We carried out an unannounced comprehensive inspection on 24 July 2014 and 9 October 2014. During this inspection we found breaches of legal requirements. As a result we undertook a focused inspection on 7 January 2015 to follow up on whether action had been taken to meet legal requirements.
You can read a summary of our findings from both inspections below.
Comprehensive Inspection 24 July and 9 October 2014
This inspection took place on the 24 July and 9 October 2014. We decided to carry out a second visit as part of this inspection as serious concerns had been raised with us following the first visit. Both visits to the home were unannounced.
The Albany Care home is situated in Headington near Oxford city centre. The home is registered to provide accommodation, nursing and personal care for up to 48 older people.
The registered manager left on the 4 August 2014 and a new manager started working in the home on the 6 August 2014 and had not yet applied to be registered with us. 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.
On the first day of the inspection we did not identify any breaches of regulations however we then received information of concern relating to the care and welfare of people living in the home.
Five registered nurses had left since August 2014. At the time of this inspection agency nurses were being used to cover the shortfall as there were no permanent registered nurses working in the home. The provider had voluntarily agreed not to take on any new admissions until registered nurses had been recruited and improvements have been made to the delivery of care for people.
The provider had reviewed the staffing arrangements since July 2014 to reduce the risks to people due to the lack of permanent registered nurses. There were 29 people in the home some with complex health care needs. The provider had ensured there were two registered agency nurses on duty at all times. The provider had also increased the care staff by one care worker per shift, to assist the agency nurses with getting to know the people living in the home.
People were not always receiving their medicines as prescribed and at the time they needed them. Systems for ordering and checking medicines were not robust. Some medicines were not available and there were some surplus to requirements which had not been destroyed appropriately. The high dependency on agency nurses had a negative impact on how people’s health care needs were being met. This included prompt updating of care plans, delivery of care and treatment, safe medicines management and day to day management of the care staff.
People were not always involved in making decisions about their care or treated in a respectful and dignified manner. Staff were not consistent in how they supported and cared for people.
Whilst the majority of the home was clean, well-furnished and free from odour. The treatment room was not clean, was cluttered and there were some risks in relation to the storage of laundry. This meant that not all risks relating to infection control had been reduced.
Staff had received some training in safeguarding, health and safety, moving and handling and keeping people safe. However, staff had not received training in meeting people’s individual needs such as dementia, Parkinson’s, diabetes or pressure area care. This meant staff were not always aware of how the person’s condition could impact on their life. Staff annual appraisals and supervision were not taking place to support good practice as there were no registered nurses employed to take on this responsibility.
There was a lack of leadership for care workers as a result of the absence of permanent registered nurses who could guide and direct them on each shift. The provider had developed an action plan to reduce some of the risks to people and support the care staff. This included ensuring there was senior management presence seven days a week including a clinical facilitator and a peripatetic manager. This had been put in place the week before the inspection carried out on the 9 October 2014 and roles were still being embedded.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
Focused inspection 7 January 2015
Following our inspection of 24 July and 9 October 2014 the provider was asked to take action to meet the requirements of the regulations. The provider sent us an action plan and advised us they would comply with the regulations by 31 December 2014.
This was an unannounced follow up inspection to ensure the provider had taken action to meet legal requirements.
The manager of the home had applied to become the registered manager and was awaiting their interview date.
We found the provider had made some improvements. However, there were still concerns that people were not receiving a service that protected their care and welfare.
Management of medicines had improved. There was a new storage area for medicines with hand washing facilities. Systems for managing stock had improved and appropriate quantities were now stored. However, there were still errors in stock balances which meant the provider could not be sure people received their medicines. Not all 'as required medicines' (PRN) had clear instructions relating to when they should be administered.
People's medical conditions were monitored regularly and recorded accurately. However some people did not always receive care as detailed in their care record.
Staff had a clear understanding of The Mental Capacity Act 2005 and supported people to make choices and involved them in decisions about their care.
Staff felt well supported and had received regular supervision. There was use of regular agency staff and the provider continued to recruit permanent nursing staff.
The provider was not monitoring the quality of service effectively. Audits had been introduced, however the audits had not identified the issues highlighted during this inspection.
We found a number breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.