Albury Care Homes Limited provides support and accommodation for a maximum of 33 older people who require residential care. The home provides both permanent and respite services. At the time of the inspection there were 22 people living at the home, some of whom were living with dementia. This was an unannounced inspection which took place on 26 July 2016.
During our inspection the registered manager was present. 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.
Albury Care Homes Limited was last inspected on 07 December 2015 when it was awarded an overall rating of ‘requires improvement’. Five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to recruitment, staff support, safe care and treatment, person centred care and quality assurance. Requirement actions were set and the provider sent us an action plan that informed us of the steps that would be taken to become compliant with the regulations. The domain of well led was rated as ‘inadequate’ and this is the reason the latest comprehensive inspection took place. We needed to check to see if the required improvements had taken place at the home.
At this inspection we found that management of the home was ineffective and that there had been a further decline in aspects of the service. Although some attention had been given to fire safety, replacing windows and carpets many other aspects of the environment were unsafe. These included locked fire exit doors, combustible items stored next to electrical installations, a lack of emergency lighting, excessive water temperatures, poor infection control practices and cleanliness.
The registered manager could not produce a number of records or certificates that would confirm the environment and facilities were safe. We requested that this be sent to us within 24 hours of our inspection. We received some within this timeframe but the majority were sent to us after. Many of the documents sent to us did not demonstrate that regular and effective checks were made. We took enforcement action in response to this and served a Warning Notice on the registered provider.
After our inspection we shared our concerns with Surrey County Council safeguarding team, Quality assurance department, the environmental health department and Surrey Fire and Rescue Service.
The registered manager had completed audits to monitor the quality of service but these had not identified any concerns and did not reflect our inspection findings. Therefore they were ineffective at driving improvements. This was the same as at our previous inspection. We took enforcement action in response to this and served a Warning Notice on the registered provider.
There was still a lack of stimulation and no opportunities for people to go out into the community. The registered manager had assessed one person and allowed them to move into the home knowing they could not meet their needs which left them isolated and unable to communicate with staff. You can see what action we told the provider to take at the back of the full version of the report.
Although people said that their care needs were met staffing numbers meant that staff did not have time to sit and talk to people as they were focused on delivering care and completing domestic and kitchen tasks. Shifts were not always covered when staff were on leave and this impacted on the quality of service provided. You can see what action we told the provider to take at the back of the full version of the report.
People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. However, the registered manager had not always ensured prompt action was taken when concerns were identified or raised. You can see what action we told the provider to take at the back of the full version of the report.
Some improvements had been made since our last inspection. Robust recruitment procedures had been followed to ensure all staff, including agency staff were safe to support people. Staff were now being provided with formal supervision and training specific to the needs of people who lived at the home had been provided.
As at our last inspection people said that they consented to the care they received. Correct procedures had been followed if people lacked capacity and were being deprived of their liberty in anyway. Further attention to ensure assessments are regularly reviewed should be given.
People said that in the main they were happy with the choice of food and drink in the home. Further consideration should be given to expand the choices available at breakfast and dinner.
People said they were treated with kindness and compassion. Our observations supported the views of people. Staff were seen to be respectful to people, talk to them kindly and to promote their dignity and privacy when providing care. This is the same as at our last inspection.
Medicines were administered, recorded and stored appropriately and people’s health care needs were managed effectively.
Risk assessments and care plans were in place that considered potential risks to people. However, the content and quality of information in care records varied. The home had been receiving support from Surrey County Council Quality Assurance team to develop its care planning systems. This was still a work in progress at the time of our inspection.
“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.