Albury Care Home is a large home registered to provide accommodation for up to 33 older people who require personal care. The service specialises in supporting older people who have dementia. At the time of the inspection there were 15 people using the service.

The service had a registered manager 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.

The service was inspected previously on 26 July 2016 and placed in ‘special measures’. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be in the same question at each of these inspections for us to place services in special measures. The registered provider sent us action plans and regular reports about the steps that were being taken to make the required improvements.

Another inspection was carried out on 24 January 2017 and although improvements were found, the service was in breach of the regulations. The service was given an overall rating of ‘requires improvement’ with an ‘inadequate’ rating in relation to the ‘well-led’ key question. This was because the service had failed to implement robust recruitment processes to ensure staff were safe to support people. The service had also failed to ensure the environment and facilities were safe for people who lived at the service and dependency tools did not consider the aspects of the lay out of the home, ancillary staff and hours for activities.

At this comprehensive inspection we found the provider had made improvements in relation to the safety of the environment, employment of ancillary staff, staff suitability to work with people living at Albury Care Home, care records, audits and the registration of a permanent manager.

Procedures in place protected people from harm and abuse. Staff had sufficient knowledge of how to identify, report and escalate suspected abuse and received on-going safeguarding training to keep people safe. Risk management plans in place gave staff clear guidance on how to support and respond to identified risks. Risk management plans were reviewed regularly and amendments shared with staff.

The service carried out regular checks of the environment to keep people safe. Records confirmed that issues identified were documented and action taken to address them in a timely manner. Emergency plans identified people’s needs and how staff should support them in the event of a fire. The service had a schedule to monitor and make improvements to the environment which was on-going.

People received support from suitable numbers of staff to keep them safe. Staffing levels were determined around the needs of people and, where those needs changed, staffing ratios were increased to keep people safe. The service had systems in place to ensure suitable staff were employed and vetted in line with good practice. Staff received on-going training to effectively meet people’s needs. Training included fire safety, safeguarding, medicines management and Mental Capacity Act 2005 (MCA).

People’s medicine was managed safely and in line with good practice. Medicine administration records (MAR) were completed correctly with no omissions or errors noted. Stocks and balances indicated people had received their medicines as prescribed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best inte

This was an unannounced inspection which took place on 24 January 2017.

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 17 people living at the home. Some of the people were living with dementia.

The home does not have a 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 previous registered manager left in July 2016. A new manager was appointed but left at the beginning of January 2017and before they had completed the registration process with us. A further new manager had been recently appointed and was present during this inspection.

Albury Care Homes Limited was last inspected on 26 July 2016 when it was given an overall rating of ‘Inadequate.’ The service was placed in ‘Special Measures’ and Warning Notices were issued due to unsafe facilities, the environment and for poor management systems and governance. Requirement actions were also set due to concerns that were identified with staffing, personalised care, safeguarding and complaints. The registered provider sent us action plans and regular reports about the steps that were being taken to make the required improvements.

As a result of this inspection the overall rating for this service is ‘Requires Improvement.’ However, we are placing the service in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

At this inspection we found that improvements to the environment, safeguarding, complaints and personalised care had taken place. Steps had been taken to improve governance, management and staffing but these had not been sustained. People and staff said the manager was approachable but that stability was needed. The home had been without a registered manager since July 2016 and the registered provider had not ensured compliance with the regulations, or that actions were taken to assess and mitigate all risks to people’s welfare. Full information about CQC’s regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

Quality monitoring systems had not ensured all aspects of the service were assessed, monitored and prompt action taken to address shortfalls. Fire safety management had improved but audits and governance systems had not identified where further work was required. Records were still not

accurate. These included care records, staff training records and rotas. There were still no separate domestic, laundry, kitchen or activity staff and care staff were responsible for undertaking these duties in addition to caring for people.

Improvements to the environment and facilities had taken place but aspects were still unsafe or affected the quality of service people received. Some areas of the home were cold and the heating was ineffective. Aspects of fire safety management still needed to be improved.

Robust recruitment processes were not always followed to ensure staff were safe to support people. This was a breach of Regulation 19 of the Health and Social Care Act (Regulated Activities) 2014.

Checks on the electrical wiring in the service, moving and handling equipment and water safety systems had taken place. Food temperatures were now being monitored to ensure it was safe for people to eat and the kitchen had been deep cleaned.

People said that they felt safe and we observed that they ap

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 no

This was an unannounced inspection which took place on 07 December 2015.

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 21 people living at the home, a few of whom were living with the early stages of dementia. Two people required assistance to move using a hoist. All other people were independent in this area and required minimal support with their care needs. The majority of people who lived at the home funded their own care.

The home has a 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 registered manager was not present during our inspection. The two directors that owned the home came and supported staff through the inspection process.

Systems to assess the quality of the service provided in the home were not effective. Records in the home were not always accurate or up to date. The registered provider could not verify that robust recruitment procedures had been followed to ensure agency staff were safe to support people. Prompt action had not always been undertaken on the home environment and equipment to ensure it was safe. All staff were not consistently provided with one to one supervision and training to fulfil their roles and responsibilities and there was little evidence that staff received training specific to the needs of people who lived at the home.

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.

There was a basic activity programme in place and we found that although people had raised concerns about the lack of stimulation and opportunities to go out into the community these had not been addressed and planned activities outside of the home had not taken place in 2015.

Staff did not have time to sit and talk to people as they were focused on delivering care and completing tasks. However, we observed that people received personal care and support promptly and at the times they preferred. Call bells were responded to quickly and people said that this was the norm. Although we observed that staff at times appeared busy and rushed we saw no signs of impatience with people. Staff appeared dedicated and committed. We have made a recommendation about this in the main body of our report.

People said that they consented to the care they received and we found that correct procedures had been followed if people lacked capacity and were being deprived of their liberty in anyway.

Everyone, apart from one person said that they were happy with the support they received to manage their health. Medicines, in the main were administered, recorded and stored appropriately. People also said that they were happy with the choice of food and drink in the home.

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.

People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

During our inspection visit we spoke with the provider, two people who used the service and three members of staff.

One of the people we spoke with told us that they had celebrated a birthday since our last inspection in May 2013. The staff at Albury Care Home Limited had organised a party which the person had very much enjoyed. The person told us, "They look after me very well and they are pretty good".

One member of staff told us "We are going through a difficult patch at the moment because of people taking leave but things have improved". A second member of staff said "It is better than it was".

As part of our visit we viewed staff rosters, past, present and future and found that staffing levels had been increased. We inspected care records and found that they were current and had been fully completed.

You can see our judgements on the front page of this report.

We spoke with six people who used the service and they all gave us positive feedback regarding the home. One person said; “I think they’re very good. Staff always speak to me well and respect me. All my needs are taken care of and I feel safe”. Another person said; “I think it’s alright. I feel my needs are met. I feel safe and would feel comfortable complaining”. Another person said; “They look after us very well. I feel safe and I think they would be good in an emergency”. Another person said; “I like it here, staff are extremely good. All my needs are met, they look after me”. Four out of six people we spoke with expressed concerns with the staffing numbers and expressed there was sometimes a lack of staff. We spoke with two healthcare professionals who also expressed their concerns around a lack of staff.

We found people’s consent had been obtained prior to care and treatment being provided. We found people’s care needs and risks had been assessed and care plans which reflected these personal needs had been created. All staff had been trained in safeguarding and information relating to the reporting of concerns was easily accessible. Staff had been appropriately recruited and appropriate checks had taken place prior to them starting work, however, there were not enough staff to safely care for people. The service had a statement of purpose in place which contained all required information.

We spoke to three people who used the service when we visited.

Some of the responses we received from people who used the service included “I have a care plan and I signed it but I cannot remember what was in it. My relatives would know.” Another person told us “I know my care plan tells the staff that I liked to be helped to get dressed.” A third person told us “I cannot remember if I had signed the care plan because I have a poor memory.”

People who used the service told us that they were able to express their views and were involved in making decisions about their care and treatment.

People told us that their bedrooms were cleaned regularly and that the home was always clean, tidy and nice smelling.

Some of the other responses included “There was always a member of staff available should I require their assistance,” “Staff respected my privacy and would always knock on my bedroom doors before entering.”

People who used the service told us that staff respected their privacy and dignity and attended to their personal care needs in the privacy of the bedrooms with the doors closed. They told us that they could not remember what was included in their care plans. None of the people we spoke to could recall being involved in the planning of their care and most were unaware that they had a care plan. One person told us that their sister knew about their care plan, and staff would talk to her if any changes were made to the care plan.

They told us that they were satisfied with the care they received, that staff were supportive and responsive to their needs. We were told that most staff responded to the call bells promptly, however, there were times when they had to wait for staff to respond as they were busy attending to other people. One person said that staff did well under the circumstances, referring to their understanding that the staffing levels at the home had been reduced.

We were told that the toilets were always cleaned every day. Some people who used the service told us that their bedrooms were cleaned every day, some people could not remember how often they were cleaned.

People who used the service told us that there were not as many staff as there used to be. They stated us that there were now fewer activities as staff were very busy doing other things like cooking and cleaning. They stated that they occasionally have music activities and keep fit exercises. People told us staff did not have any time to sit and talk with them like they used to do.