Albert House

We found the following examples of good practice.

¿ The provider had created an online portal, which allowed the registered manager to access all guidance, policies and procedures in one place. The Business Continuity Plan had also been updated to reflect the Covid-19 pandemic.

¿ The provider had created a charitable fund to top-up statutory sick pay, in the event staff were required to self-isolate.

¿ Staff had access to all required Personal Protective Equipment (PPE) and had received training in donning and doffing procedures. Staff were seen to be maintaining social distancing appropriately.

¿ The service had been providing ‘garden visits’ with robust infection control procedures in place. Visits were limited, temperatures checked, and infection control measures followed.

¿ People’s wellbeing had been prioritised. A sensory space had been created within the home, which people were enjoying on the day of our visit. The registered manager also described the various arts and crafts and gardening activities, which had taken place at the service.

Further information is in the detailed findings below.

A registered manager was in post. 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.

This inspection took place on 24 August 2017 and was unannounced.

At the last inspection in July 2015, the service was rated Good. At this inspection we found the service remained Good overall, but with one area for improvement.

Despite systems being in place to ensure the service acted in line with legislation and guidance in terms of seeking people’s consent and assessing their capacity to make decisions about their care and support, people's finances were not always managed in line with Best Interest decision making processes.

Why the service is still rated Good:

Staff had been trained to recognise signs of potential abuse and keep people safe. Processes were also in place to manage identifiable risks within the service to ensure people were supported safely and did not have their freedom unnecessarily restricted.

There were sufficient numbers of suitable staff to keep people safe and meet their needs and checks were being carried out on new staff to make sure they were suitable and safe to work at the service.

People received their medicines when they needed them and in a safe way.

Staff received the right training to ensure they had the necessary skills and knowledge to meet people’s needs.

People had a choice of food, and had enough to eat and drink.

The service worked with external healthcare professionals, to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff provided care and support in a caring and meaningful way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people’s privacy and dignity, and treated them with kindness and compassion.

People were given opportunities to participate in meaningful activities.

Arrangements were in place for people to raise any concerns or complaints they might have about the service. People and relatives were given regular opportunities to express their views on the service they received.

The management team provided effective leadership at the service, and promoted a positive culture that was open and transparent.

Systems were in place to monitor the quality of the service provided and drive continuous improvement.

Further information is in the detailed findings below.

The inspection team for this inspection gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well- led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

We found that the home had a safeguarding policy in place which was in accordance with local multi-agency policies. Staff were noted to be aware of the different types of abuse and what action to take if they suspected abuse had taken place. We saw that systems were in place to ensure that lessons were learnt from safeguarding investigations. This reduced the risk to people and helped the service to continually improve.

We found that care records and assessments relating to people's risk factors were appropriately maintained and updated on a regular basis. They enabled staff to provide consistent care to people, that was reflective of their needs.

Is the service effective?

We found that people's needs had been assessed before admission to the home. People or their relatives, when appropriate were involved in the planning and development of their care plan, although we found that not all of those we reviewed had been signed.

Staff spoken with said that they had been provided with appropriate induction training and the records seen supported this. We found that supervision and appraisal for staff was now more regular than on our previous inspections. This demonstrated that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

Is the service caring?

We observed six people being supported by staff. We found that people appeared relaxed in the presence of the staff that supported them and asked them for their opinions about the assistance they required, in a way that they could understand. This demonstrated that staff had developed a caring and positive relationship with the people they supported.

Is the service responsive?

The staff we spoke with said that they knew how to make a complaint or raise a concern, however not all of them had confidence in the provider's ability to take action. We found in care records that people had an easy read complaints policy and we also saw a copy of this displayed on the notice board. We observed that the home maintained a record of complaints and that past ones had been investigated. There were no current complaints but our review of previous issues evidenced a clear audit trail of the outcome of the investigation to verify that complaints had been resolved to people's satisfaction.

Is the service well-led?

We found that the home had quality assurance processes in place which were generally well embedded into staff practice. Quality assurance processes were in place to ensure that people received a good quality service. Records showed that staff had attended training and were supported with regular supervisions by the manager.

At the time of our inspection visit, the home did not have a registered manager in post. We were aware that an application had been received for processing by CQC. Staff spoken with said that they felt well supported and listened to by the home manager. They said that the manager operated an open door policy and was supportive of them, although some felt that their concerns were not effectively actioned or resolved. They did state that this did not impact upon people's care.

During our inspection in September 2013, we identified areas of non-compliance regarding administering and storing medicines and staffing numbers. We found the provider could not fully evidence the service had effective processes in place to protect people from poor quality care caused by inadequate staffing numbers and ineffective medicines systems.

We imposed compliance actions and told the provider they needed to make improvements. The provider submitted an action plan in October 2013, which stated they had implemented improved systems to ensure the identified areas had been addressed and that compliance would be achieved by November 2013.

On 16 December 2013, we found that people looked relaxed and well cared for, and we observed staff took time to talk with people. We spoke with two members of staff, including the new manager and found that staff were pleased with the recent changes that had taken place.

There were updated systems for management of medicines and we found that changes in staffing had benefitted the home and meant that people could enjoy increased activities because staff had more time to dedicate to people. The changes also meant that staff better understood their roles within the service.

We found that medicines were not always administered safely. There were no clear systems in place for the recording and receipt of medication within the home. We also noted that staff did not consistently maintain a clear audit trail of the medication held in the home.

protected people who used the service from staff who were not suitably qualified and skilled. We imposed a compliance action and told the provider they needed to make improvements in this area.

On 7 August 2013, we reviewed the action the provider had taken on the non-compliance. We observed that people were offered support at a pace which was correct for them. The staff were friendly and courteous in their approach to people and interacted positively with them.

We found that improvements had been made to address past issues with staff training and supervision. The manager had implemented a more regular system of staff supervision and we noted that there was a more comprehensive induction training programme in place for new starters. Refresher training for relevant subjects was also available to existing staff on a regular basis.

During our inspection we found issues with regards to staffing levels in the home and identified concerns that the number of staff on duty was not consistently sufficient to meet the needs of people living at Albert House. Staff told us that, "It is difficult to do all that we need to do at times, we are so busy and cannot always meet people's needs in the way we need to."

We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. The people we observed were happy in the company of staff providing care and support for them. One resident was engaged in looking at magazines which was their activity of choice. Another resident was offered a choice of music to listen to through their headphones. The atmosphere in the home was relaxed and people were at ease in their environment and with the staff who supported them.

The staff were polite and respectful in their approach to people and interacted appropriately with them using their preferred method of communication. We observed that staff encouraged people to make decisions about all aspects of their lives; including how they spent their time and what they had to eat or drink.

We did however note that there were gaps in the training and supervision records for staff. This indicated that some staff were not always appropriately trained or supported to meet the needs of people in this home effectively and safely although there had been no obvious impact upon people who lived at the home.

We observed the care and support provided to the people living at Albert House and found they were happy with the care they received. There was a relaxed atmosphere in the home and people were at ease in the company of the staff supporting them. The staff were friendly and polite in their approach and interacted confidently with people.

We observed some positive interaction between care staff and people using the service, which showed that staff understood the needs of the people they were supporting. We saw that people were offered support at a level which encouraged independence and ensured their individual needs were met.