The Albany Care Home

The Albany is a care home providing nursing and personal care to older people, some of whom are living with dementia. The service also supports people who are discharged from hospital and require support with rehabilitation prior to returning to their own homes. These are referred to as 'HUB beds'. The Albany is registered to accommodate up to 38 people with 14 of these being used as HUB beds. At the time of our inspection there were 36 people living at the service.

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

There had been some improvements made to improve people’s outcomes. However, the providers’ quality assurance processes were still not being used to drive improvement. We found some records were not completed correctly and the provider’s audits had not identified these shortfalls. Where shortfalls had been identified, there were either no clear timelines for the actions to be completed or the timelines were not met.

People told us they felt safe living at the Albany. Staff knew how to identify and report any concerns. Whilst the home was no longer using agency staff, we still received mixed feedback from people, relatives and staff regarding staffing levels against the demands of the HUB beds. On the day of the inspection, we saw staff were continuously busy and ensured call bells were attended to in a timely manner, even if it was just to let the person know they would be with them as soon as they finished what they were doing. Following the inspection, the provider sent us an update that the staffing levels would be increased following a discussion with the senior management team. The provider had safe recruitment and selection processes in place.

The home environment could be improved. The provider had already identified this and were working through an environmental refurbishment action plan to improve the home décor.

Risks to people's safety and well-being were managed through a risk management process. Medicines were managed safely, and people received their medicines as prescribed.

Staff access to supervisions and appraisals had improved and staff told us they felt supported. New staff went through an induction programme which included the provider’s own mandatory training as well as shadowing opportunities of experienced members of staff.

People had a pleasant dining experience which offered a variety of appetising homemade food choices available at times that suited people's preferences. The menu was overseen, and food prepared by an enthusiastic catering team who knew people’s needs very well. Staff supported people to maintain food and fluid intakes.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied.

The home was well-led by a long-standing registered manager who was committed to improving people's quality of life. The registered manager knew the service well and had support from a deputy manager. There was a clear management structure and an established group of staff who worked well as a team. Staff worked well with external social and health care professionals.

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 August 2022). The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive inspection.

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 the provider remained in breach of regulations.

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.

We carried out an unannounced comprehensive inspection of this service on 24 and 31 May 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve 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, Effective and Well-led which contain those requirements. 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 remained 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 The Albany Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance at this inspection. 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.

About the service

The Albany is a care home that can support up to 38 people. The service is in one adapted building over two floors. Management offices and reception are located on the ground floor along with the dining room, living room, conservatory, and access to the gardens.

The service provides support to people with long standing care and nursing needs. The service also supported people who were discharged from hospital and required support with rehabilitation prior to returning to their own homes. These were referred to as 'HUB beds'. At the time inspection 36 people were using the service, with 14 of these being used as HUB beds.

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

People living at The Albany received care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had struggled to recruit permanent nursing staff and domestic staff. The service was using nursing agency staff which impacted on the safety of the service at times. The provider had safe recruitment and selection processes in place and were in the processes of employing permanent nursing staff. They provided care that was tailored to individual needs of each person, including their likes, dislikes and preferences.

People were supported to engage in activities, the activities coordinator worked with staff and volunteers to organise weekly activities that were meaningful to those who wished to participate. People felt they were cared for and that they could access care in emergencies from staff if required.

We found people's records were not always up to date and people were not always fully involved in planning and reviewing their care and support needs. The provider had not identified these shortfalls in their last audit action record.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Staff understood their responsibilities to report any concerns and followed the provider's policies in relation to safeguarding and whistleblowing, however it was not always clear how safeguarding concerns were communicated to the wider team as not all staff were aware of a recent safeguarding.

Medicines were managed safely, and people received their medicines as prescribed.

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

The care at The Albany Care Home is person-centred and promotes people dignity however it did not always promote people’s privacy.

Staff received regular training which provided them with the knowledge and skills to meet people's needs in an effective, responsive and personalised way. Staff supported people to choose food they liked and to eat healthily. People received enough food and fluids to remain healthy and staff monitored this when required.

People were encouraged to express their opinions and supported to have their voice heard. There was a complaints procedure in place and people felt confident to raise any concerns either with staff or the registered manager if they needed to.

Staff told us they were supported by the management team who showed empathy and understanding. The provider had systems in place to monitor and improve the quality and safety of the service. However, at the time of the inspection not all necessary actions identified had been completed so we could not be fully assured of the effectiveness of these systems.

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 insufficient to rate (published 9th April 2021)

The last rating for the service under the previous provider was Good, published on 24th July 2019

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.

The Albany is a care home that can support up to 38 people. The service is in one adapted building over two floors. The service supported people who were discharged from hospital and required support with rehabilitation prior to returning to their own homes. These were referred to as 'HUB beds'. At the time inspection 33 people were using the service.

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

Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

There were sufficient staff deployed to meet people's needs and staff recruitment was on-going. Risks to people's safety and well-being were managed through a risk management process.

Medicines were managed safely, and people received their medicines as prescribed. The systems in place to monitor the quality of care within the service were effective. The Registered Manager promoted a positive person-centred culture and fully understood their responsibilities as a Registered manager.

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

Rating at last inspection This service was registered with us on 31 July 2020. We completed a targeted inspection looking at infection prevention control (13 February 2021).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, nutrition, HUB beds and risk management. 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.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full 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.

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.

We found the following examples of good practice.

There was a safe system to manage visitors that included checks of temperature and taking various details for a contact tracing purpose. Where possible safely arranged visits were being facilitated and where people received end of life care, relatives' visits were supported after individual risk assessments had been carried out.

A designated visiting suite was installed, it contained a room divided by see-through glass and was in line with the good practice guidance. Where people had not been able to use it, additional opportunities for contacting relatives using technology were being offered. Staff encouraged social distancing and isolation where required and designated activity staff ensured people had been visited in their bedrooms to offer companionship.

The provider ensured a sufficient stock of personal protective equipment (PPE) and we observed staff wearing a full set of PPE. Staff had received infection prevention and control training, including how to put on and take off the PPE.

The PPE was allocated around the home and information and guidance to prompt staff in the infection correct procedures was promptly displayed. The provider's policies outlined how to safely dispose of the used PPE.

The service was fresh and clean. The cleaning schedules included the high-risk areas and frequently touched surfaces. Regular audits of the environment had been carried out.

The provider ensured regular Covid-19 testing for staff and people took place. The registered manager informed us the process of Covid-19 vaccinations had started.

The home was very well supported by the provider's senior management team and the local external health professionals.

Further information is in the detailed findings below.