Albemarle is a residential care home for up to 42 older people including those living with dementia. At the time of our inspection there were 41 people living at the home. The home is set out over two floors with communal areas and access to a large secure garden area. There is a passenger lift to assist people to get to the upper floor.

The inspection took place on 2 May 2018 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At our previous inspection in November 2015, we made a recommendation that the registered manager followed the latest guidance on notifications that are required to be submitted to the Care Quality Commission (CQC). At this inspection we checked and found the registered manager had notified the CQC of certain important events as part of their registration.

At our previous inspection in November 2015, we made a recommendation that the registered manager sought advice in regards to their quality management systems so that appropriate and accurate records were held. At this inspection we checked and found the registered manager completed quality assurance checks to maintain standards of service and identify any areas for improvement.

Staff had received appropriate training to ensure people were protected from avoidable harm and abuse. Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised.

The provider maintained safe staffing levels. Staff recruitment included pre-employment checks that meant only suitable employees were recruited to work in the home.

People received appropriate care and support to meet their individual needs because staff were supported to have the skills, knowledge and supervision they needed to carry out their roles.

Assessments of risks associated with people’s care and support and for their environment had been completed. Support plans provided information for staff and other health professionals to ensure people received safe care and support without undue restrictions in place.

Systems and processes ensured safe management of medicines and infection control.

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

The registered provider was committed to providing people with a positive caring partnership with staff who were clear about the importance of paying attention to people’s well-being, privacy, dignity and independence.

The provider equipped staff with the skills and knowledge to appreciate and respond to the principles of equality and diversity. The provider ensured everybody received care and support that reflected their wishes and preferences. Records were being reviewed to improve this information.

People were included in discussions about their care and support and associated information was person centred. Records were evaluated for their effectiveness and amended to ensure they were up to date and reflective of the person’s current needs.

Staff supported people with everyday choices and to enjoy a variety of meaningful activities.

Systems and processes were in place to support people should they need to raise a complaint.

People, their relatives, staff and other health professionals were consulted with and their views and feedback used to help shape the service and maintain high standards of care and support.

Further information is in the detailed findings below.

Albemarle provides accommodation for up to 42 people who need support with their personal care. The service mainly provides support for older people and people who are living with dementia.

Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The service has all single bedrooms and nine bedrooms have en-suite facilities. There were 40 people living in the service at the time of our inspection.

This inspection was unannounced and took place on 4 November 2014. During the inspection we spoke with the four people who used the service, four visitors to the service,  four staff and 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.    

The last inspection took place on 19 December 2013. At that inspection we found the provider was meeting all the essential standards that we assessed.

Although people told us they felt safe in the service, we found they were not fully protected from the risks of infection.  There was a significant and unpleasant odour in one of the communal areas and the corridor carpets were heavily stained. People who used the service, relatives and visiting health and social care professionals had all given feedback on cleanliness to the provider using the systems to assess the quality of the service, but no action had been taken. This meant the quality monitoring processes were not effective as they had not ensured that people were provided with a clean environment in which to live.

Some people who lived in the service were not able to make important decisions about their care due to living with dementia.  We saw that steps had been taken to make sure people who knew the person and their circumstances well had been consulted to ensure decisions were made in their best interests. However, some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty without a standard authorisation being in place. This meant there were inadequate systems in place to keep people safe and protect them from unlawful control or restraint.

People told us that they, and their families, had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. All of the people we spoke with said they were well cared for. They told us staff went out of their way to care for them and all said that it was a lovely place to live.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings. 

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the service. People had been included in planning menus and their feedback about the meals in the service had been listened to and acted on.

People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the service. People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to protecting people by maintaining the service to a clean and hygienic standard, Deprivation of Liberty Safeguards and not monitoring the quality of the service well enough. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our visit there were 41 people residing at the service. The majority of people who used the service were living with dementia.

Care records were detailed and were reviewed regularly to ensure they accurately reflected people’s current needs. People we spoke with told us they were satisfied with the support they received. One person told us “I have been treated really well in every way”.

All staff had a good awareness of the dietary requirements of people who used the service. People were supported to eat in the manner that suited their needs and preferences.

We considered the safeguarding of vulnerable adults as our records showed there had been a large number of safeguarding notifications. We found the provider had acted in accordance with the local safeguarding authority’s reporting protocol and had taken all reasonable steps to try to reduce the number of safeguarding incidents.

Medicines were managed in a way that minimised any risks to people who used the service. We found all records to be in order.

The manager explained the staffing levels employed at the service and that the needs of potential new people were assessed prior to their admission to the service to ensure their needs could be met within the staffing structure.

The manager worked in accordance with the provider’s quality assurance policy to ensure they monitored the quality of the service provided.

During our inspection visit on 15 November 2012 we spoke with four people about their experience of using the service. The people we spoke with were complimentary about the staff. One person told us that "staff are good" and that they had been supported by the same staff for quite a while. Another person described the service as "homely" and said they had "no idea there were such caring people about".

A relative of a person who used the service told us that "the place is happy" and that there were always plenty of staff about when they visited.

Staff told us they felt supported by the manager and were confident that they could go to the manager if they had any concerns regarding the care and welfare of the people who used the service and that these would be addressed.

The temporary manager informed us that she had recently been appointed to the post on a permanent basis and would be making an application to CQC to become a registered manager.

We spoke with two people that lived in the home about their lifestyles and the care they received. Although one of them had some minor concerns that we relayed to the manager they were both appreciative of the staff and said they had been well looked after. One of them told us there was no reason to complain, the staff were helpful and Albemarle was a nice place to live.

We carried out this inspection on 3 and 4 November 2015. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was unannounced; which meant that the staff and registered provider did not know we would be visiting.

The home is required to have a registered manager in post and on the day of the inspection there was a registered manager in post who had been registered with the Care Quality Commission (CQC) since July 2013. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run.

At the last inspection on 4 November 2014 we asked the provider to take action to make improvements to infection control, the safeguarding of people from unlawful care and treatment and how the service was assessed and monitored. We found this action had been completed.

Albemarle provides accommodation for up to 42 people who need support with their personal care. The service mainly provides support for older people and people who are living with dementia.

Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The service has all single bedrooms and nine bedrooms have en-suite facilities. There were 42 people living in the service at the time of our inspection.

The service submitted statutory notifications in line with requirements. However, they had failed to notify the CQC when people had a DoLS application authorised. We made a recommendation regarding this in the report.

We found the provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support. However we found that the audits had failed to identify that food and fluid charts were not always accurately recorded and also that some elements of care planning had not been updated. We made a recommendation regarding this in the report.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were appropriately actioned.

People’s nutritional needs were met. People enjoyed a good choice of food and drink and were provided with regular snacks and refreshments throughout the day. People told us they enjoyed the food and that they had enough to eat and drink. People were supported to maintain good health and had access to healthcare professionals and services. However, we found the recording of people’s food and fluids charts to be inconsistent.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately in the service.

We found assessments of risk had been completed for each person and plans to manage these risks had been put in place. Incidents and accidents in the home were accurately recorded and monitored monthly.

The home was clean, tidy and free from odour and effective cleaning schedules were in place.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as safeguarding, moving and handling and infection control and also home specific training such as dementia awareness.

The registered manager was able to show they had an understanding of Deprivation of Liberty Safeguards (DoLS) and we found the Mental Capacity Act (MCA) (2005) guidelines were being fully followed.

People told us they were well cared for. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were able to make choices and staff supported them with this.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported. The home employed activity coordinators and offered a variety of different activities for people to be involved in. People were also supported to go out of the home to access facilities in the local community.