We carried out a comprehensive inspection of Alban House on the 2 and 23 May 2018. The first day of inspection was unannounced; we arranged the second day of inspection before we visited.

Alban House 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.

The care home accommodates up to 23 people in one adapted building.

At the last inspection in January 2017, we rated the service as requiring improvement. This was because the home was not fully safe, effective and well-led. We found three breaches of the Health and Social Care Act 2008 (Regulations 2014). This was because people’s medicines were not managed and administered safely; people were not protected from the risk of infection; care was not always delivered to ensure it supported people with individual risks; parts of the home were not kept clean and infection free and systems to audit and monitor the quality and safety of the home were not robust.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Is the service safe; is the service effective and is the service well-led?

The provider submitted an improvement action plan to address these concerns, stating what they intended to do and when this would be achieved. At this inspection we found improvements had been made so all the regulations had been met in respect to the breaches found at the previous inspection.

One of the providers was also 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.

At this inspection, we found the registered manager did not always set a good example as a role model to staff. We also found the provider had not followed the requirements of the regulations to display the rating from their last inspection on their website. We therefore rated the Well-led domain as requiring improvement.

A deputy manager was being trained to run the home by the registered manager. The registered manager had introduced new systems and processes with the support of staff. These had helped to improve the quality and safety of the care provided. The deputy manager was very well thought of by people living at Alban House, by the providers and by staff.

Care records reflected the care people needed to support them with their risks, needs and preferences. Staff knew people really well and were able to describe the care and support they needed. People said staff were kind and helpful. Throughout the inspection we observed numerous interactions where staff showed kindness and respect to people.

Activities were offered both within the home and in the community to support people with maintaining their interests.

People said they liked the food, which was freshly prepared. Staff took time to ensure people had a meal of their choice. This included supporting people who needed help to eat and drink. People were offered drinks to keep them hydrated.

The home was clean and well maintained. There were systems in place, which staff followed, to ensure a safe and infection-free environment. People’s bedrooms were individually decorated and furnished according to their preferences.

Medicines were received, stored, administered and disposed of safely. Medicine administration records and other records relating to medicines were completed accurately.

Staff were recruited safely. Staff undertook an induction to introduce them to the service and ensure they had the knowledge and skills to support people s

This comprehensive inspection took place on 11 and 19 January 2017 and was unannounced on the first day.

The home provides accommodation and personal care for up to 23 adults who require personal care. The home specialises in providing care to predominantly older people with mental health needs or neurological conditions such as Multiple Sclerosis.

The home consists of two adjoining properties located in the seaside town of Ilfracombe.

One of the providers was also the registered manager for the home. 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 previously inspected in November 2013 when the service was found compliant in all the regulations we looked at.

The home had a relaxed and happy atmosphere. People, their relatives and health professionals all said that staff were kind and compassionate, treating people with dignity and respect. Staff knew people well and were able to describe how they supported them. A visiting professional said “The care here is very good; they have a good group of staff”. People and their relatives knew how to complain, but said they had not had reason to.

Staff were recruited safely with checks carried out before they were allowed to start working at the home. Some staff were not up to date with their training. This meant that staff might not have the right skills, knowledge and experience to work effectively with people. Staff had received training to support people who had physical impairments, suffered strokes or had long term conditions including Multiple Sclerosis and dementia. Some staff had been supported to undertake nationally recognised qualifications in care.

Staff understood their responsibilities and duties in terms of safeguarding people from the risk of abuse. Staff were able to describe the actions they would take if they had a concern.

Individual risks to people’s safety had been assessed and plans written to show how these were being addressed. The home had an emergency evacuation plan and had also developed individual personal evacuation plans to support each person.

Where someone was assessed as lacking capacity to make a particular decision, staff had not always followed the principles outlined in the Mental Capacity Act 2005.

People were supported to remain as independent as possible and were encouraged to do activities of their choice both within the home and in the community. Relatives and friends were welcomed into the home and were able to use communal areas and people’s bedrooms to meet in private if they wished.

Peoples’ medicines were not managed, stored and administered safely because current relevant professional guidance was not being followed.

People were provided with a choice of meals which were freshly prepared. Hot and cold drinks were available for people throughout the day. People said they enjoyed the food. Where people had specialist dietary needs, staff ensured that food was prepared to meet these. Some people were at risk of losing weight. Although staff encouraged them to eat additional food, food record charts were not being used. This meant that it was not possible to see what people had actually eaten and whether they continued to be at risk.

Although maintenance of the home had been undertaken, some areas of the home were in need of redecoration and refurbishment. Some communal areas were showing signs of wear and looked ‘tired.’ Although there were sufficient care staff to support people’s needs, there were not enough domestic staff on duty each day to ensure that all areas of the home were kept clean and free from infection. Some kitchen equipment needed replacing and some more difficult to reach par

The home was registered to provide personal care and accommodation for up to 22 people. On the day of the inspection we spoke with nine of the people who lived at Alban House Residential Care Home. We were able to speak with the relatives of one person, and three of the staff on duty.

The majority of people expressed satisfaction with the service. The comments we received included “It is the best care home I have lived in,” and “It is very nice and the food is very good,” and “the owners are absolutely brilliant…they are very passionate about providing good care .”

People told us the staff were respectful and treated them with dignity. We were told there were some activities available. People were happy with the care they were provided with. People told us staff supported them with their personal care in a manner which they wanted. People said care was unrushed and supportive. The medication system was well organised and operated effectively. People said staff were polite, kind and friendly. People were happy with the food. On the day of the inspection there were satisfactory numbers of staff on duty.

The accommodation was furnished, decorated and maintained to a satisfactory standard. The home was clean and satisfactory infection control procedures were in place. The quality assurance system was appropriate.

There were 22 people living at the service, with one person in hospital when we visited. We spoke with six people living there, four care workers, a relative and two professionals.

We saw care and support was delivered in a kind and respectful way. People told us that their views were respected with comments like, “I’m in control and tell them what I want to do”. We saw on two occasions when people’s personal matters were discussed with them in communal areas within earshot of other people. We highlighted promotion of people’s confidentiality and dignity as an area for improvement

We looked at some key documents including care plans, risk assessments and quality assurance records. This helped us to make a judgement about how well the home was being run.

Care was being planned and people were involved in making decisions about their care and treatment and activities of daily living. People were encouraged to do various activities. We were told that the provider had given the staff team additional hours to take people out and about in the community and organised activities within the home.

Everyone we spoke with made positive comments about the home. For example one person told us “Alban House is a very homely and friendly place to be”. Another person said “I am treated fairly and all of the staff are very kind”. Professionals told us “The team is very good here, hot about care and support. We have no concerns at all about Alban House”.