registered on 05/06/2008. The site visit was unannounced and it was carried out on 21/05/2009. The first inspection was on 28/11/2009. Both company directors were present. One of the directors is currently the home manager. There are 24 people in residence. The inspection visit included a tour of the premises, lunchtime observation and time was spent observing how the staff interacted with the residents during activity sessions and the interaction with individuals in their bedrooms. Staff, residents and visitors were spoken to and key documents were examined. The inspection ended with a thorough discussion with the two directors. Care Homes for Older People Page 6 of 27 Information received by us included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the people using the service What the care home does well: What has improved since the last inspection? Since the last inspection six months ago, the new provider for this service has completed their first-stage development plan. Many of the facilities and decor of the premises have been completed. New equipment, including commodes and zimmer frames replaced the old ones to the benefit of the residents. Additional facilities included two new hoists and a wheelchair and there is now an assisted shower facility for residents. There is an additional office for staff. Since the last inspection, the service has employed a deputy manager with NVQ4, some experienced care workers with NVQ2 and NVQ3 and a professional chef with Care Homes for Older People Page 8 of 27 experience of international cuisine. One of the directors is currently managing the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be confident that they will be supported for the home will only admit a prospective client whose care needs can be met. A prospective client can be assured that a thorough pre-admission assessment will be carried out to ensure that the home can meet all their care needs and there is a trial period before a permanent contract is agreed. Evidence: The pre-admission documents for two new admissions were examined and they were found to be detailed and informative. The manager had carried out a thorough assessment of each prospective clients personal, healthcare and social care needs. The manager said that the home will only admit prospective clients whose care needs can be met appropriately. The two new admissions seemed settled in their new home. There is a trial period of stay of 4-6 weeks before the contract is finalised. Since the last inspection, the service had transferred a couple of residents whose care needs Care Homes for Older People Page 11 of 27 Evidence: could not be met appropriately in the home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be treated with respect and they will receive personal care and support in the way they prefer and require. They are safeguarded by the homes Medication Policy and Procedure. Evidence: During the site visit it was noted that members of staff interacted well with the residents and one-to-one attention was given to each resident as they walk about in the communal areas. Since the last inspection, the written care plan format has been changed to personcentred format to reflect the person-centred care provided. The care plans of the two recent admissions were examined and they were found to be detailed and informative. Appropriate risk assessment documents were seen in the care plan folder. All key workers are currently being trained to write person-centred care plans. Each resident has a regular review of their care needs that involves all parties including the next of kin and the relevant social worker. Care Homes for Older People Page 13 of 27 Evidence: All the residents have access to healthcare if required. Each of the residents is registered with a general practitioner of their choice and residents have access to other specialist professionals according to their care needs. On the day of the inspection, the district nurse, the dentist, the chiropodist and the hairdresser were in the home at different times throughout the day seeing to those residents who had made prior appointments and those who required specialist treatment. The visiting professionals gave positive feedback about the service and care provided. One of the residents is visited regularly by their doctor due to weight loss. The weight chart and the daily food and fluid intake charts were kept up to date. The resident has also being referred to a dietician. A trained member of staff administers the medication. All medicines are stored in the drug trolley that is attached securely to the wall in the main administrative office when not in use. There is a controlled drug cupboard which is attached to the wall in the office. Currently there are no controlled drugs in use. The Medication Administration Record (MAR) Charts were examined and no gaps were found. It was noted, however, that some containers of medicines had no opening date written on them. These were the ones brought in by the new admissions. The management ensures that when these are reordered, the opening date will be written on the containers. There is a weekly audit of medication to ensure that the staff follow the homes medication policy and procedures and that medication is administered in accordance with legislation. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be given the opportunity to make everyday choices, including recreational activities and menu, and that their preferences and requests will be respected. They will be encouraged to maintain links with their friends and families and they will be encouraged to have a healthy diet. Evidence: On the day of the inspection, most of the residents were in the communal areas. They seemed content and relaxed. One resident spoken to said that they prefer to sit in the small lounge next to the dining area,by the bookshelf so that they can have easy access to the library books. Most of the books are in large print which suits the resident who has poor eyesight. The resident seemed very content. A member of staff was seen conducting a quiz game in the larger lounge. Six residents participated and they seemed to enjoy themselves. Generally both management and members of staff interacted well with the residents who were given one-to-one attention intermittently throughout the day, including those who were in their bedrooms. The manager said that members of staff take turns to organise the group activities. Other indoor group activities include music and movement, card games and puzzles. Care Homes for Older People Page 15 of 27 Evidence: There was social entertainment during Christmas and Easter time. Some residents have daily walks outside the premises and some are taken out to the local shops as they wish. Lunchtime was observed to be unhurried. Members of staff were readily available to assist those residents who needed some help. It was noted that the residents seemed to enjoy their hot lunch of mince meat stew and vegetables. The home has employed an experienced chef who ensures that the meals provided are nutritious and balanced. The chef deals with the menu and has a one-to-one consultation with each resident. It was noted that the home caters for residents from diverse backgrounds. A member of staff said that one of the residents routinely selects the ingredients for a member of staff to cook their favourite cultural breakfast and main meals. On the morning of the site visit, the same resident was seen enjoying a late breakfast of a cultural Asian dish. Another resident was provided with television channels from their own country. As these residents are not able to speak English, a member of staff was able to assist and communicate with them in their own language. Two recent admissions had the privacy of their own bedroom during their prayer time. The manager said that residents are consulted on all aspects of life in the home and are encouraged to make their own decisions and to get involved in the daily routine in the home. Visitors are welcome at all reasonable times. During the site visit, it was noted that there was a stream of visits from various professionals, including the district nurse assistant, the chiropodist, the dentist, the hairdresser and the workman. The visitors spoken to commented positively about the service and the care provided. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the service has a robust Complaints Policy and Procedure, and people can be assured that their complaints will be listened to, and that any concerns raised will be investigated and appropriate action taken. Evidence: A residents meeting is held regularly and the management deals with any issues raised promptly and effectively. All members of staff have had training on Abuse Awareness and Whistle-Blowing Policy and they are familiar with the joint agency Safeguarding Procedures of Hertfordshire County Council Adult Care Services. The home is not involved in the financial affairs of the service users, and the majority of the residents managed their own finances. However, the manager assists a few residents with their personal allowances. Individual accounts are kept, together with receipts. There have been two safeguarding referrals under the new management. In both cases, the clients were transferred elsewhere because the home was not able to meet their changing healthcare needs. The management has since improved their preadmission assessment process to ensure that the home will only admit prospective Care Homes for Older People Page 17 of 27 Evidence: clients whose care needs can be met. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they live in a homely, comfortable, clean and safe environment, and that specialist equipment is provided to maximise their independence. Evidence: Residents benefit from the improved facilities within the premises, which are wellmaintained. There is an ongoing maintenance programme and the first phase of the refurbishment programme has been completed. This includes an assisted shower room. Equipment such as zimmer frames and commodes has been replaced and additional wheelchairs, two new hoists, recliner chairs and dining room chairs have been purchased. All the bed linen has been replaced. There is also an additional freezer. On the day of the inspection, the workman was busy finishing the renovation work in the dining area. The bar area has been removed to provide more space for the dining area. A second administrative office has been constructed in the corner of the dining room for staff to use and there is a storage space for documents and care plans, thus giving staff easy access to the documents and an office for them to write their care plans and daily records. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them, and can be confident that they will be safeguarded by the homes robust recruitment policy and procedure. Evidence: The skill mix and staffing level are well maintained. On the day of the inspection, the two proprietors (one of whom is currently managing the service), the operations manager and the newly appointed deputy manager, a senior worker and three care workers were assisting 18 residents, most of whom were up and about in the main lounge. The chef and the domestic staff member were also on duty. The management encourages staff to undertake professional development in addition to mandatory training. There is a rolling training programme and all new staff have induction training that is in line with the Skills for Care guidelines. All the new recruits are experienced care workers with NVQ2 and NVQ3. The deputy manager has NVQ4. Most of the staff have had training on Dementia, Medication, Infection Control and the management has made arrangements with a firm of solicitors to conduct training on the Mental Capacity Act and Deprivation of Liberty issues. The home has a robust recruitment policy and procedure to safeguard residents. New Care Homes for Older People Page 21 of 27 Evidence: recruits only commence work after Criminal Bureau Record (CRB) checks and the Protection of Vulnerable Adult (POVA) Register checks have been cleared. The staff files for two new staff were checked and were found to be satisfactory. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the service is well maintained and will support their interests, and that their health and safety will be promoted and protected. Evidence: The standards of administration and management of the service are well maintained. Since the first inspection, the home recruited a home manager who has since left following a trial period. One of the two directors continues to manage the home and she is assisted by a deputy manager, who is experienced and has NVQ4 Management Award. The servicing records have been kept up to date and all the required policies and procedures are in place and updated to comply with current legislation. Staff handled confidential information in accordance with the Data Protection Act 1998. On the day of the site visit it was noted that all the documents and care plans were kept in locked cabinets in the administrative office. Care Homes for Older People Page 23 of 27 Evidence: The home is not involved with the residents finances. The Registration Certificate and the Liability Insurance certificate are on display in the entrance hall. The provider is in the process of conducting its first annual survey of the service as part of the annual quality assurance and monitoring system. This will include sending out survey questionnaires to residents, relatives, staff and stakeholders. Information received is collated and analysed and an annual audit report will then be produced. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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