We carried out a review of the data available to us about Albert House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Albert House Nursing Home, you can give feedback on this service.
We found the following examples of good practice.
Safe practices were in place to support visits to the care home. Visitors were greeted on arrival. Visitors were required to undertake a COVID 19 lateral flow test (LFT) and wait for the result, before they entered the care home. When they entered the home, their temperature was checked and they were asked to confirm their current health status. They were asked to clean their hands and supported to put on the personal protective equipment (PPE) provided. This included aprons, masks and gloves.
Prominent signage and guidance was displayed throughout the home. Visitors were directed to the area of the home they were visiting, to ensure they had no contact with other people living in the home, and minimal contact with staff.
The director and the registered manager communicated changes and provided updates for relatives on a regular basis, using an electronic communication system. They provided clear guidance and set out the care home expectations. This meant relatives would know clearly how any changes would be implemented, and what it would mean for them.
People were also supported to keep in touch with relatives by phone and video calls. They were provided with group and individual activities, facilitated by the two activity coordinators. The recent activity and engagement programme had focussed on the provision of one to one support. This was because, until the day before the inspection, people had all been isolating in their rooms.
Isolating and cohorting was used to manage the spread of infection. This meant people could be safely isolated, with a dedicated and consistent small team of staff to support them. New admissions were planned for the week following the inspection. People would be tested for COVID 19 prior to admission and when they were admitted. In addition, they would also be isolated in their rooms for 14 days.
The registered manager told us they also tried to mitigate the risks of the spread of infection, with enhanced cleaning of frequently used surfaces. Cleaning schedules and records were completed by the housekeeping team. The home was clean and tidy and free from unnecessary clutter.
A regular programme of testing for staff and people who used the service, was in place. This meant prompt actions could be taken if positive results were received. In addition, 29 people who used the service and 19 members of staff had received at least one dose of the COVID 19 vaccine.
The clinical manager spoke positively about the support and guidance they had received from the Local Authority and CCG support teams and the GP practice. They also told us they felt, 'very proud' of their staff team. They said they had worked incredibly well as a team, since the onset of the pandemic. They had not used agency staff for approximately 12 months. Staff had worked flexibly, often changing or working additional shifts if needed. This was because they wanted to ensure people received care and support from staff who knew them well.
Staff had received Infection Prevention and Control training and were provided with workbooks and regular updates. There were sufficient supplies of PPE, that included gloves, aprons, masks, face visors and hand sanitisers. Regular detailed audits and checks were completed by the management team. We saw evidence of actions taken when shortfalls were identified. Policies, procedures and risk assessments related to COVID 19 were detailed and up to date. This all supported staff to keep people safe.
There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
Medicines were in the main managed safely. However, PRN (as required) protocols were not in place. PRN protocols provide information for staff on when and why people might require additional medicines and should also include information for staff on how to recognise when people might need them.
People’s rights were upheld under the Mental Capacity Act 2005. However the computer software led to some conflicting recording which the provider rectified following the inspection.
The provider had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA).
There were sufficient numbers of suitably qualified staff employed at the service. The provider's recruitment process ensured that only staff deemed suitable to work at the home were employed. Staff did not commence working in the home until all pre-employment checks had been satisfactorily completed.
Environmental checks had been undertaken regularly to help ensure the premises were safe.
People were supported to maintain good health as staff had the knowledge and skills to support them. There was prompt access to external healthcare professionals when needed.
Staff supported people in a respectful, kind and caring way and involved them as much as possible in day to day choices and arrangements. Enabling relationships had been established between staff and the people they supported. We observed that people's privacy and dignity was respected at all times.
People undertook activities personal to them and were supported in what they wanted to do. They maintained contact with their family and were therefore not isolated from those people closest to them.
Staff felt well supported and said that they would not hesitate to speak to the manager if they needed to. The registered manager encouraged an open line of communication with their team.
The provider had systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.
The inspection was unannounced, which meant the staff and provider did not know that an inspection was planned on that day.
This location is registered to provide nursing and personal care and accommodation for up to 38 people. At the time of our inspection 36 people used the service. The location provided four rapid response beds for people who required an emergency discharge from hospital.
The home did not have a registered manager at the point of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The provider told us and we saw that the manager had submitted an application to become registered and they were awaiting a response from CQC.
During our observations at lunchtime we found that most people’s individual needs had been met. We observed one person who was leaning to one side. Staff had not supported the person to move to an upright position to eat their meal, to ensure they were not at risk of choking or poor digestion.
People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints. We found that one person's complaint had not been resolved to their satisfaction.
In care plans that we looked at we could not find written evidence that people and those acting on their behalf were involved in the assessment and planning of people’s care.
The provider had ensured that people were safe at the home. There was enough staff to meet the needs of people who used the service. Staff received on-going supervision and appraisals to monitor their performance and development needs.
Staff were kind, caring and respectful to people when providing support and in their daily interactions with them.
There were audit processes in place intended to drive service improvements.
The manager and staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This legislation sets out how to proceed when people do not have capacity and what guidelines must be followed to ensure people’s freedoms are not restricted. The manager told us she had recently attended training in light of changes in the interpretation of DoLS legislation following the Supreme Court judgement, to ensure that best practice guidelines were followed. The manager discussed examples where DoLS applications had been made for individuals to ensure they provided care in the least restrictive way for those people.
Records showed that we, the Care Quality Commission (CQC), had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.
We saw there were the necessary arrangements for the management of risks associated with infection. However there were no specific infection control audits as recommended by the latest department of health guidance . Staff demonstrated a good understanding of good practice around infection control.
Monitoring and auditing of medicines were in place to ensure medicines management was effective and safe. Action had been taken in response to a pharmacy audit in relation to some prescribed medicines. There were inadequate storage arrangements which meant that the effectiveness of medicines could be affected.
We looked at how care staff were deployed because of comments made to us by care staff. We saw care staff were undertaking tasks which impacted on their availability to meet people's needs effectively.
We found from the records and evidence we looked at that the provider is now compliant with Outcome 4. New arrangements and improved practice around recording had been implemented and actioned. As part of our inspection process we may look at Outcome 4 when we next inspect the service. This will provide us with evidence that the improvements which had been made were sustained.
We found that people's care needs had been assessed and reviewed so that care plans accurately reflected the health and social care needs of the person. However we found that people's health and welfare were potentially at risk because of failures to record the completion of care tasks.
People told us they felt safe in the home and how staff were, "kind and thoughtful". We found that staff had a good understanding of their responsibilities in relation to reporting any concerns they had about possible abuse. All staff had completed safeguarding of vulnerable adults training so that they had the knowledge and skills to respond to any concerns or allegation about possible abuse.
We found that staff received the necessary level of training so that they could perform their role in a professional and competent manner. We found a failure with the providing of one to one supervision but noted new arrangements had been put in place in an attempt to improve the one to one supervision of staff in the home.
We found that the provider had effective systems to monitor and review the quality of care provided in the home.
People told us 'we stay in the lounge to watch TV, as we don't have to be in our room all day'.
People told us they felt safe and were very well looked after 'especially at night when the staff look in to see if I am ok'.
Another person told us they liked to be independent and do get taken out sometimes. 'I can go out but need to have someone with me, we sometimes go to the park'.
People did tell us that they sometime had to wait for bells to be answered and sometimes were left in bed waiting for a shower.
People told us that they get enough to eat and drink with many commenting that the food is very nice and there is always a choice.
We have asked the provider to make some improvements in three areas in order to sustain compliance with all of the essential quality and safety standards.
When peoples needs have changed staff need to demonstrate that this is recorded.
All relevant checks and recruitment procedures need to be complied with.