St Albans Nursing Home

St Albans Nursing Home accommodates 34 people in one adapted building. Accommodation is on 2 floors with a passenger lift for access between the floors. St Albans Nursing Home is situated in Knott End on Sea close to a regular bus route, shops and facilities. At the time of our inspection 32 people lived at the home.

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

Staff kept the building clean and tidy and maintenance checks were in place and up to date. Recruitment procedures were in place, and one recently employed staff member said, “A really good induction period and all checks were done before starting work.” There were sufficient staff to care for people. Safeguarding training was mandatory, staff were aware of the processes to follow to enable people to be safe. Risks were assessed in detail and monitored to ensure individuals safety and promoted their independence within a risk framework. People received their medicines safely.

The management team had auditing systems to maintain ongoing oversight of St Albans Nursing Home and an efficient management team provided oversight and guidance for the service. Quality assurance processes ensured people were able to give their views of the service. A relative said, “They keep me informed all the time about [relative]. It is a very well-run home.”

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 at this service was good (published 16 February 2018)

Why we inspected

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had dedicated staff to ensure people were admitted safely and continued to be supported in the service in accordance with national guidance. Infection prevention and control (IPC) policies and procedures were kept under review. We found safe processes were in place and appropriate action had been taken. The local commissioner’s IPC team was providing advice and support when required.

Social media systems such as computer systems and ‘face time’ access was used to facilitate contact between people and their relatives. The registered manager was facilitating safe visiting in line with government guidance. One person said, “They have made sure we have kept in contact with my family with visits and phone calls, no complaints.”

During our visit we observed the staff using Personal Protective Equipment, (PPE) safely. The registered manager told us sufficient stocks of PPE were available and we confirmed this on the visit. One person said, “They have been very strict with wearing masks and aprons especially around me and the other residents.”

People living at St Albans and staff were tested regularly for COVID-19. There were no staff employed who had not been vaccinated as now required.

The home was clean and hygienic. Cleaning schedules were in place and PPE stations in each of the rooms. Staff carried out regular checks of the environment and cleanliness and any issues would be addressed.

St Albans Nursing Home accommodates 34 people in one adapted building. Accommodation is on two floors with a passenger lift for access between the floors. St Albans Nursing Home is situated in Knott End on Sea close to a regular bus route, shops and facilities. At the time of our inspection 27 people lived at the home.

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

St Albans was clean and hygienic. This reduced the risk of infection outbreaks. The infection prevention and control policy was up to date and renewed regularly. One staff member said, “We have lots of training on infection control and Covid-19 guidance, the manager is so up to date with all of that.” There were sufficient staff to meet people’s care and support needs. They were employed subject to robust recruitment processes. People’s safety was at the centre of care delivery. One person said, “I am so lucky to be here the staff and manager are truly wonderful.”

We found good quality assurance and risk management of care delivery as previously found at the last inspection. The organisation and registered manager provided opportunities for people to pass on their views of the service and general care provided. A staff member said, “We have a great manager who continues to improve the home and provides opportunities for staff and residents to pass on opinions." People praised the registered manager and staff. One person said, “[Registered manager] is lovely so helpful and always finds time to spend with people, they all do in fact.”

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 good (published 17 February 2018).

Why we inspected

The inspection was prompted in part due to specific concerns received about Infection control, staffing and quality assurance systems. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the safe key question. We look at this in all 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Albans Nursing Home 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.

St Albans Nursing Home accommodates 33 people in one adapted building. Accommodation is on two floors with a passenger lift for access between the floors.

St Albans Nursing Home is situated in Knott End on Sea close to a regular bus route, shops and facilities and can accommodate 33 people. Accommodation is over two floors, with bedrooms, lounge and dining areas on both floors. Some of the rooms have extensive coastal views. At the time of our inspection 29 people lived at the home.

St Albans Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The inspection team consisted of an adult social care inspector and an expert-by-experience. The expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had a background supporting older people.

At the last inspection in September 2015, the service was rated ‘Good’. At this inspection we found the service remained Good and met the all relevant fundamental standards.

We found the registered provider continued to provide a good standard of care to people who lived at the home.

At the time of inspection, there was a manager in post who was in the process of registering with the Care Quality Commission. 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 had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the commission when required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not commence in post until the management team completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles. One staff member told us, “The induction training included shadowing staff. It helped me get to know the residents and their routines.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and found it had been refurbished, maintained, was clean and a safe place for people to live. We found equipment had been serviced and maintained as required.

Medication care plans and risk assessments provided staff with a good understanding about specific requirements of each person who lived at St Albans Nursing Home.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

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.

We only received positive comments about the quality of meals provided. One person commented, “I do enjoy the meals, and there is plenty of choice.” A relative commented, “I have had meals here and they are very good.” We observed lunch time and noted people had their meal in the dining room where they sat or in their bedroom. People told us it was their choice.

We observed only positive interactions between staff and people who lived at St Albans Nursing Home. There was a culture of promoting dignity and respect towards people. We saw staff took time and chatted with people as they performed moving and handling procedures in communal areas. People who lived at the home told us staff treated them as individuals and delivered personalised care that was centred on them as an individual. Care plans seen confirmed this.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided. In addition annual surveys were carried out for people who lived at St Albans Nursing Home, their relatives and staff.

During our inspection we looked at how staff supported people to give their consent to their care and treatment, we looked at a sample of care plan records, how people were supported to take a balanced diet, the recruitment of new staff and the quality monitoring systems in place.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We looked at the care plan arrangements the service had in place. We found they had recorded information to ensure the people they supported were receiving the appropriate level of care. We saw the service had systems in place for staff to follow should a person be unable to give their consent to any aspect of their care and treatment. This would include undertaking a mental capacity assessment. This meant there was guidance in place for staff to follow regarding their responsibilities to support people with their consent to care and treatment.

Is the service effective?

In the kitchen we saw the catering team had information regarding people`s dietary requirements. They told us information was updated on a regular basis as and when people`s needs changed. Records indicated what nutritional requirements people had been assessed for, their food preferences, dislikes and any known allergies. We saw that information was well organised and readily available within the kitchen for staff to access for information and guidance.

We spoke with people and relatives regarding their experiences of the catering at the home. One person told us, 'The food is very good although you can wait a long time.' A second person told us, 'Its lovely food I really look forward to it.' One relative told us, 'The staff are very patient with Dad. His health has improved over the last year and a half. He now eats and drinks which he did not do in hospital.'

Is the service caring?

We observed the care people received. Staff we met with appeared to be caring and helpful when supporting people. There was a friendly and welcoming atmosphere within the home.

Is the service responsive?

Care plan records were reviewed on a regular basis or when people`s needs changed. We saw the staff worked in partnership with a range of healthcare professionals to meet the assessed needs of people. We saw evidence of recent work with GP`s, social workers and community health liaison team.

Is the service well-led?

Since the last inspection the provider and the registered manager were developing the services to support the needs of people with dementia type conditions. Staff had been supported to attend relevant training to develop their knowledge and skills in dementia care.

The provider visited the home on a weekly basis. This meant they could offer guidance and support and closely monitor the developments taking place within the service. Information was maintained on a centralised computer system. This meant the provider had oversight regarding all aspects relating to the management of the home.

At our last inspection in May 2013 the provider had been assessed as non compliant because they did not have an effective system in place to regularly assess and monitor the quality of the service they were providing. At this follow up inspection we saw that those risks identified had now been managed. We looked at six care plan records and saw that risk assessments were in place to identify the potential risks posed to people and what actions were required to minimise those risks. We saw there was a range of systems in place for the manager to identify, monitor and manage the risks to people living, working or visiting the home.

Although we recognised improvements had been made in developing the care plan records, we noted that some information regarding people’s allergies and health conditions had not been fully completed. Some risk assessments were not in place and PRN guidance was put of date. We conducted a tour of the building and our checks confirmed that it was being maintained. Staff had received training to meet the needs of people who lived at St Albans nursing home and were being supported to provide care and treatment.

There was a new management team in place that included a newly created role of area manager. Although some audits and systems were being introduced to improve the quality monitoring, we noted that some care plan information had not been transferred over into the new records. Medication audits had not taken place and the guidance relating to the use of medication was out of date.

We observed one person in distress calling for staff support but as the care staff were elsewhere we called the staff ourselves.

We saw other people not being supported to eat their lunchtime meal.

When we spoke with people who lived at the home one person told us, `It’s nice here isn’t it`.

When we spoke with some visitors they had some positive comments and told us, The place is lovely, really nice and the staff are friendly and nice with the residents`.