Archived: St Albans House

The aim of the inspection was to follow up on a compliance action that was made at the last inspection of the home in May 2014.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

At the last inspection we queried with the provider whether their facilities for storing controlled drugs met regulatory requirements. At this inspection we found that no action had been taken as the provider told us they thought we would be giving feedback about whether the cabinet was compliant. Following the inspection the provider notified us that they had liaised with their pharmacist and a new cabinet meeting regulatory standards had been purchased. At the time of the inspection the home was not storing any controlled drugs and so there were no risks to people's safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which apply to care homes. Everyone living at the home at the time of our inspection had capacity to make decisions and therefore no applications for DoLS were required. Staff we spoke with told us that they had received training in the Mental Capacity Act 2005 and DoLS.

Is the service caring?

As we were following up on compliance with standards for supporting staff, we did not look at standards concerned with caring for people. At the last inspection in May 2014 we heard from people that they felt well cared for and there were no concerns about how people's needs were met in a caring manner.

Is the service responsive?

The provider demonstrated responsiveness by taking action to address the non-compliance at the last inspection concerning staff support, as well as taking prompt action after this inspection to purchase a new controlled drugs cabinet.

Is the service effective?

We found that deficits in staff training identified at the last inspection in May 2014 had been addressed so that staff now had been updated with training.

Is the service well led?

At the last inspection in May 2014 we found that the provider had systems in place to gain feedback from people using the service through surveys and informal discussions on a daily basis with people living at the home.

At this inspection we focused on standards for supporting staff only. The staff we spoke with told us they were very positive about the registered manager and providers, saying that they felt very supported. One member of staff, who had worked at the home for many years, told us, 'The owners are very supportive and very approachable.'

We were provided with a staff training matrix that showed that the provider had taken action in both monitoring when refresher training was required for staff and also making sure that staff had been trained in core subjects so that they were competent to carry out their role.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

There were nine people living at the home at the time of inspection.

Is the service caring?

People's privacy was maintained. We spoke with three people and one person's relative. One person told us, 'The staff always tap on the door. Their manners are excellent.' Another person said, 'They respect my privacy. I feel very much that this is my world and my home.' A further person commented, 'I like to have my door shut. I read a lot and watch TV. I have my privacy. The staff always knock on my door before coming in.' We saw that bedroom and bathroom doors were kept closed when people were being supported with their personal care.

People were treated with consideration and respect. One person told us, 'They take their time with me. I never feel rushed.' Another person said, 'The staff are very kind. I've not come across one member of staff who is unfriendly, unkind or unhelpful.' A further person commented, 'The staff are very friendly.' We saw that staff interacted with people in a polite and friendly manner.

People were involved in decisions about their care. One person told us, 'There is a routine, but it's not rigid. If I want to stay in bed I can. If I want to go to bed later I can.' Another person said, 'There are always choices.' One person's relative commented, 'It's individualised care here.' We looked at three people's care records which were signed by the person indicating their agreement and involvement.

Is the service responsive?

People accessed health care services as required. One person told us, 'The doctor comes in if there is anything you want to see him for.' Another person said, 'The doctor comes very regularly. They get the professional help if I need it.' A further person commented, 'The doctor comes to see me if I need them.' We found that people's contact with healthcare professionals was recorded and advice was followed. For example, one person had experienced difficulty sleeping. The GP was contacted and advised that the time of one of their medicines should be changed. We found that this change had been made by the staff. Another person had a skin complaint. We saw that the success of the prescribed treatment was monitored by staff and the GP contacted for further advice and changes to the treatment.

Is the service safe?

People told us that their medicines were given to them safely. One person told us, 'The staff give me all my medicines. I hardly take anything.' Another person said, 'The staff give me my various pills and potions. They are very precise. They stay with me while I take them.' A further person commented, 'The staff bring me my medication at night. I haven't had any wrong ones yet!' We looked at medicine records which were signed indicating people had received their prescribed medicines.

There were no appropriate arrangements in place for the storage of controlled drugs (CD). No CD requiring specific arrangements for their safe custody were being used in the home. However, the registered manager showed us a cupboard which would be used to store CD should a person be prescribed them. This cupboard was unsuitable for storing this type of medicine as it was not sufficiently secure.

People's needs were assessed and care was planned to meet people's needs. We found that a variety of assessments were undertaken to identify people's needs. For example, all three people's needs in relation to mobility, eating and drinking and washing and dressing had been completed. Where a need was identified there was a plan in place to meet this need. For example, one person had been assessed as being at risk of falls. This person had a plan which stated that they needed the support of one member of staff and a walking stick to mobilise. We spoke with two members of staff who were aware of people's needs and how they should be supported.

Care was delivered to meet people's needs. One person told us, 'They look after me all the time.' Another person said, 'Whatever I ask them to do they will do. I have called them in the night and they come up and help me.' A further person commented, 'I ring my bell when I am ready to get up and a cup of tea appears. It's wonderful.' We saw that people had access to call bells and drinks.

Is the service effective?

People told us that they were confident in the abilities of staff. We spoke with three people and one person's relative. One person told us, 'The staff seem to be well trained. They have been here a long time.' Another person said, 'I have every confidence in the staff.' A further person commented, 'The staff are perfect.' However, we found that the provider did not have suitable arrangements to support staff.

The provider had not made suitable arrangements to ensure staff received appropriate training and development. The registered manager told us that staff training records were not up to date. There was no clearly defined training plan to indicate which staff required training or when training would be completed. We were shown training certificates which indicated that staff had received some training, however there was not an effective system to ensure every member of staff received the required training to enable them to support people safely. The registered manager told us that training was delivered mainly through distance learning workbooks.

The registered manager told us that staff were supervised and appraised on an informal basis. The registered manager told us that staff could approach them at any time if they had concerns or issues they wished to discuss. The registered manager told us that they worked alongside the staff team providing direct care and support to people and offered guidance and feedback as required at the time it was needed. We spoke with two members of staff who told us that they received feedback regarding their performance from the registered manager. We looked at supervision and competency assessments which had been completed for 10 of the 15 staff. These assessments looked at performance in relation to topics such as report writing and supporting people with their mobility. The assessments required the assessor to tick a box to state whether the staff member was capable or required further training. The registered manager told us that no staff had identified any additional learning needs.

Is the service well led?

People were able to express their views in relation to the service. One person told us, 'If I don't like what I've got they will change things. It's not all their own ideas. They listen to us and the staff as well.' Another person said, 'I wouldn't have the slightest hesitation in saying what I want and I am sure they would take notice.' The registered manager told us that they directly provided care and support to people and obtained their feedback daily and used this to improve the service provided. The registered manager told us that suggestions and comments mainly related to the individual's care, for example in relation to meal choices.

The provider monitored the quality of the service on an ongoing basis. The registered manager told us that they were present in the home every day and walked around speaking with people, staff and visitors in addition to carrying out visual checks. The registered manager told us that changes would be made as required, for example if they noticed that a light bulb required replacing.

All of the people that we spoke with were positive about the way the home was run and managed. People told us that staff were, "Kind" and the food was, "Excellent". One person told us, "I don't think it can get any better than this".

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Appropriate checks were undertaken before staff began work.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

The provider had some systems for reviewing and monitoring the quality of service provided to people, but these had not always been implemented effectively to ensure that people were not at risk of unsafe or inappropriate care.

People living at St Albans House were very positive about their experience of living at the home and no one had any complaints or concerns about how the home was run and managed. They told us that they had good relationships with the staff, who were described as 'brilliant'.

They told us that the home was kept clean. They told us that there was a range of food and drinks available. They said there were activities arranged to keep them occupied, but would enjoy more. People told us that they were involved in decisions about how they were looked after and that they could choose when they got up and when they went to bed.

We spoke with staff who understood what safeguarding was and what they would do if they suspected someone was being abused. Staff told us they felt fully supported by their manager

We found that the home had systems for reviewing and monitoring the quality of service provided to people.