Albany Park Nursing Home

Albany Park Nursing Home is a residential care home providing personal and nursing care to people aged 65 and over, some of whom were living with dementia. Albany Park Nursing Home accommodates up to 47 people in one adapted building. At the time of the inspection there were 45 people living at the home.

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

Premises were not maintained to a standard which promoted a good atmosphere. We found significant issues around identifying and acting on maintenance issues. Auditing processes failed to identify the concerns found at the inspection.

We had received concerns around restrictions on visiting and relatives needing to call and make a 1-hour appointment slot. The manager assured us this had happened in the past and was no longer in place.

We have made a recommendation around visiting procedures.

People had clear risk assessments which provided staff with information on how to minimise risks. Staff knew how to effectively work with people to keep them safe. People received their medicines safely and on time. There were clear systems in place to manage medicines. Staff received training and competency check around administration of medicines. There were enough staff on duty to ensure people’s care and support needs were met. People told us they felt safe at Albany Park Nursing Home. Staff had received training in safeguarding and understood how to report any concerns.

Staff were well trained, and we saw records of regular staff training. People were fully involved in choosing what they wanted to eat. People were complimentary of the chef and the quality of food that was provided. People were supported to maintain their health and well-being through routine and specialist healthcare appointments. 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.

People told us they felt safe and staff were kind and friendly and treated them well. People were encouraged to be part of planning their care. People were treated with dignity and respect. Cultural and religious beliefs were supported. Staff encouraged people’s independence and helped them do things for themselves around daily activities.

There was an activities coordinator in post, and we saw numerous activities on offer. People were fully involved in planning activities during weekly meetings. People had detailed and person-centred care plans which clearly documented people’s care and support needs.

People had good outcomes of their care based on the person-centred care people received. People and relatives’ feedback was valued and used to improve the service. Staff were positive about working at the home and felt supported. Staff worked in partnership with other healthcare agencies to improve and maintain people’s quality of life.

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 29 July 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 around person centred care, providing activities and adequate staffing levels.

At our last inspection we recommended that the provider follow the guidance, at the time around proper use of Personal Protective Equipment (PPE). Staff had not been wearing face masks properly which placed people at risk of infection. At this inspection there was no government guidance around the use of PPE as this had been lifted. Staff had access to face masks and wore them when appropriate.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement

We have identified breaches in relation to good governance of the home and maintaining the premises and equipment.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Albany Park Nursing Home is a residential care home providing personal and nursing care to people aged 65 and over, some of whom were living with dementia.

Albany Park Nursing Home accommodates up to 43 people in one adapted building. At the time of the inspection there were 32 people living at the home.

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

Throughout the inspection we observed people receive care and support that met their basic care needs. Relatives spoke positively in general about the care and support that their family member received. However, we found significant concerns around how the home was managed, low staffing levels, poor activity provision and aspects of health and safety which placed people at increased risk of harm.

Staffing levels found within the home did not match the levels which should be in place according to the provider’s own staffing dependency level assessment. Staff and relatives also stated that there were not enough staff available to ensure people’s needs were appropriately met.

People did not have access to activities which would provide stimulation and support their well-being. People did not always receive person centred care and support as per their needs and wishes.

Health, safety and the environment were not always well managed. We found a number of issues which placed people at risk of harm. Some care staff were seen not wearing face masks. Hand sanitising gel and cleaning materials had been left in areas which were easily accessible for people to take and possibly consume. The environment was in a poor state of repair.

There was a lack of managerial oversight of the home. Audits of care delivery were ineffective and did not identify the issues we found as part of this inspection. Written care records were not always a true record of the care people received.

We have made a recommendation about the appropriate use of PPE and the safe storage of chemicals.

Communication between the home and relatives was not effective with relatives telling us that they were not kept updated about their family members health and welfare. Visiting guidance and procedures had not been clearly communicated to relatives.

Risk assessments were comprehensive and detailed. Staff were provided with clear guidance and direction on how to minimise risk to keep people safe from the risk of harm.

People received their medicines safely and as prescribed. Systems and processes in place supported this.

Staff recruitment checks provided assurance that staff employed had been appropriately assessed as safe to work with vulnerable adults. However, we did find that the service did not always review criminal record checks in line with best practice.

Staff understood safeguarding and how to keep people safe from abuse. Staff told us that they received training to support them in their role.

Relatives knew who to speak with if they had any concerns or complaints to raise.

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 18 April 2019).

Why we inspected

We received concerns in relation to poor communication and the registered manager not being available at the home especially during the pandemic. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Albany Park Nursing Home on our website at www.cqc.org.uk

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report. We have identified three breaches of regulation around person centred care, staffing and good governance. We have also made a recommendation around the use of PPE and the safe storage of chemicals. The failings found are detailed in the main body of the report.

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.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

This inspection took place on 23 and 24 January 2019 and was unannounced.

At our last inspection we rated the service as ‘requires improvement’ overall. However, safe was rated as ‘inadequate’. At this inspection we found that identified issues had been addressed. The service is now rated ‘good’.

At the last inspection in June 2018 we identified breaches of Regulations 12 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to people not always having access to their call bells to ensure they would be able to call for help; easy access to staircases which resulted in an incident of a fall and a person absconding. There was a strong smell of urine in the communal area chairs and 11 people’s bedrooms. We also found that some equipment and furniture was not in a good state of repair.

Due to the seriousness of the breaches found, we issued two warning notices to the registered provider Warning notices give the provider a specific time frame in which to improve in the areas identified at the inspection. At this inspection we found that these concerns had been addressed.

In addition, at our last inspection we also identified breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to a lack of structured activities and interaction, especially for those remaining in their rooms during the day and a lack of management oversight of the home and auditing processes. At this inspection we found that these concerns had been addressed.

There was a registered manager in post who was registered with CQC on 12 October 2018. 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.

New call bells had been installed in all rooms above people’s beds which were accessible. There was also a call bell that was next to the person. People had two types of call bell to ensure they could summon help.

The home was clean and fresh throughout the inspection. There was a plan of works in place including replacing carpets and furniture.

Activities had improved at the home. The activities coordinator had received further training since the last inspection.

There were improved systems in place for the registered manager to ensure oversight of the home. This included, a better auditing system and daily walk rounds by the registered manager.

Staff and relatives were positive about the changes since the last inspection.

People’s individual risks were well documented and there was detailed guidance for staff on how to minimise the risks.

Medicines were given safely and on time. There were systems in place to monitor medicines including regular audits.

Staff had received training in infection control and were aware of how to control and prevent infection.

Staff understood what safeguarding was and were aware if how to report any concerns if they had them.

Staff were recruited safely and appropriate checks conducted before commencing employment.

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

Staff received regular training supervision and appraisal to support them in their role.

We observed a warm friendly atmosphere throughout the home. There were good interactions between staff and people and staff knew people well.

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. Care plans were regularly reviewed and updated immediately if changes occurred.

There was good oversight and governance of the home including regular audits for various aspects of care and the environment.

Our last inspection took place on 11, 12 and 14 July 2017 and the home was rated as ‘requires improvement’. However, over the last several months prior to the inspection we had received multiple concerns regarding the quality of care, safety of people, staffing and environmental issues. Due to these concerns we decided to inspect the home earlier than originally scheduled.

This inspection took place on 11, 12, 19 and 21 June 2018. On 11 June 2018 we conducted an early morning visit, arriving at 6.10am. On 19 June 2018 we completed an evening inspection at 8.45pm to look at some specific issues. We provided feedback to the manager on 21 June 2018. On the 13 June we contacted relatives to gain their feedback.

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. There was no registered manager in place at the time of the inspection. However, a new manager had been appointed and had been in post for one and a half weeks prior to the commencement of the inspection. The manager had applied to register with CQC.

At our last inspection we found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had not sustained improvements made following the last inspection.

People did not always have access to call bells both during the day and at night. People were not always able to summon help if they needed to.

The home was not always clean. Chairs, bedding and flooring was often malodorous with urine and on-suite bathrooms were not always clean. Furniture including bed rails and bedroom side cabinets were in a state of disrepair.

People had been placed at risk of harm as they were able to access staircases. The provider had not addressed this issue despite an incident in September 2017.

There were activities within the home. However, we found that there was insufficient stimulation for people. People that spent the majority of their time in their rooms were often left alone for long periods of time.

Staff were not adequately deployed during meal times to ensure that all people received the necessary support to have a safe and enjoyable meal time.

We received mixed feedback about the food provided at the home. People did not always have easy access to drinks.

Audits completed by the home had failed to identify the issues found at the time of the inspection.

Risk assessments gave staff detailed guidance and ensured that risks were mitigated against in the least restrictive way. Risk assessments were reviewed and updated regularly.

Medicines were managed safely and people received their medicines on time. There were systems in place to audit medicines and identify any concerns.

Staff had access to Personal Protective Equipment (PPE) to ensure that people were protected from the risk of infection.

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

Staff received regular, effective supervision and appraisal.

We observed some caring interactions between staff and people. However, we also observed some interactions that were not always caring.

Relatives involvement in planning and reviewing peoples care was inconsistent.

People’s care files documented that people had access to an advocate to help them make certain decisions if necessary.

People and relatives said that they felt that staff asked for consent when carrying out any care tasks.

There was a complaints process in place and people and relatives knew how to make a complaint. Complaints were investigated and followed up.

We identified breaches of regulations 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of 43 older people, some of whom are living with dementia. At the time of the inspection the service was supporting 38 people.

There was a registered manager in place. The registered manager was present throughout 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 2008 and associated Regulations about how the service is run.

The communal area was unclean with heavily stained furniture. Two bedroom carpets smelled strongly of urine. Some people’s bed linen had not been changed despite it being unclean.

We observed caring interactions between staff and people. However, on two occasions in the communal lounge, we observed periods of time where there was poor interaction between people and staff. Staff were often talking amongst themselves without taking to people and completing some care tasks without talking to the person.

Three staff had not been comprehensively assessed prior to employment. The home had not ensured that staff had appropriate criminal records checks in place.

There were detailed risk assessments in place that provided staff with clear guidance on what the risks were to that individual person and how identified risks could be mitigated. Risk assessments were reviewed and updated regularly.

Medicines were now safely managed. The home had employed a clinical lead who had addressed issues found at the last inspection. There were regular medicines audits completed. Staff that administered medicines had been signed off as competent and safe to administer medicines.

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

People and relatives were involved in end of life care planning. People experiencing end of life care were treated with compassion and empathy.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care.

Healthcare professionals and relatives were positive about the management of the home.

At this inspection, we found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This focused inspection took place on 20 September 2016 and was unannounced. During this inspection we looked at safe and effective following information received from the local authority on the management of pressure areas, medicines and nutrition and hydration.

An inspection took place on 26 January 2016. During the inspection the home was in breach of two legal requirements and regulation associated with the Health and Social Care Act 2008. People were not protected from the risks of receiving unsafe care as the provider had not made sure that safe recruitment practices were being followed. People were at risk as appropriate measures had not been taken to mitigate the risk of fire as fire drills had not taken place in line with the provider’s policy. During this inspection we looked at recruitment practices and fire safety arrangements to check if this was compliant.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of forty-three older people, some of whom may have dementia. There were 39 people living at the home on the day of our inspection.

The home had a registered manager in place during our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks assessments were being carried out to identify people at risk of skin complications. Action plans were not in place to minimise the risk of serious skin complications for people identified as high risk of skin complications. Some actions were not being carried out to support people with pressure sores such as repositioning regularly and using devices to relieve pressure.

Medicines were not being managed safely.

Comprehensive systems were not in place to calculate staffing levels contingent with people’s dependency levels.

Records did not show how the home supported nurses with their continuing professional development (CPD) and revalidation, which are part of the requirement of registration for nurses with the Nursing and Midwifery Council. We made a recommendation that support should be introduced for nurses in relation to their CPD and revalidation.

We did not find food was being monitored for some people at risk of malnourishment to ensure they had a healthy balanced diet. One person required weekly weight monitoring, we found the person’s weight was not being monitored and recorded weekly. Referrals were being made to health professionals for people at risk of malnourishment. Choices were offered for people during meal times.

Pre-employment checks had been made for new staff members to ensure they were of good character and were suitable for the role.

Appropriate fire safety arrangements were in place to protect people in the event of an emergency.

We identified breaches of regulations relating to medicines, risk management and nutrition and hydration. You can see what action we have asked the provider to take at the back of the full version of this report.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of forty-three older people, some of whom may have dementia. There were 41 people using the service on the day of our inspection.

The home 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.

We found two breaches of regulations at this inspection. People were not protected from the risks of receiving unsafe care as the provider had not made sure that safe recruitment practices were being followed. People were at risk as appropriate measures had not been taken to mitigate the risk of fire as fire drills had not taken place in line with the provider is policy.

People’s needs were met as a system had been put in place to ensure that staff were deployed consistently to care and support them.

People could choose to be engaged in meaningful activities that reflected their interests and supported their well-being.

The registered manager had a plan for the redecoration and refurbishment of the service that took into consideration the needs of people so that they were not disturbed whilst these redecoration were taking place.

Appropriate procedures were in place to protect people from abuse. Risks to people were identified and staff took action to reduce those risks. People were provided with a choice of food.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People were treated with dignity and respect. There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt confident to express any concerns, so these could be addressed.

People using the service, relatives and staff said the registered manager was approachable and supportive.

At this inspection there were breaches of regulations in relation to the need for fit and proper persons and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and records we looked at.

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

Is the service safe?

We spoke to eight people who used the service and four relatives who told us they were consulted about their needs. One person's comment was typical when they said, "I feel I am properly cared for as staff know what I need." A relative told us they had been involved in the initial assessment of a person's needs. The relative said, "we discussed how the home could make it easier for my mother to settle."

There were arrangements in place to deal with foreseeable emergencies. Staff had been trained in how to respond to medical emergencies. For example, they had completed first aid training. Staff explained how they responded to accidents and incidents involving people who used the service in order to maintain their safety.

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. The manager was not aware of the recent Supreme Court decision regarding Deprivation of Liberty Safeguard (DOLs). A lock was in use on the front door which prevented people who use the service from leaving if they wished to. We looked at five people's care records and there were no capacity assessments relating to this restriction. People's capacity had not been assessed where they made decisions that affected their safety and well-being. One person's care plan showed that they regularly refused personal care, but there was no DoLs in place so that staff could intervene to support this person safely. People were at risk from unlawful or excessive control as the provider had not made suitable arrangement to address this.

Is the service effective?

We spoke with eight people who used the service. They were positive about the support that they received and felt that they were well cared for. One person said 'my call bell is usually answered quickly.' Another person said that staff, 'do everything that is needed.' We looked at five care records which contained initial assessments of people who had recently come to use the service. These contained information on People's care needs, dietary preferences and whether and how they wished to practice their religion. Initial assessments also recorded in people's life history and interests.

People who used the service were positive about the care they received. One person said, 'staff here always help me.' People felt that staff knew how to meet their needs. We saw that staff understood people's needs. The staff training matrix showed that staff had been trained in mandatory areas, such as manual handling, administration of medication and food hygiene.

Is the service caring?

People who used the service and their relatives told us that staff understood their needs. People's and relatives comments were, "the staff are supportive and caring," "the staff always helps me" and "they are gentle with me." We looked at five care plans and saw that these had been reviewed monthly. Care plans had been updated and changes to people's needs had been fully addressed.

Is the service responsive?

People who used the service said they could ask for things that they wanted. Three people said that staff anticipated their needs. One person said that staff were able to tell what he wants and that "they respond to that." People said that staff either sees when they need help or ask if it is needed. One person's comments were typical when they told us "the people here always help me."

Is the service well- led?

People and relatives we spoke with felt that they had the care and support they needed. One person's comments were typical when they told us, 'the care is better here than I was getting in my own home.' There were care plan audits for the last three months and these showed that a sample of care plans had been checked. Where any improvements were needed these were highlighted and a date for completion was recorded. We looked at care plans referred to in these audits and saw that these changes had been made.

People and relatives spoken to felt that they had the care and support they needed. People and relatives comments included, "I am very impressed by the quality of care" and "the care is very good." However, care plans showed that care was provided in a way that was not sensitive to and promoted people's equality and human rights. For example, people's cultural and religious needs were not identified in their care plans. The five care plans we looked at had not been regularly updated and changes to people's needs had not been fully addressed. For example, one care plan (dated 25/04/ 2012) indicated that a person was diabetic. The care plan did not explain what foods they could eat. The risk factors resulting from the person's diabetes were not explained in the care plan or how staff should respond if the person became ill.

People and relatives told us they were given information about the care they received. Relatives told us that staff always informed them about any changes to people's needs. A relative said, "we just chat about things as they arise." People and relatives told us that care was delivered in a sensitive and supportive manner which made them feel safe in the home. One person said, "the care is good, lovely.'

People and relatives confirmed that the service made sure they had access to a range of medical professionals to meet their care and treatment needs. One person told us that, "I am seen by my general practitioner, I just ask the staff and they arrange it." People's care records showed that where they had been admitted to hospital an appropriate plan had been put in place when they were discharged to ensure they received the care and treatment they needed.

The manager told us that care plan audits had not been carried out. Care plans had not been reviewed regularly in line with the provider's policy. The five care plans we looked at were not always up-to-date and people's needs had not been responded to in a timely manner. People and relatives told us that staff were available when they needed them and had the skills to meet their needs. The manager explained that there were meetings with relatives and people with dementia so that they could give their views of their care and treatment. Relatives told us that they felt this provided an important way for them to express their views of the service.