Albury Care Homes Limited

Albury Care Homes Limited (Albury Care Home) is a residential care home providing accommodation and personal care to up to 33 people. The home provides support to older people with physical and health related support needs, some of whom live with dementia. At the time of our inspection there were 26 people using the service.

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

People were protected from abuse, neglect and avoidable harm and received care which empowered them to keep well and to live the life they wanted. Staff knew people, their individual risks and capabilities and provided safe support. People had clear care plans in place.

Staff knew how to support people safely with their medicines. The provider ensured lessons were learnt from any adverse events in the service and from people’s, their representatives and staff feedback. The management team followed up on those lessons learnt which had improved the home and people’s experience.

New staff were recruited safely and there was enough staff to support people timely. Staff adhered to good infection prevention and control.

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.

The provider reviewed their management structures and ensured there was good, hands on leadership available on a day-to-day basis in the home. The systems and processes of quality and safety monitoring were improved, and additional support of a care consultant was sought by the management. Staff completed regular checks and audits, worked well with other health and social care partners and took action to improve when needed.

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 02 December 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 27 October 2020. 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 medicines management and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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 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 requires improvement to good. 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 Albury Care Homes Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Albury Care Homes Limited is a care home registered to provide accommodation for up to 33 older people who require personal care. The service supports older people who have dementia. On the day of the inspection there were 28 people using the service.

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

We found that risks to people were not always assessed consistently across the service. Medicines were not always being managed safely for people. We found that staff were not always being deployed in a structured way to ensure people received consistent and timely care.

We found that there had been a lack of management oversight with the service which had resulted in quality audits not being robust enough to identify the issues we found at the inspection. It was also difficult at times to obtain information in a timely manner during the inspection.

Feedback had not always been sought from people and relatives, but this had also been due to prioritising safety around Covid-19. The registered manager assured us that this process would be restarted again.

People told us they were happy living in the home, and they felt that staff were kind, caring and supportive when they were available. However, people we spoke to told us they often had to wait for staff to support them with personal care or lunch.

Relatives told us they were happy with the level of contact from the registered manager and the staff. Relatives said staff were kind and caring when they had been able to visit the home prior to Covid-19 and also felt that the information around the pandemic had been communicated well.

A visiting healthcare professional gave positive feedback about the management of the home.

The registered manager was receptive of feedback and stated that lots of work had been identified where improvements could be made. The provider had recruited a consultant to assist with identifying and driving areas of improvement. The registered manager had developed a service improvement plan around the areas requiring improvement. Following our inspection, the registered manager sent us an updated plan which contained our feedback for additional areas to improve.

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 03 November 2017).

Why we inspected

We undertook this focused inspection in part to respond to concerns raised to us 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 Good 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering

what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to

hold providers to account where it is necessary for us to do so.

We have identified two breaches of regulation in relation to safe care and treatment and good governance at this inspection.

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 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.

The service had a registered manager 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.

The service was inspected previously on 26 July 2016 and placed in ‘special measures’. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be in the same question at each of these inspections for us to place services in special measures. The registered provider sent us action plans and regular reports about the steps that were being taken to make the required improvements.

Another inspection was carried out on 24 January 2017 and although improvements were found, the service was in breach of the regulations. The service was given an overall rating of ‘requires improvement’ with an ‘inadequate’ rating in relation to the ‘well-led’ key question. This was because the service had failed to implement robust recruitment processes to ensure staff were safe to support people. The service had also failed to ensure the environment and facilities were safe for people who lived at the service and dependency tools did not consider the aspects of the lay out of the home, ancillary staff and hours for activities.

At this comprehensive inspection we found the provider had made improvements in relation to the safety of the environment, employment of ancillary staff, staff suitability to work with people living at Albury Care Home, care records, audits and the registration of a permanent manager.

Procedures in place protected people from harm and abuse. Staff had sufficient knowledge of how to identify, report and escalate suspected abuse and received on-going safeguarding training to keep people safe. Risk management plans in place gave staff clear guidance on how to support and respond to identified risks. Risk management plans were reviewed regularly and amendments shared with staff.

The service carried out regular checks of the environment to keep people safe. Records confirmed that issues identified were documented and action taken to address them in a timely manner. Emergency plans identified people’s needs and how staff should support them in the event of a fire. The service had a schedule to monitor and make improvements to the environment which was on-going.

People received support from suitable numbers of staff to keep them safe. Staffing levels were determined around the needs of people and, where those needs changed, staffing ratios were increased to keep people safe. The service had systems in place to ensure suitable staff were employed and vetted in line with good practice. Staff received on-going training to effectively meet people’s needs. Training included fire safety, safeguarding, medicines management and Mental Capacity Act 2005 (MCA).

People’s medicine was managed safely and in line with good practice. Medicine administration records (MAR) were completed correctly with no omissions or errors noted. Stocks and balances indicated people had received their medicines as prescribed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We checked whether the service were supporting people in line with the MCA and found their policies followed the legislation.

The service ensured people’s consent was sought prior to care and support being delivered. People were encouraged to make decisions and were given information in a manner they understood to make informed decisions. People’s decisions were respected and where possible implemented into the delivery of care.

People’s health and wellbeing was monitored and action taken to address concerns identified were taken in a timely manner. People were supported to access food and drink that met both their dietary needs and requirements.

People described staff members as, ‘great’, ‘kind’ and ‘compassionate’. Staff were observed as treating people with dignity and respect and encouraging them to be as independent as possible. People had their privacy maintained.

People’s confidentiality was maintained. Records were stored securely in locked cupboards with only authorised persons having the code. Staff spoke in quietened voices when talking about people, ensuring confidential information could not be overheard.

People received personalised care, where people and their relatives were encouraged to participate in the development of their care plans. Care plans were comprehensive, reviewed regularly and gave staff guidance on how to deliver care in a way that met their needs.

People were supported to participate in planned activities, both in the home and in the local community. An activity schedule was located in the communal areas whereby people could choose to participate or not.

The service had a complaints procedure that gave people and staff guidance on how to raise their concerns, what to expect and how to escalate their complaint if they were dissatisfied with the outcome.

People spoke positively about the registered manager confirming she was approachable, supportive and had made positive changes to the service since the last inspection.

The service devised regular audits to monitor and drive improvements within the home. Audits were detailed and issues identified were acted on in a timely manner. The registered manager then reviewed all audits and where appropriate an action plan was implemented and timeframe for work to be completed in place.

The registered manager actively sought partnership working from other healthcare professionals. Feedback from healthcare professionals, people and their relatives were sought and where appropriate implemented into the delivery of care.

Albury Care Homes Limited provides support and accommodation for a maximum of 33 older people who require residential care. The home provides both permanent and respite services. At the time of the inspection there were 17 people living at the home. Some of the people were living with dementia.

The home does not have a 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 previous registered manager left in July 2016. A new manager was appointed but left at the beginning of January 2017and before they had completed the registration process with us. A further new manager had been recently appointed and was present during this inspection.

Albury Care Homes Limited was last inspected on 26 July 2016 when it was given an overall rating of ‘Inadequate.’ The service was placed in ‘Special Measures’ and Warning Notices were issued due to unsafe facilities, the environment and for poor management systems and governance. Requirement actions were also set due to concerns that were identified with staffing, personalised care, safeguarding and complaints. The registered provider sent us action plans and regular reports about the steps that were being taken to make the required improvements.

As a result of this inspection the overall rating for this service is ‘Requires Improvement.’ However, we are placing the service in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

At this inspection we found that improvements to the environment, safeguarding, complaints and personalised care had taken place. Steps had been taken to improve governance, management and staffing but these had not been sustained. People and staff said the manager was approachable but that stability was needed. The home had been without a registered manager since July 2016 and the registered provider had not ensured compliance with the regulations, or that actions were taken to assess and mitigate all risks to people’s welfare. Full information about CQC’s regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

Quality monitoring systems had not ensured all aspects of the service were assessed, monitored and prompt action taken to address shortfalls. Fire safety management had improved but audits and governance systems had not identified where further work was required. Records were still not

accurate. These included care records, staff training records and rotas. There were still no separate domestic, laundry, kitchen or activity staff and care staff were responsible for undertaking these duties in addition to caring for people.

Improvements to the environment and facilities had taken place but aspects were still unsafe or affected the quality of service people received. Some areas of the home were cold and the heating was ineffective. Aspects of fire safety management still needed to be improved.

Robust recruitment processes were not always followed to ensure staff were safe to support people. This was a breach of Regulation 19 of the Health and Social Care Act (Regulated Activities) 2014.

Checks on the electrical wiring in the service, moving and handling equipment and water safety systems had taken place. Food temperatures were now being monitored to ensure it was safe for people to eat and the kitchen had been deep cleaned.

People said that they felt safe and we observed that they appeared happy and at ease in the presence of staff. Safeguarding concerns had been reported appropriately to the local authority and to CQC when required.

People said that they were happy with the care and attention they received and we found that people’s health and care needs were managed effectively. Appropriate arrangements were in place in relation to the recording, storage and administration of medicine to help people look after their medicines safely. People in the main, received responsive care based on their individual needs.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems were in place to support this practice.

People said that the food at the home was good and that their dietary needs were met. There was a quiet and calm atmosphere during lunch; no one was rushed. Staff checked that people were satisfied with their meals and offered support throughout. Since our last inspection there had been an increase in the choice of fresh food and snacks people could access.

Staff said that they felt fully supported and that they received training and supervision relevant to their roles and responsibilities. Since our last inspection staff had been provided with training in areas that included infection control, moving and handling and safeguarding.

Everyone that we spoke with said that staff treated them with kindness, dignity and respect. There was a relaxed atmosphere throughout the inspection which benefited people who lived at the home. We observed instances of genuine warmth between staff and people. Staff were able to explain how they respected people’s privacy and dignity.

People said that they were involved in making decisions about their care as much as they wanted to be. Since our last inspection the frequency of residents meeting had increased which offered people more opportunities to be involved in decision making processes.

Since our last inspection improvements to the range of activities had taken place. People appeared to enjoy the activities that took place on the day of our inspection.

Systems for identifying, recording, handling and responding to complaints had improved. Records now included evidence of actions taken to investigate and resolve complaints. People said were aware of their rights to raise concerns or complaints.

This was an unannounced inspection which took place on 26 July 2016.

During our inspection the registered manager was present. 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.

Albury Care Homes Limited was last inspected on 07 December 2015 when it was awarded an overall rating of ‘requires improvement’. Five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to recruitment, staff support, safe care and treatment, person centred care and quality assurance. Requirement actions were set and the provider sent us an action plan that informed us of the steps that would be taken to become compliant with the regulations. The domain of well led was rated as ‘inadequate’ and this is the reason the latest comprehensive inspection took place. We needed to check to see if the required improvements had taken place at the home.

At this inspection we found that management of the home was ineffective and that there had been a further decline in aspects of the service. Although some attention had been given to fire safety, replacing windows and carpets many other aspects of the environment were unsafe. These included locked fire exit doors, combustible items stored next to electrical installations, a lack of emergency lighting, excessive water temperatures, poor infection control practices and cleanliness.

The registered manager could not produce a number of records or certificates that would confirm the environment and facilities were safe. We requested that this be sent to us within 24 hours of our inspection. We received some within this timeframe but the majority were sent to us after. Many of the documents sent to us did not demonstrate that regular and effective checks were made. We took enforcement action in response to this and served a Warning Notice on the registered provider.

After our inspection we shared our concerns with Surrey County Council safeguarding team, Quality assurance department, the environmental health department and Surrey Fire and Rescue Service.

The registered manager had completed audits to monitor the quality of service but these had not identified any concerns and did not reflect our inspection findings. Therefore they were ineffective at driving improvements. This was the same as at our previous inspection. We took enforcement action in response to this and served a Warning Notice on the registered provider.

There was still a lack of stimulation and no opportunities for people to go out into the community. The registered manager had assessed one person and allowed them to move into the home knowing they could not meet their needs which left them isolated and unable to communicate with staff. You can see what action we told the provider to take at the back of the full version of the report.

Although people said that their care needs were met staffing numbers meant that staff did not have time to sit and talk to people as they were focused on delivering care and completing domestic and kitchen tasks. Shifts were not always covered when staff were on leave and this impacted on the quality of service provided. You can see what action we told the provider to take at the back of the full version of the report.

People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. However, the registered manager had not always ensured prompt action was taken when concerns were identified or raised. You can see what action we told the provider to take at the back of the full version of the report.

Some improvements had been made since our last inspection. Robust recruitment procedures had been followed to ensure all staff, including agency staff were safe to support people. Staff were now being provided with formal supervision and training specific to the needs of people who lived at the home had been provided.

As at our last inspection people said that they consented to the care they received. Correct procedures had been followed if people lacked capacity and were being deprived of their liberty in anyway. Further attention to ensure assessments are regularly reviewed should be given.

People said that in the main they were happy with the choice of food and drink in the home. Further consideration should be given to expand the choices available at breakfast and dinner.

People said they were treated with kindness and compassion. Our observations supported the views of people. Staff were seen to be respectful to people, talk to them kindly and to promote their dignity and privacy when providing care. This is the same as at our last inspection.

Medicines were administered, recorded and stored appropriately and people’s health care needs were managed effectively.

Risk assessments and care plans were in place that considered potential risks to people. However, the content and quality of information in care records varied. The home had been receiving support from Surrey County Council Quality Assurance team to develop its care planning systems. This was still a work in progress at the time of our inspection.

“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

One of the people we spoke with told us that they had celebrated a birthday since our last inspection in May 2013. The staff at Albury Care Home Limited had organised a party which the person had very much enjoyed. The person told us, "They look after me very well and they are pretty good".

One member of staff told us "We are going through a difficult patch at the moment because of people taking leave but things have improved". A second member of staff said "It is better than it was".

As part of our visit we viewed staff rosters, past, present and future and found that staffing levels had been increased. We inspected care records and found that they were current and had been fully completed.

You can see our judgements on the front page of this report.

We found people's consent had been obtained prior to care and treatment being provided. We found people's care needs and risks had been assessed and care plans which reflected these personal needs had been created. All staff had been trained in safeguarding and information relating to the reporting of concerns was easily accessible. Staff had been appropriately recruited and appropriate checks had taken place prior to them starting work, however, there were not enough staff to safely care for people. The service had a statement of purpose in place which contained all required information.