Alban House Residential Care Home

We found the following examples of good practice.

The service had worked well with relevant health and social care professionals during a recent Covid-19 outbreak. All recommendations and advice had been taken on board and actioned in order to keep people safe. The service was due to open again to visitors on 14 February 2022 and visiting arrangements were being organised for people to see their loved ones.

Facilities were in place to wash hands or use hand sanitiser on entering and leaving Alban House. Prior to and post Covid-19 outbreak, visitors were supported to wear a face covering when visiting, and wash hands before/after use. All visitors were screened for symptoms of COVID-19 before being allowed to enter the service. There was prominent signage and instructions to explain what people should do to ensure safety. Information was easily accessible on arrival and before visits to ensure visitors followed guidance, procedures and protocols to ensure compliance with infection prevention control.

The registered manager communicated with people, relatives, staff and health and social care professionals regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe. The service was following government guidance regards to visitors. People commented, “The staff always wear a mask” and “I have no concerns about the staff keeping me safe.” Staff supported people to occupy themselves whilst maintaining their safety.

Staff were following current infection prevention and control guidance to help people to stay safe. There were suitable risk assessments and an up to date infection control policy and procedure in place. The registered manager ensured staff understood why every measure was essential.

Personal Protective Equipment (PPE) was readily available around the buildings. We saw there was a good supply of PPE for staff to use. Staff were observed to be wearing PPE appropriately and disposed of it in clinical waste bins. Whole home testing was undertaken, with frequency of testing people and staff in line with current guidance.

Staff had completed training to ensure safe infection prevention and control measure were in place and knew how to keep people safe during the COVID-19 pandemic.

Infection prevention and control audits were carried out to ensure the premises was meeting infection control measures. A cleaning schedule for all areas of the service was in place and implemented to ensure the whole service was effectively cleaned on a regular basis, including high touch points.

Alban House Residential Care Home is a 'care home'. The home is registered to accommodate up to 23 people in one adapted building. At the time of this inspection there were 17 people living there. The home cared for older people, including people with dementia, learning disabilities and other mental health needs. The home also cared for younger adults with physical disabilities, including neurological conditions such as Multiple Sclerosis.

Alban House has been adapted from three adjoining Victorian terraced houses. There are four floors accessed by a shaft lift.

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

People’s individual risks had been identified and risk assessment reviews had been carried out to identify ways to keep people safe. For example, risk assessments for pressure area care, constipation and those risks associated with specific physical health conditions, such as Multiple Sclerosis and Parkinson’s disease. The service recognised that further work was needed to individual risk assessments and this formed part of the service’ improvement plan. The plan stated: ‘Latest audit shows that some bespoke risk assessments are outstanding.'

The service had implemented an ‘escalation steps’ procedure surrounding the health of individuals, in order for changing needs to be addressed in a timely manner. This involved updating care plans, risk assessments and seeking health and social care professional involvement to address people’s individual needs.

Health and safety failings and areas of the home in need of repair had now been addressed. All relevant health and safety checks were now scheduled in an annual diary. This clearly indicated who was responsible for all checks, including external contractors, visiting for instance to service moving and handling equipment. These checks were being completed in a timely way.

People were protected because the organisation took safety seriously and had appropriate procedures in place. Comments included: “The staff look after me very well” and “I am very comfortable.”

Care plans had been reviewed and clearly detailed people’s individual needs, wishes, goals and how to support them to ensure all individual health conditions and preferences were addressed. Sections specific to people’s physical health conditions were now detailed and explained how certain physical health needs affected people’s lives. For example, for people living with Multiple Sclerosis or Parkinson’s disease. Further work was underway to ensure care plans provided enough information to ensure staff delivered consistent care and support. The service’ improvement plan cited that further work was needed to care plans and this work was on-going.

Improvements had been made to the induction process for new employees. Staff training on essential topics had improved, which enabled staff to feel confident in meeting people’s needs and recognising changes in people’s health. A staff member commented: “100% improved. We have had lots of training we are interested in so we can look after people properly. I am looking forward to doing end of life care training soon.” Staff were now receiving on-going supervision in order for them to feel supported in their roles and to identify any future professional development opportunities.

The staff team had stabilised and felt well supported by the management team and felt able to raise concerns.

A redecoration programme was in place and was being worked through to improve the home’s environment, ensuring it was comfortable for people living there.

Before people received any care and treatment they were asked for their consent and staff acted in accordance with their wishes. People's legal rights were protected because staff knew how to support people if they did not have the mental capacity to make decisions for themselves. People’s capacity to make decisions about their care and support was assessed on an on-going basis in line with the Mental Capacity Act 2005.

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.

Systems to monitor the service had improved to ensure people received a safe service according to their individual needs. Quality monitoring systems were increasingly becoming more effective to provide clear oversight of the service to ensure it was safe for people and reduce risks to their health and well-being. These systems needed to be fully embedded in practice.

The service was being supported by the local authority Quality Assurance Improvement Team (QAIT) to ensure robust systems were in place to ensure people received the appropriate person-centred care and support.

Medicines were safely managed on people’s behalf. There were safe staff recruitment and selection processes in place. Staffing arrangements met people’s needs. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

We continue to receive statutory notifications in relation to safeguarding events and serious injuries in a timely manner.

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 15 January 2021) and there were multiple breaches of regulation. 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 undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also followed up on further breaches of regulations 11 (Need for consent); 12 (Safe care and treatment); 15 (Premises and equipment) and 18 (Staffing). This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contains those requirements. The overall rating for the service has not changed following this focused inspection and remains requires improvement.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alban House Residential Care Home on our website at www.cqc.org.uk.

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.

Alban House Residential Care Home is a 'care home'. The home is registered to accommodate up to 23 people in one adapted building. At the time of this inspection there were 22 people living there. The home cared for older people, including people with dementia, learning disabilities and other mental health needs. The home also cared for younger adults with physical disabilities, including neurological conditions such as Multiple Sclerosis.

Alban House has been adapted from three adjoining Victoria terraced houses. There are four floors accessed by a shaft lift.

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

At the time of the last inspection in 2019 a new manager had recently been registered with the CQC. During the Covid-19 pandemic there were further changes to the management team. The new manager had been absent from the home for a period during the spring months of 2020. They later applied to cancel their registration and the application was approved in September 2020. This meant the home did not have a registered manager in post at the time of this inspection. An existing member of the staff team was appointed as acting manager while the provider sought to appoint a new registered manager. At the time of this inspection the provider had been unsuccessful in appointing a new manager. There had also been a change of key members of Alban Quality Care Ltd at the end of 2019.

Systems were not in place to ensure people received safe care and treatment. There had been a high turnover of staff. New staff had been appointed but they did not always have the knowledge or skills to meet people’s needs safely. The provider had found records relating to staff induction, training or qualifications were missing. They also found a number of care plans were missing, out of date, or did not provide sufficient information about people’s care needs. At the time of this inspection the acting manager was in the process of writing new electronic care plans and risk assessments.

Care plans did not provide evidence of each person’s ability to make decisions about all aspects of their lives. Mental capacity assessments had not been carried out. Staff had not received training on the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

At the last inspection we found some areas of the home appeared tired and dated, and some areas of the home and equipment had not been fully maintained. At this inspection we found little progress had been made on redecorating and maintaining the property. Some works were planned for the near future, including the replacement of some flooring.

In recent months the provider had received support from the local authority to help them draw up a service improvement plan and put in place monitoring systems to help them identify any further issues in future. However, this service has been rated as Requires improvement for the last four inspections. Systems that had been put in place following previous inspections to monitor and improve the service had either been ineffective or had not been maintained. The new systems being put in place to monitor and improve the service had not yet been established and therefore we could not be confident the service will maintain the improvements being made.

People and relatives told us they were happy with the care people received. A person living in the home said, “They are absolutely brilliant!” Comments from relatives included, “I love the care, I love the people. They are looking after [relative] beautifully” and “On the whole it’s ok”.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 14 October 2019). There were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 and 19 July 2019. Breaches of legal requirements were found. Since the last inspection we had also received concerns.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The inspection was also prompted by the recent concerns we had received including tissue viability, constipation, poor moving and handling procedures and lack of adequately trained staff. This report only covers our findings in relation to the Key Questions Safe, Effective 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.

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.

The overall rating for the service has remained 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, Effective and Well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alban House Residential Care Home on our website at www.cqc.org.uk.

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

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 breaches in relation to need for consent, safe care and treatment, premises and equipment, good governance and staffing. Please see the action we have told the provider to take at the end of this report.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Alban House is a 'care home'. The home is registered to accommodate up to 23 people in one adapted building. At the time of this inspection there were 23 people living there. The home cared for older people, including people with dementia, learning disabilities and other mental health needs. The home also cared for younger adults with physical disabilities, including neurological conditions such as Multiple Sclerosis.

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’s experience of using this service and what we found

People told us they felt safe. However, risks from the environment had not always been assessed, and actions had not always been taken to minimise the risks. We found risks associated with people smoking on the premises, scalding from hot water, Legionella, and falls from windows that had not been identified or addressed. Fire precautions had not always been checked at the required frequencies. Other risks such as risks to people’s individual health and safety had been assessed and staff knew the actions needed to support people to stay safe.

Staff were recruited following safe recruitment checks and procedures. Staff were well trained and supported. There were mixed views on the staffing levels, with some people and staff expressing concerns about low staffing, while others felt there were generally sufficient staff to meet people’s needs. During the inspection we saw there were sufficient staff to meet people’s personal care needs, but staff did not have time to meet people’s social needs adequately. There were very few activities provided and people told us they would like to go out more often. The registered manager told us they will review staff rotas and people’s dependency levels and consider any changes necessary.

Tablets and liquid medicines were safely stored and recorded when administered. However, some creams and lotions were not always recorded to have been administered.

The home was generally clean. The number of cleaning staff had been increased since the last inspection. However, some areas of the home appeared tired and in need of updating. A torn table top in the dining room appeared shabby and potentially posed an infection risk. Some floorings were worn.

People’s needs were assessed before they moved in and a care plan drawn up and agreed with them. Staff had sufficient information about each person to understand the care they needed, their likes and dislikes and preferred daily routines. People were supported by staff who knew them well and were caring and kind. Staff understood and respected people’s legal rights to make decisions about their daily lives. Where people were restricted to protect them from harm, legal authorisation had been sought appropriately.

A new registered manager had been appointed since the last inspection. They were well liked and respected by staff, people living in the home, relatives and professionals. They had made changes and improvements since the last inspection including medicine audits. However, one person had been upset by the provider the previous day and told us the provider had “screamed” at them. This had been observed by staff. At the last inspection we found the provider had not always acted as a good role model for the staff, and this incident meant the breach we found at the last inspection is repeated once again.

Rating at last inspection (and update) The last rating for this service was Requires Improvement (published 29 August 2018).The service remains rated as requires improvement. The service has been rated as requires improvement for the last three consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. This plan stated that the provider, who was also the registered manager at the time, was stepping down as registered manager. A new manager was appointed who has since been registered with the Care Quality Commission.

Enforcement

At this inspection insufficient improvements had been made and the provider was still in breach of regulations. We also found further breaches of regulations and areas where improvements have been recommended.

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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

Alban House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 23 people in one adapted building.

At the last inspection in January 2017, we rated the service as requiring improvement. This was because the home was not fully safe, effective and well-led. We found three breaches of the Health and Social Care Act 2008 (Regulations 2014). This was because people’s medicines were not managed and administered safely; people were not protected from the risk of infection; care was not always delivered to ensure it supported people with individual risks; parts of the home were not kept clean and infection free and systems to audit and monitor the quality and safety of the home were not robust.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Is the service safe; is the service effective and is the service well-led?

The provider submitted an improvement action plan to address these concerns, stating what they intended to do and when this would be achieved. At this inspection we found improvements had been made so all the regulations had been met in respect to the breaches found at the previous inspection.

One of the providers was also the 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.

At this inspection, we found the registered manager did not always set a good example as a role model to staff. We also found the provider had not followed the requirements of the regulations to display the rating from their last inspection on their website. We therefore rated the Well-led domain as requiring improvement.

A deputy manager was being trained to run the home by the registered manager. The registered manager had introduced new systems and processes with the support of staff. These had helped to improve the quality and safety of the care provided. The deputy manager was very well thought of by people living at Alban House, by the providers and by staff.

Care records reflected the care people needed to support them with their risks, needs and preferences. Staff knew people really well and were able to describe the care and support they needed. People said staff were kind and helpful. Throughout the inspection we observed numerous interactions where staff showed kindness and respect to people.

Activities were offered both within the home and in the community to support people with maintaining their interests.

People said they liked the food, which was freshly prepared. Staff took time to ensure people had a meal of their choice. This included supporting people who needed help to eat and drink. People were offered drinks to keep them hydrated.

The home was clean and well maintained. There were systems in place, which staff followed, to ensure a safe and infection-free environment. People’s bedrooms were individually decorated and furnished according to their preferences.

Medicines were received, stored, administered and disposed of safely. Medicine administration records and other records relating to medicines were completed accurately.

Staff were recruited safely. Staff undertook an induction to introduce them to the service and ensure they had the knowledge and skills to support people safely. Staff were supported to refresh their knowledge and skills and also take nationally recognised vocational qualifications.

The staff had been trained in the Mental Capacity Act (2005) and understood their responsibilities in relation to the Act. Staff also understood how to keep vulnerable people safe from the risks of abuse.

Health and social care professionals said staff contacted them appropriately. Where the professionals gave advice about a person’s care, there was evidence that staff followed this.

There were systems in place to monitor the quality and safety of the home. This included the service improvement plan, which had been drawn up.

There was a policy and procedures to deal with complaints. People said they had not needed to complain. No complaints had been received since the last inspection.

We found two breaches of regulations; firstly, as people were not always treated with dignity and respect and secondly because the provider had not displayed their ratings from the previous inspection on their website as they are required to do. We also made a recommendation that the service should consider how to support people with dementia in terms of their environment.

This is the second consecutive time the service has been rated Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.

The home provides accommodation and personal care for up to 23 adults who require personal care. The home specialises in providing care to predominantly older people with mental health needs or neurological conditions such as Multiple Sclerosis.

The home consists of two adjoining properties located in the seaside town of Ilfracombe.

One of the providers was also the registered manager for the home. 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 previously inspected in November 2013 when the service was found compliant in all the regulations we looked at.

The home had a relaxed and happy atmosphere. People, their relatives and health professionals all said that staff were kind and compassionate, treating people with dignity and respect. Staff knew people well and were able to describe how they supported them. A visiting professional said “The care here is very good; they have a good group of staff”. People and their relatives knew how to complain, but said they had not had reason to.

Staff were recruited safely with checks carried out before they were allowed to start working at the home. Some staff were not up to date with their training. This meant that staff might not have the right skills, knowledge and experience to work effectively with people. Staff had received training to support people who had physical impairments, suffered strokes or had long term conditions including Multiple Sclerosis and dementia. Some staff had been supported to undertake nationally recognised qualifications in care.

Staff understood their responsibilities and duties in terms of safeguarding people from the risk of abuse. Staff were able to describe the actions they would take if they had a concern.

Individual risks to people’s safety had been assessed and plans written to show how these were being addressed. The home had an emergency evacuation plan and had also developed individual personal evacuation plans to support each person.

Where someone was assessed as lacking capacity to make a particular decision, staff had not always followed the principles outlined in the Mental Capacity Act 2005.

People were supported to remain as independent as possible and were encouraged to do activities of their choice both within the home and in the community. Relatives and friends were welcomed into the home and were able to use communal areas and people’s bedrooms to meet in private if they wished.

Peoples’ medicines were not managed, stored and administered safely because current relevant professional guidance was not being followed.

People were provided with a choice of meals which were freshly prepared. Hot and cold drinks were available for people throughout the day. People said they enjoyed the food. Where people had specialist dietary needs, staff ensured that food was prepared to meet these. Some people were at risk of losing weight. Although staff encouraged them to eat additional food, food record charts were not being used. This meant that it was not possible to see what people had actually eaten and whether they continued to be at risk.

Although maintenance of the home had been undertaken, some areas of the home were in need of redecoration and refurbishment. Some communal areas were showing signs of wear and looked ‘tired.’ Although there were sufficient care staff to support people’s needs, there were not enough domestic staff on duty each day to ensure that all areas of the home were kept clean and free from infection. Some kitchen equipment needed replacing and some more difficult to reach parts of the kitchen required cleaning. The providers brought their dogs into the home, which people liked. However, the dogs were allowed to wander into the dining room during mealtimes, which could pose a health risk to people when eating.

The registered manager and her deputy were well known to people, relatives, staff and visiting professionals. Everyone we spoke with said they were very committed to ensuring that people were well cared for. Staff said they felt supported by senior staff and were able to raise concerns with them, both informally and during supervisions.

Although there were some quality assurance systems in place, these had not identified and addressed some issues, including building maintenance, equipment replacement, training and medicines management.

We found breaches of the Health and Social Care Act (2008) Regulations 2014.

The majority of people expressed satisfaction with the service. The comments we received included 'It is the best care home I have lived in,' and 'It is very nice and the food is very good,' and 'the owners are absolutely brilliant'they are very passionate about providing good care .'

People told us the staff were respectful and treated them with dignity. We were told there were some activities available. People were happy with the care they were provided with. People told us staff supported them with their personal care in a manner which they wanted. People said care was unrushed and supportive. The medication system was well organised and operated effectively. People said staff were polite, kind and friendly. People were happy with the food. On the day of the inspection there were satisfactory numbers of staff on duty.

The accommodation was furnished, decorated and maintained to a satisfactory standard. The home was clean and satisfactory infection control procedures were in place. The quality assurance system was appropriate.

We saw care and support was delivered in a kind and respectful way. People told us that their views were respected with comments like, 'I'm in control and tell them what I want to do'. We saw on two occasions when people's personal matters were discussed with them in communal areas within earshot of other people. We highlighted promotion of people's confidentiality and dignity as an area for improvement

We looked at some key documents including care plans, risk assessments and quality assurance records. This helped us to make a judgement about how well the home was being run.

Care was being planned and people were involved in making decisions about their care and treatment and activities of daily living. People were encouraged to do various activities. We were told that the provider had given the staff team additional hours to take people out and about in the community and organised activities within the home.

Everyone we spoke with made positive comments about the home. For example one person told us 'Alban House is a very homely and friendly place to be'. Another person said 'I am treated fairly and all of the staff are very kind'. Professionals told us 'The team is very good here, hot about care and support. We have no concerns at all about Alban House'.