Albury House

Albury House is a small family run care home which provides personal care and accommodation for up to 12 older people. At the time of the inspection, 11 people were living at the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider did not have a comprehensive oversight of the service. Following the last inspection improvements had not been made in the areas of greatest concern.

We identified shortfalls relating to checks on staff suitability to be employed in a care role, the maintenance of records relating to care and the building, the Mental Capacity Act 2005 (MCA)/Deprivation of Liberty Safeguards [DoLS] procedures and meeting regulatory requirements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care records and risk assessments were not always person-centred and lacked detail. Some risks were not appropriately assessed so measures could not be put in place to keep people safe.

Medicines were not always managed safely. Medicines audits were not clearly documented, and some medicine care plans were out of date. Most people received their medicines.

Staff, people and relatives were not always engaged with in line with the provider’s policies.

Staff had not received training in the MCA, or in learning disabilities and autism. Staff had received training in other aspects of care. There were enough staff to care for people safely.

People were supported to eat and drink enough to maintain their health. The provider worked well with visiting healthcare professionals and ensured people received healthcare support whenever they needed it.

People and relatives said the care they received was good. We observed staff knew people’s needs and gave person-centred care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 April 2023). At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider review staff training. At this inspection we found that sufficient improvements had not been made in this area. We had recommended that the provider review their information sharing systems, we found that the provider had made improvements in this area.

Why we inspected

We received concerns in relation to overall management of the service and the safety of care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider took action to reduce immediate risks to people during the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Albury House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the provider’s oversight and management of the service, recruitment processes, mental capacity and best interest decisions, staff training and display of ratings.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Albury House is a small family run care home which provides care and accommodation for up to 12 older people. At the time of the inspection, 10 people were living at the home.

People’s experience of using this service and what we found

We identified shortfalls relating to recruitment procedures, the availability and maintenance of records, the Mental Capacity Act 2005/Deprivation of Liberty Safeguards [DoLS] procedures and meeting regulatory requirements, These issues had not been highlighted by the provider’s governance systems. Following our inspection, the general manager told us they were signing up to enrol on the local authority's 'Excellence in care' programme to further enhance their knowledge and skills. They also explained they were going to apply to be a registered manager.

An effective system was not fully in place to demonstrate how staff worked in partnership with external stakeholders and other services. We have made a recommendation about this.

A training programme was in place. However, there was no evidence staff had undertaken MCA/DoLS training or the Oliver McGowan Mandatory training on Learning Disability and Autism. We have made a recommendation about this. Following our inspection, the general manager told us staff had completed MCA/DoLS training and learning disabilities training.

There were sufficient staff deployed to meet people’s needs including their emotional and social needs. Staff had time to spend with people and they also supported people to access the local community. A system was in place to manage medicines. We identified minor recording issues relating to medicines management, which the general manager told us would be addressed.

People were supported to eat and drink enough to maintain their health. There was an emphasis on fresh produce and home baking.

There was a cheerful atmosphere at the home. People and relatives spoke positively about the staff and the home. Comments included, “They go out of their way to be caring” and “It’s great because it's small and personable.” Staff also spoke enthusiastically about working at the home and the care provided. One staff member said, “They get 5 star treatment. It would definitely be good enough for my family and friends.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 21 August 2019).

Why we inspected

The inspection was prompted following a specific incident. We carried out a focused inspection to review the key questions of safe and well led.

When we inspected, we identified a concern with the Mental Capacity Act 2005/DoLS procedures so we widened the scope of the inspection to include the effective key question.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. Please see the full report for further details.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Albury House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 6 breaches in relation to safe care and treatment, need for consent, good governance, fit and proper persons employed, duty of candour and the display of the provider's CQC ratings. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents).

Please see the action we have told the provider to take at the end of this report.

We made two recommendations in the effective and well led key questions in relation to training and working in partnership with external stakeholders and other services. Please see these sections for further details.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Albury House is a small family run care home which provides care and accommodation for up to 12 older people. At the time of the inspection, 11 people were living at the home, some of whom had a dementia related condition.

People’s experience of using this service and what we found

People were complimentary about the home and the staff. One person told us, “I would describe it in my eyes as perfect – it is very homely and the staff are wonderful, it couldn’t be nicer.”

Systems were in place to safeguard people from abuse. People told us they felt safe and staff said they had not seen any care practices which concerned them. An effective system was in place to manage medicines.

Sufficient staff were deployed, and safe recruitment practices were followed. Staff were suitably trained and supported to enable them to meet people’s needs.

People were supported to eat and drink enough to maintain their health and wellbeing. There was an emphasis on home baking and local produce. Staff assisted people to access healthcare services and receive ongoing healthcare support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received personalised care which reflected their needs and preferences. People were supported to continue their hobbies both within and outside of the home.

A complaints procedure was in place. No complaints had been received.

A range of audits and checks were carried out to monitor the quality and safety of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last visited the service on 8 April 2016 to carry out a focused inspection where we looked at the questions, “Is the service safe” and “Is the service well-led.” We found that the provider was meeting all the regulations we inspected against.

Albury House is a care home and provides residential care for up to 12 people. It is located near the centre of Berwick upon Tweed and provides accommodation on two floors. There were 11 people living at the home at the time of the inspection.

The provider is a husband and wife partnership, Mr and Mrs Burn. Mrs Burn was also the registered manager. 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. The registered manager was supported by the assistant manager.

People told us that they felt safe at the service. There had been no safeguarding concerns. Medicines were managed safely.

Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. We saw that staff carried out their duties in a calm unhurried manner.

The premises were clean. Checks and tests had been carried out to ensure that the premises and equipment were safe.

Staff told us, and records confirmed that training was available. There was an appraisal and supervision system in place. This meant there was a system in place to ensure that staff were supported and competent to carry out their job role.

Staff followed the principles of the Mental Capacity Act 2005. People’s nutritional needs were met and they had access to a range of healthcare services.

We observed very kind and thoughtful interactions between staff and people. Staff were knowledgeable about people’s needs and could explain these to us. A computerised care management system was in place to plan, assess and review people’s care.

An activities programme was in place to help meet people's social needs. The provider had their own transport to enable people to access the local community.

There was a complaints procedure in place. No complaints had been received in the last 12 months. None of the people or relatives with whom we spoke raised any complaints about the service.

Audits and checks were carried out to monitor all aspects of the service. There was a refurbishment programme in place and continual improvements to the environment were being made. Staff told us that they enjoyed working at the home and said they felt valued by the provider.

The registration requirements of the service were met. The provider had notified us appropriately of any changes and events at the service in line with legal requirements.

At our last inspection in July 2015, we found that the provider was not meeting two regulations relating to safe care and treatment and good governance. We issued two warning notices and told the provider they needed to take action to improve.

At this inspection we found that action had been taken to improve and the provider was now meeting legal requirements. While improvements had been made, we have maintained the overall rating as requires improvement. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating at the next comprehensive inspection.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Albury House on our website at www.cqc.org.uk.

Albury House provides care and accommodation for up to twelve people. Some of whom have dementia related conditions. There were 11 people living at the home at the time of our inspection.

The provider is a husband and wife partnership, Mr and Mrs AG Burn. Mrs Burn is also the registered manager. The home has been open since 1990 and Mrs Burn has always been the registered manager. Their son, who we refer to as the assistant manager throughout the report, played an active role in the service. A registered manager is a person who has registered with the 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.

The premises were safe and well maintained. Checks, tests and assessments had been carried out on all areas of the premises. These included water, electrical installations and portable electrical equipment. No concerns were noted.

There were sufficient staff on duty at the time of our inspection to meet people’s needs. Night time staffing levels had been assessed to ensure that people could be evacuated safely in an emergency. There had been no changes in staff since our last inspection. Staff confirmed that safe recruitment procedures were followed.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. There were no ongoing safeguarding concerns. There was a safe system in place for the receipt, storage, administration, recording and disposal of medicines.

Comprehensive audits and checks were carried out to monitor all aspects of the service. These were carried out daily and covered areas such as medicines, accidents and incidents, infection control and health and safety.

Records relating to people, staff and the management of the service were stored safely and completed accurately. The provider used a computerised management system which they had personalised to record and store people’s care records.

The manager informed us that ‘residents’ and relatives’’ meetings were not well attended so they were looking at different ways to communicate with them. She said they were introducing an email survey to see if this would be more successful. She told us, and people and staff confirmed that she was always around and any issues were dealt with immediately.

Staff told us that morale was good and they enjoyed working at the home. They said they felt well supported by the management team.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We found equipment was regularly serviced and tested to make sure it was safe and working effectively. There were enough staff on duty to meet the needs of the people living at the home. Staff personnel records contained information required by the Health and Social Care Act and this demonstrated people were suitable to work in the home. Staff received training to equip them with the skills to provide appropriate care and support to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff were aware of when an application should be made and how to submit one.

The provider had in place effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls or of developing.

We saw there were systems in place to ensure any repairs or failures in equipment were addressed promptly.

Is the service effective?

People told us they were happy with the care that was provided and their needs were met by the staff team. One person told us, 'I am very happy living here. I find the staff are very kind and helpful. They know what support I need and respect my privacy and dignity." People's health and care needs were assessed with them and they were involved in this process. We saw that particular needs were identified for example, skin care or dementia care in individual's plans. Staff training was provided that took account of the needs of the people in the home. For example we saw training in dementia and catheter care had been provided.

Is the service caring?

We saw staff responded kindly and promptly to people. Care workers were patient and encouraging to people as they assisted them. People told us, 'This is a small home and the staff are as well known to us as we are to them. This means we get good support and individual attention.' People's preferences, interests, aspirations and diverse needs were recorded and staff were able to give examples of these when we spoke to them.

Is the service responsive?

We saw evidence that the care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that concerns about people's health were quickly identified and action taken to seek and act on advice from health professionals.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person had their dog living with them and enjoyed daily walks either on their own or with a care worker if the weather was inclement.

Is the service well led?

The staff we spoke to were all aware of the complaints, safeguarding and whistle blowing procedures. All of the staff said they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this. Staff had regular supervision and staff meetings which meant they were able to feedback to the management of the home their views and suggestions. Staff we spoke with confirmed their views were listened and account was taken of them.

We saw relationships between staff and people were good and there was a relaxed atmosphere.

People's needs were assessed and care and treatment delivered in line with their individual care plan.

People told us the food was good. We saw people were supported to be able to eat and drink sufficient amounts to meet their needs.

The home was clean and no odours were evident. People were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection.

We saw staff responded to requests for assistance promptly. There were enough qualified, skilled and experienced staff to meet people's needs.

There were effective systems in place for assessing the quality of the service and these included the use of questionnaires completed by people who used the service. We were satisfied that people, their representatives and the staff were asked their views about the service and the provider took account of them.