Archived: St Albans House

People’s experience of using this service:

St Albans House has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People were supported to take their medicines in a safe way. Risks to people were identified and mitigated.

There were enough staff who had appropriate training to support people and it was clear to see people felt relaxed and comfortable in the company of staff. Peoples health was well managed and staff had links with professionals, which promoted well-being for them.

People had a choice of what they had to eat and drink. Refreshments were available throughout the day and people were encouraged to make their own drinks and help prepare meals. 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 provided care and support in a caring way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

The service was well-led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis. The service was currently being sold to a new provider, staff reported communication about these changes had been excellent.

Rating at last inspection: Good (report published 15 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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

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

The service had 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.

Staff had a thorough understanding of the processes for keeping people safe, and had undertaken and regularly refreshed their training on safeguarding vulnerable adults. There were very detailed risk specific risk assessments in place, which identified the risk, the potential outcomes and the actions which needed to be taken to minimise the risk as far as practicable. There were safe recruitment processes in use in the service, with all appropriate checks being carried out prior to staff commencing work.

There were sufficient staff deployed, to not only meet people's needs safely but also to ensure people were able to participate in activities which they enjoyed and which enriched their lives.

Medicines were managed safely and the service was very clean. The service was nicely decorated. People who lived at the service chose the colours for all areas of the home. The equipment was of good quality and there was a programme of monitoring and replacement for all aspects of the home.

All staff had received a comprehensive induction and received regular refresher training to ensure they had up to date knowledge. Staff told us the training was interesting and effective.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

People were supported by staff who supported them to make day to day decisions. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Three people at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to nutritious and healthy meals and drinks. People who lived at the service were able to choose the meals which would be served as part of their inclusion in the running of the home.

We saw staff were kind, caring and very considerate. Staff treated people with dignity and respect and there was an obvious fondness between staff and people who used the services.

Care plans were very detailed and person centred. There was evidence throughout of people's likes, dislikes and preferences.

The registered manager was very visible in the service and was clearly a very regular presence in the home. The service’s ethos was that of delivering high quality services which improved the levels of independence and confidence of the people who lived there.

There were robust policies and procedures in place, which incorporated the organisation's vision and values. There was regular monitoring and auditing of all aspects of the service to ensure any issues were picked up. Where there had been any issues highlighted there were clear records of the actions which had been taken in response and the outcome. The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

As part of our inspection, we spoke with four people who used the service, the manager and three staff working at the service. We also spoke with one person's relative. We observed people receiving support and looked at the care records for three people. We considered our inspection findings to answer the questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is it safe?

The people we spoke with told us that they felt safe and secure. One person said, 'I know I can talk with the manager if I have any problems.' One relative said, 'My family member is safe there.' Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm.

People were protected from the risk of abuse as staff were able to describe the different types of abuse people might experience and they had received appropriate training.

The provider and staff recognised their responsibilities under the Mental Capacity Act (MCA) 2005 and had taken action to ensure that 'best interest' decisions had been taken where necessary. The MCA provides a legal framework about decision making and having capacity means being able to make your own decisions. The provider had made an appropriate submission for a Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards are in place to minimise the risks of people being unlawfully deprived of their liberty in order to ensure their safety

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is it effective?

People we spoke with told us, and our observations confirmed, that people were happy and confident living at St. Albans House. One person said, 'I like it here.' We saw people smiling and talking confidently with staff about the activities they had been doing during the day. Staff who worked at the service told us they really enjoyed their job, that they had received good training and were well supported by the management team.

It was clear from our observations, and from our conversations with staff and the manager, that staff knew people's needs well. Care plans gave staff detailed guidance about the ways in which each person's needs should be met. This included information and guidance on how to support people to maintain a nutritious and well-balanced diet

Is it caring?

We saw that staff people related well with the staff, who supported them in a professional way, with respect and in a kind and friendly manner. We saw that personal care was offered in a way which ensured that people's privacy and dignity were respected and also respected each person's preference for how their care was provided. One person's relative said, 'I am very happy with the care. They look after my family member very well.'

We observed that people's views were listened to. The staff we spoke with had a thorough understanding of the complex needs of the people who used the service and demonstrated a desire to support each person to enjoy a good quality of life.

Is it responsive?

People's needs were regularly re-assessed and reviewed by the staff at the home and each person was involved in the review of their care plans. Support plans included people's preferences and their likes and dislikes. This was done to ensure care and support was delivered in the way people wanted it to be.

People participated in a range of activities of their choice, both at the service and in the local community. Staff demonstrated that they provided person centred care and support which fully responded to people's individual needs. This included supporting people to attend appointments and supporting them to engage in activities. People were supported to maintain contact with their relatives. One person's relative said, 'I am happy with the staffing levels. My family member always has one to one support and is out and about everyday.'

Is it well-led?

There was effective leadership in place. This ensured that people's needs were met and that they were kept safe. Staff were well supported. The provider had a range of quality assurance and audit systems in place to ensure that all aspects of the service were monitored and improvements made where necessary.

One person's relative said, 'If anything happens they always tell us. We are always kept well-informed.'

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

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

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with the requirements of the Mental Capacity Act 2005.

We reviewed four people's care records and found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We also found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

As part of our inspection we found that there were effective systems in place to reduce the risk and spread of infection. We saw that appropriate checks were undertaken before staff began work. There were effective recruitment and selection processes in place.

People's care records were accurate and fit for purpose. Staff records and other records relevant to the management of the services were updated regularly and reflected the needs of the service. Records were kept securely and could be located promptly when needed.

During our discussions with staff we found that they had a good understanding and awareness of people's care needs and preferences and they were enthusiastic about providing a good quality of service to people living at the home. One relative told us, 'They really understand X's care.'

The care records we looked at included detailed information on how people's needs were to be met by staff. Staff and relatives told us some people who lived at the home enjoyed their independence and often went out shopping or travelled into town. We saw evidence from the records we looked at that people received the support they needed to maintain their independence.

There were policies and procedures, records, and monitoring systems in place for the protection of people who used the service. Staff were trained and well supported by the manager so that they could carry out their caring responsibilities effectively. We found that the provider had systems in place to monitor and respond to any complaints received by the home.