Albert Residential Home

Albert Residential Home is a care home providing personal and nursing care to three people living with mental health needs and physical disabilities living in one adapted building. There were three people using the service at the time of our inspection.

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

We saw that improvements had been made to the way risks to people’s safety were assessed and monitored. The provider had acted upon concerns from the last inspection relating to fire safety and the management of people’s medicines. Although improvements had been made, we did see some gaps in the monthly auditing during the COVID-19 pandemic. More time will be needed to fully embed and maintain these changes across the service and to ensure they are consistently monitored.

People had individual risk assessments in place and staff knew people and their needs very well. People told us they felt safe living at the home and relatives also stated they felt their loved ones were safe. Safeguarding concerns were recorded and reported to the appropriate authorities in a timely manner. There were enough staff appropriately deployed both day and night to ensure people were kept safe. Effective infection control measures were in place and staff had received training in relation to protecting people during the COVID-19 pandemic.

There had been improvements made with the overall leadership and management oversight in the service. The registered manager had been open and accepting of support provided to them following the previous inspection. This included developing a service improvement action plan and ensuring this was completed. Although it did not have any impact on people or their care, some of the paper records around this were difficult to navigate. We spoke with the registered manager about this who stated they would review the paper records.

Staff felt supported and received training and guidance in their roles. The provider had ensured a range of resources were available to support the team in making improvements to the service.

The registered manager was receptive of feedback and stated that lots of work had been implemented following the previous inspection and inadequate rating. The registered manager had plans to further develop and obtain ideas and support from other local services.

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 Inadequate (report published 13 December 2019) and there were multiple breaches of regulation. These were regarding the safety of people’s care, how staff were deployed within the home and management and oversight of the service. The provider completed an action plan after the last inspection to show what they would do and by when in order to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements in relation to people’s safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

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.

Albert Residential Home is a care home providing personal and nursing care to three people living with mental health needs and physical disability living in one adapted building. There were three people using the service at the time of our inspection.

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

People were at risk of harm as there were unsafe arrangements for dealing with emergencies in relation to fire safety management. People’s dependency assessments were not carried out to determine staffing levels and to deploy adequate staff for day and night shift. People received their medicines but were not managed safely. People were not protected against the risk of infection. There was no system and process to prevent reoccurrences of incidents and accidents. People were not supported to access information in a way they understood. People were not cared effectively. People were not afforded meaningful activities to keep them simulated and access the community. The provider had a system to manage complaints. However, we noted the registered manager had not responded to the complainant in a professional way.

There was a registered manager in post, however, they did not understand their role and responsibility in line with the Duty of Candour. People did not receive a service that was well-led. There were systematic and widespread failings of the monitoring and oversight of the service. The provider had not notified CQC about a safeguarding investigation.

We have made two recommendations about the complaints management and completing person centred care plans.

Pre-admission assessments of people’s needs were in place. Staff were trained to ensure they had the appropriate knowledge and skills to meet people’s needs. People’s nutritional needs were met. People had access to local healthcare professionals including a GP surgery, district nurses, speech and language therapist and dietician.

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. Staff we spoke with understood the importance of gaining people’s consent before they supported them

People told us they were happy with the service and staff were kind and treated them with respect. People were involved in the initial assessment and planning of their care. People were treated with dignity, their privacy was respected, and were supported to maintain their independence.

People had care plans which described their likes, dislikes, interests, family and friends, communication, healthcare needs. People’s end-of-life preferences had been discussed with them, and care plans developed to ensure their preferences in this area were met

The provider sought people’s views through the use of satisfaction surveys and worked in partnership with a range of professionals and acted on their advice.

Rating at last inspection: The last rating for this service was good (published 26 June 2017).

Why we inspected: This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to fire safety management, adequate numbers of e staff, management of medicines, risk of cross contamination, to prevent reoccurrences of incidents and accidents, access to information in a way people understood, a meaningful activity to keep people simulated and access the community, notification to CQC, and there were systematic and widespread failings of the monitoring and oversight of the service found at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

There was a registered manager in post. The provider 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.

At the last inspection on 17 February 2016, we told the provider to take action on ensuring that the premises and equipment were suitable and well maintained. The registered manager had provided us with an action plan. We found on this inspection, improvements had been made and these actions have been completed.

There were sufficient staff to keep people safe. There were recruitment practices in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults. They knew how to report abuse, but a recommendation has been made to review staffs knowledge on identifying safe guarding concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as falls and moving and handling.

The registered manager had processes in place to review incidents and accidents and take action as necessary. Equipment that was in place to support people’s care was well maintained and clean.

The registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessments and best interest decisions had been completed. Staff were heard to ask for people’s consent before they provided care.

The provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Where appropriate applications had been made to the local authority. Improvements could be made in staff’s knowledge of the MCA.

People had sufficient to eat and drink.

People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. Staff received regular supervision.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

People, their relatives and health and social care professionals were involved in planning peoples care.

People’s choices and views were respected by staff. Staff and the registered manager knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in their care plans. Care plans contained information for staff to support people effectively.

There were activities in place which people enjoyed.

The home listened to staff, people’s views. There was a complaints procedure in place. Complaints had been responded to in line with the home’s policy.

The management promoted an open and person centred culture. Staff and people told us they felt supported by the registered manager.

There were procedures in place to monitor and improve the quality of care provided. The management understood the requirements of CQC and sent in appropriate notifications.

At the time of inspection, there were three people living at the home. This inspection took place on 17 February 2016 and was unannounced.

The service was run by a registered manager who is also the registered provider, who was present for part of the day of the inspection. ‘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 and associated Regulations about how the service is run.

One person who lived at the home said, “It’s nice and cosy and staff are friendly.” Another person told us that they “Try their best.” One relative told us that they were very “Pleased with the care and improvements they have noticed” in their family member since they moved into the home. One staff member told us that they were, “Very happy here and feel supported.”

There was positive feedback about the home and caring nature of staff from people who lived at Albert Residential Home.

Risks to people were not always acted upon. The registered manger had not sought the assistance of the Speech and Language Team (SALT) or a dietician to help minimise the risk of people choking while eating or drinking. Staff had limited written information about risks to people and how to manage these. We found the registered manager had not considered additional risks to people in relation to trips, storage of items such as additional hoists, commodes and choking.

Some adaptations have been made for people with mobility needs, such as rails and toilet seats. The registered manager and staff worked well to keep the feeling homely for people who lived there. It was however noted that the décor of the building looked tired and some areas were not clean. The bathroom and separate toilets were used as storage for items that the registered manager told us that they “may have a need” in the future.

Staff were not aware of the home’s contingency plan, in the event of a situation occurring that could stop the service running for example power cuts or floods. They explained actions that they would take to keep people safe in the event of a fire. People who lived at the home did not have personal evacuation plans in place.

The home did not have a robust system of auditing processes in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager told us that they had assessed incidents and accidents, staff recruitment practices, care and support documentation, medicines and decided if any actions were required to make sure improvements to practice were being made. However we found no evidence or an accident record for someone who had had a fall two days before the inspection visit.

Events that needed to be notified to the Care Quality Commission had not always been made by the registered manager.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Staffing levels were appropriate to meet the needs of people in the home. The registered manager had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received an induction and ongoing training, tailored to the needs of the people they supported. Staff were however seen to support people to keep them safe. People did not have to wait to be assisted.

Processes were in place in relation to the correct storage of medicine. All of the medicines were administered and disposed of in a safe way. Staff were trained in the safe administration of medicines.

People’s views were obtained by holding regular informal meetings and by communicating on a daily basis. People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some people’s health needs and language presented challenges and these were responded to with one to one support from staff.

People’s human rights were not affected as the requirements of the Mental Capacity Act 2005 was followed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. The provider was in the process of finalising DoLS documentation.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We were informed that staff had endeavoured to learn to cook specific ethnic meals for one person living at the home.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People had an individual support plans, detailing the support they needed and how they wanted this to be provided. We read in the support plans that staff ensured people had access to healthcare professionals when they needed. People’s care had been planned and this was regularly reviewed with their or their relative’s involvement. A relative told us “We have meetings with the staff regarding care and we are asked about our opinions.”

The registered manager told us how the people who lived at Albert Residential Home were involved in the day to day running of the home. It was clear from our observation that the managers knew people very well and that people looked at them as a person to trust. Staff felt valued under the leadership of the registered manager.

Complaint procedures were up to date and people and relatives told us they would know how to make a complaint. Confidential and procedural documents were stored safely but not fully accessible if the registered manager was not available.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; you can read at the back of the report what action we told the provider to take.

We carried out this follow up inspection to see if the provider had made any changes which ensured that people received their first choice of meal and that they stored and reheated food appropriately.

We saw that people were treated with respect and noted that staff knocked on doors before entering a room. We spoke to all three people who used the service as well as one relative and one care professional who was involved with the home. Each person told us they felt they were treated respectfully.

We observed lunch being served during our inspection. When we asked people about the quality and the choice of the food, we received mixed responses. We had some concerns about the way the food was stored.

We saw that the provider carried out appropriate checks when they employed staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

We noted the provider had made the complaints policy available to the people who lived in the home.

We saw that people experienced safe and effective care based on detailed care plans. There were risk assessments that met individual needs and provided good guidance to staff to minimise potential risks. We saw that good nutritional care was provided in a way that met people's needs and preferences.

People using the service were protected from abuse as the staff had appropriate knowledge and training on safeguarding adults. One person told us that if they had any concerns they would report them to the manager.

Staff we spoke to and records we reviewed, demonstrated that staff were suitably experienced, skilled and supported to ensure that people received care that met their needs. Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The provider had systems in place to monitor the quality of the service. The provider collected the views of families, other visitors and people who used services and they were very positive about the service. One visitor wrote that they observed how people appeared well care for and were happy.