About the service:

• Albany Lodge Nursing Home is a residential care home that provides accommodation, nursing and personal care to up to 100 older people in a purpose-built building over five floors. At the time of the inspection 98 people were using the service, several of whom were living with dementia.

People’s experience of using this service:

• People felt safe using the service. There were systems in place to protect people from abuse and harm. Risks were appropriately assessed and managed. Staff made sure equipment people needed was safe to use.

• People were protected from the risk of infection because staff followed appropriate guidance.

• Medicines were managed safely.

• The provider responded appropriately to accidents and incidents to prevent them from happening again where possible.

• There were enough staff to care for people safely. There were robust recruitment procedures to avoid unsuitable staff being recruited.

• People’s needs were assessed and, where appropriate, other agencies were involved in assessments and care planning to ensure care was delivered in line with appropriate guidance.

• Staff had appropriate training and support to equip them with the skills and knowledge they needed.

• People had a choice of nutritious, good quality food. People had enough to eat and drink and received support to use healthcare services when they needed to.

• The environment was adapted to meet people’s needs. The home was spacious, wheelchair accessible and pleasantly decorated.

• Staff obtained people’s consent before providing care to them. Where people did not have the capacity to consent, the provider followed appropriate legal processes to ensure decisions about people’s care were made in their best interests, including where decisions were made to deprive people of their liberty as part of the care they received.

• People were involved and enabled to make choices about their care. Staff knew how to communicate information to people so they understood it, including people who did not speak English and people with sensory or cognitive impairments.

• Staff spoke to people in a friendly and respectful way so that people felt comfortable and valued. Staff took time to get to know people well.

• People received care and support from staff who had a good understanding of how to respect and promote their privacy and dignity.

• Staff gave people enough time, encouragement and support to enable them to do as much for themselves as possible.

• People had person-centred care plans that they and their relatives were involved in developing. The care plans contained detailed information about people’s needs, preferences, routines and interests.

• Care plans took into account people’s diverse needs relating to, for example, religion or sexuality.

• The provider had improved the activities that were on offer since our last inspection. People now had more opportunities to engage in individual activities if they did not want to take part in group activities.

• Staff made sure people’s social needs were met, particularly if they did not have relatives visiting them regularly.

• People had end of life care plans to ensure they received appropriate care in their last days.

• There was a robust complaints procedure. The registered manager dealt with concerns and complaints appropriately.

• The provider had clear values and made sure these were communicated to staff. The registered manager made an effort to get to know people and make sure people knew who they were.

• There were clear lines of accountability within the staff team and the registered manager took action where appropriate to ensure staff were clear about their roles and responsibilities.

• Records were generally kept to a high standard. However, we identified some minor concerns around the recording of people’s food and fluid intake and unnecessary paperwork in care files, which the registered manager told us they would address.

• People, relatives and staff had oppor

Albany Lodge Nursing Home 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. Albany Lodge Nursing Home accommodates 100 people across four separate units, each of which have separate adapted facilities. Two of the units specialise in providing care to people living with dementia. At the time of our inspection 85 people were using the service.

We undertook an unannounced inspection on 23 and 24 January 2018. At our previous inspection on 12 and 13 September 2017 we rated the service ‘requires improvement’ and identified six breaches of legal requirements relating to safe care and treatment, person centred care, good governance, staffing, notifications about deaths and other incidents. We issued warning notices in relation to the breaches of regulation relating to good governance and staffing. We undertook this inspection to review the quality and safety of the service and to ensure action had been taken to address the breaches identified at our previous inspection.

The registered manager remained in post. 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 provider had taken sufficient action to address the breaches of regulation identified at our previous inspection. We also saw the provider had taken sufficient action to improve their rating to ‘good’ for the key questions ‘safe’, ‘effective’ and ‘caring’. However, we found the provider was still rated ‘requires improvement’ for the key questions ‘responsive’ and ‘well-led’.

We found that whilst improvements had been made and people were now receiving person-centred care, that some staff’s lack of verbal and written English was impacting on the quality of interactions with people and/or their relatives. The provider had begun providing English classes to staff where English was not their first language and they told us they would continue to do so. Care records had been updated and improved and now provided clear information about people’s support needs and the support staff delivered. However, we found some care records were disorganised and there was a risk that some information may be missed. The provider’s quality and compliance team were in the process of redesigning the care records which would address these concerns.

The group activities programme remained in place and people continued to enjoy the activities on offer. However, we continued to find there was a lack of engagement and stimulation for people who were unable or did not want to engage in the group programme, particularly for people living with dementia. We recommend the provider implements best practice guidance and resources to further support meaningful engagement with people living with dementia.

The registered manager improved their practices to review and improve the quality of service delivery. We saw the programme of monthly audits of key areas of service delivery were adhered to, as well as analysis of key service data to identify any trends which indicate additional support or improvement is required. Whilst much progress was made to improve the monitoring of the quality of service delivery, we saw the staff had not undertaken health and safety checks at regular intervals. The management team told us they would ensure this was rectified.

People felt safe at the service. Risk management processes had been improved and staff were knowledgeable about the risks to people’s safety and how these were to be mitigated. Equipment was regularly checked to ensure it was in good working order and

Albany Lodge Nursing Home provides accommodation, care and nursing support to up to 100 older people. At the time of our inspection there were 87 people using the service. The service is delivered over four floors, with two floors offering general nursing support and two floors providing nursing services for people living with dementia.

At our last comprehensive inspection in September 2016 the service was rated requires improvement and a breach of regulation relating to good governance, specifically in relation to care records, was identified.

The registered manager had been in post since February 2016. 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.

Sufficient action had not been taken since our previous inspection to address the concerns relating to good governance. Accurate, complete and contemporaneous records were not maintained in regards to the people using the service. Detailed records were not maintained about the support provided. Robust systems were not adhered to in order to review and improve the quality of service provision.

Staff assessed the risks to people’s safety, however, sufficient action was not always taken to minimise and mitigate the identified risks. Risk management plans were not always updated in response to changes in people’s needs and equipment was not sufficiently checked to ensure it was used in a safe way.

Staff did not always follow advice and guidance provided by multi-disciplinary professionals which impacted on the quality of care provision, and at times there was a lack of action recorded in response to changes in people’s health and support needs. There were varying levels of communication between staff and people which impacted on staff’s ability to provide person-centred care.

An activity programme was in place and we observed the activities delivered were well attended and people appeared engaged and enjoying the entertainment. However, for those that did not attend the group activities there was little stimulation and engagement provided. People were often left sitting in silence and staff did not use the resources available to support people living with dementia.

The registered manager had not ensured staff had the knowledge and skills to undertake their duties. Staff had not completed the provider’s mandatory training. The registered manager did not assess staff’s competency to undertake their duties. Staff did not receive regular supervision and appraisal.

The registered manager had not adhered to the requirements of their registration. They had not submitted notifications about death of a service user or allegations of possible abuse.

People received their medicines as prescribed and on the whole safe medicines management processes were followed. However, we identified that accurate records were not always maintained in regards to the administration of topical creams. Staff adhered to the principles of the Mental Capacity Act 2005 and arranged best interests’ meetings for people that did not have the capacity to consent to particular decisions. Staff adhered to the restrictions authorised through Deprivation of Liberty Safeguards (DoLS) in order to keep people safe. Staff supported people with their dietary requirements. A GP visited the service regularly and staff supported people to access healthcare appointments.

Staff respected people’s privacy and did not enter a person’s room without their permission. People were supported to practice their faith. Staff respected people’s wishes in regards to their end of life care decisions.

Mechanisms remained in place to obtain people’s and relatives views and opinions. A complaints process remained in place and staff supported peopl

We carried out an unannounced comprehensive inspection of this service on 6, 7 and 14 September 2016. After that inspection we received concerns in relation to staffing levels at weekends. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Albany Lodge Nursing Home on our website at www.cqc.org.uk

We received concerns that staffing levels had been poor over the weekend especially on Sundays. We undertook a focused inspection on 11 December 2016 to check staffing levels on each floor. At our previous inspection we saw staffing levels had improved and the way the registered manager monitored staffing across the service was getting better. However, we felt there were still improvements to be made to the way staffing levels were determined and monitored. During this focused inspection we found staffing levels were adequate. Staff allocated to each floor were found to be working where and when they should be.

Our inspection took place on 6, 7 and 14 September 2016 and was unannounced. At the end of the first day we told the provider we would be returning to continue with our inspection.

At our last inspection during 24 and 25 November 2015 five breaches of legal requirements were found. This was because there had been a lack of contingency plans to deploy sufficient staff when required. Medicine procedures and records did not always keep people safe. The provider did not always consider peoples mental capacity and follow procedures to make sure people were protected from abuse. Not all care and treatment met people’s needs and reflected their preferences and systems and processes were not in place to identify and assess risk, health and safety and the welfare of people using the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. During this comprehensive inspection we found that the provider had followed their plan and the above legal requirements had been met.

Albany Lodge Nursing Home provides nursing care for up to 100 people over the age of 65, some of whom are living with dementia. It is a purpose built nursing home located over four floors all accessible by lift. At the time of our inspection 89 people were using the service. The manager had applied to the Care Quality Commission (CQC) to be a registered manager for the service.

A registered manager is a person who has registered with the CQC 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.

People's care records were in the process of being updated to focus on each individual. These now included details such as peoples likes, dislikes, social histories and how they would like to be cared for. These were near completion at the time of our inspection. The service had also introduced bedside folders to help staff understand individual needs and preferences. These also contained essential information about people’s daily care and checks to ensure people received the care they needed. However, we found some of this information was not completed at times or completed incorrectly. We spoke with managers about our concerns.

People told us they felt safe living at the service. They said staff were kind, caring and respected their privacy and dignity. Staff spoke with people in a kind and sensitive way. They were helpful and polite while supporting people at mealtimes to make sure people had sufficient amounts to eat and drink. People and their relatives were mostly positive about the food at Albany Lodge Nursing Home. Special dietary requirements were catered for and people’s nutritional risks were assessed and monitored.

Staffing levels were adequate at the time of our inspection to help make sure people were safe. New systems had been introduced to ensure a flexible workforce. People, their relatives and staff told us staffing levels had improved, however, there were still times when additional staff cover was needed. Managers were working on new ways to monitor staff numbers to further reduce the risk of inadequate numbers of staff deployed in the home.

The recruitment procedures were appropriate at the time of our inspection and any gaps in staff training had been identified.

We found improvements in the way people’s medicine was being ordered and managed. People received their prescribed medicines at the right times and these were stored securely and administered safely by registered nurses.

People had access to healthcare services when they needed it and received on going healthcare support from GPs and other healthcare professionals.

The provider was aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensu

At our last inspection of this service in June 2013 we judged that the service was not meeting The Essential Standards of quality and safety with regard to staffing levels and staff training. We undertook this inspection in order to monitor their progress on becoming compliant with these standards.

During our inspection we spoke with the people who were using the service, their visiting relatives and several members of staff that regularly worked there.

All of the people we spoke with told us they were happy with the overall standard of care provided at the home and felt that staff who worked there were always kind and caring. One person said “all the staff are lovely… I cannot fault any of them”. Another told us “the health care assistants are fantastic here. They are so kind and caring to my mother”. Throughout our inspection we saw staff interactions with people who use the service and their guests was always characterised by kindness, warmth and empathy.

However, although people using the service and their visiting relatives told us they were happy with the staff that worked at Albany Lodge; we found people’s needs may not always be fully met because the provider had failed to ensure that, at all times, there were sufficient numbers of care staff working in the home. One person told us “all the staff are so nice, but sometimes you have to wait ages for someone to answer your call bell because they’re so busy”. Another person said “the staff work so hard here, but there’s often not enough of them around to look after all the people here properly.

We were able to see that staff training within the service had improved. Staff told us that during the last six months they had attended training to help them fulfil their role and we were able to see documentary evidence of this as well.

Since our last inspection we have been made aware of a number of safeguarding concerns that have occurred within the service. This is where the health and safety of one or more people may not have been protected. All of these concerns were reported to us and to the local authority in line with current guidance. We were able to talk with the manager about the measures that had been put in place to minimise the risk of any future concerns

Albany Lodge provides nursing care for people who may have dementia. People that we spoke with and their relatives were all very pleased with the way that they were cared for and supported in the home. They told us “I am very happy here”, and “I love this home, I’m very happy here”. People told us they were able chose how they spent their day. They were able to join in with organised activities if they wanted to and able to decline, if it was not something that interested them. Comments we received included “I have a choice what to do and “they (the staff) always ask me if I want to join in, and I can go out into the garden.

People told us “I like the food here, but if I don’t like the choices they make me an omelette”, and “the food here is excellent”, the food is very nice” and “there is always plenty to eat”. We saw that tea coffee and soft drinks were available throughout the day.

We have raised some concerns about the way staffing levels were organised in the home. We saw that some people, particularly on the dementia units, were not being appropriately supported. We also judged that not all of the staff had been able to access training to provide them with the necessary skills to meet the needs of the people using the service.

All of the people we spoke with told us they were very happy living in this service. They told us that the staff were very cheerful, kind and caring. They said the food was very good and they were always offered a choice.

One person said "this is the best, it's really good here" and another told us "we have lovely rooms, always clean and I could bring things in from home, it made it feel more like my own".

People knew how to raise a concern, should they need to. One person said " I know how to make a complaint, but I haven't got any". Another told us " if we have any complaints they ( the management team) sort them out straight away".

On the day that we visited the service we judged it to be compliant. However, during the course of our review of compliance, we had been informed of a previous serious safeguarding matter. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. There was evidencethat the provider had taken the appropriate action by immediately informing the relevant authorities and following their own procedures for responding to it. Since that time some staff have ceased to be employed by the service and there have been changes within in the management structure.

There had also been an improved programme of monitoring by senior personnel within the organisation and a new person had been appointed to manage the home.

The people that we spoke with were generally very happy. All of them told us how kind the staff were, always cheerful, willing and happy to help them. Several said that they felt very lucky to be living in such a nice place. They said that they felt very safe in the home and should they have any concerns they were confident that they would be addressed by the manager.

Those people who were able to speak with us told us that their health care needs were being met in a way which suited them; they were able to choose what time they got up in the morning and went to bed at night, the clothes that they wore and how they wanted to spend their day. One person said that they had had been able to express a reference for having support from a female member of staff and that this had not been a problem. Others, who were not able to contribute to the review, looked well cared for, clean and tidy. Those people who were being nursed in bed, because they were unwell, looked very comfortable and had mattresses designed to help prevent them from developing pressure sores.

People told us that the home was always clean and rarely smelled like a nursing home. They said that they had lovely rooms and we were able to see that they had had been able to personalise them with pictures, photographs and small items of furniture from home.

We were told that there are various activities arranged for people to join in with if they wanted to although some of them did tell us that they would have liked even more things to do in the day.

We visited on a Friday and most people were enjoying a traditional meal of fish and chips. We saw that mealtimes were a very sociable occasion with several relatives also staying for lunch. We were told that menu choices are always available and that the standard of food is very good. The catering manager is able to meet the needs of people who have particular requests such as kosher or Halal food.

Our inspection took place on 24 and 25 November 2015 and was unannounced. At the end of the first day we told the provider we would be returning the next day to continue with our inspection.

At our last inspection during April and May 2015 the provider met the regulations we inspected.

Albany Lodge Nursing Home provides nursing care for up to 100 people over the age of 65, some of whom are living with dementia. At the time of our inspection 89 people were using the service. A manager had been appointed and was nearing the end of the process of applying to the Care Quality Commission (CQC) to be a registered manager for the service.

A registered manager is a person who has registered with the CQC 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.

At the time of our inspection staff levels were adequate to provide safe care to people, however, we were concerned about the lack of contingency plans the provider had in place to cover nurse and care staff absence when they were on leave or sick, so people were at risk of poor quality of care.

People were given their medicines by registered nurses. However, we found areas of concern with regard to how people’s medicine was being ordered and managed. For example, some people did not get their medicine on time and some people’s records were not complete.

The provider was aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. However, some people’s mental capacity assessments were not fully completed or details were not clear. When a person was found to lack capacity the reasons for making decisions on people’s behalf were not clearly recorded.

People told us they felt safe living at Albany Lodge. They said staff were kind, caring and respected their privacy and dignity. They thought that the care they received was good and that staffing levels had improved, although people commented that sometimes there were still staff shortages and staff did not have the time they needed. We observed some staff were very task focused spending little time speaking or engaging with people in a meaningful way. The recruitment procedures were appropriate at the time of our inspection.

People were mainly positive about the meals served at the service and we observed how people were given a choice of something different if they asked for it. People’s specific dietary needs were catered for.

People’s rooms contained personal belongings and items that were special or of personal value to them, however, more could be done to improve the environment for those people living with dementia.

There was an activities programme at Albany Lodge. The activities staff tried hard to ensure people had the opportunity to be involved in meaningful pastimes to help stop them from feeling lonely or isolated but we found people living with dementia may have benefited from more engagement and stimulation in the lounge environments.

People’s care records were reviewed regularly and focused on their healthcare needs and the risks associated with them. There was very little information on people’s individual needs, history, their likes, dislikes and preferences. This meant that sometimes staff did not know people well which impacted on how staff were able to manage and support people when they became upset.

We have recommended that the service refers to current best practice guidance around activities and the environment for people living with dementia.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, the management of medicines, person centred care, governance and safeguarding people from abuse and protecting their rights. You can see what action we told the provider to take at the back of the full version of this report.