We carried out an unannounced comprehensive inspection on 2 and 3 January 2019.

Albany House is a care home without nursing for up to 18 people. On the day of our inspection there were 16 people living at the service. The home provides support to people with mental health needs that include schizophrenia, bi-polar, dementia and depression.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was 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.

At the last inspection on 13 June 2016, the service was rated Good. At this inspection we found the service had improved to Outstanding.

Why the service is rated Outstanding.

We spent time with people during our visits and some people had chosen to write us a letter describing their experience of living in Albany House. Feedback received from people living in the service was extremely positive, saying things like “I feel safe. I feel loved” and “I feel like staff and residents are family”.

Feedback received from professionals was also very positive. They told us about the impact the great service had for people. The provider’s website also had many positive reviews from relatives of people using the service. Most rated the service as excellent.

The service was extremely well led. The provider’s values and vision were embedded into the service, staff and culture. The provider and registered manager were passionate and committed to developing a service where people received genuinely person-centred care. This was evident throughout our visit. People, relatives, staff and professionals said the registered manager was very approachable.

People were supported to develop close relationships with each other and with all the staff. The management and staff created a warm and relaxed environment and we observed a strong caring relationship between people and the registered manager. Relationships were professional but two way and people knew about the registered manager’s and staff families and interests which helped maintain these relationships.

People’s equality and diversity was respected and people were supported in the way they wanted to be. The service had a clear policy on equality and diversity and staff and people received training on this topic. The registered manager gave us examples of how the service had provided support to meet the diverse needs of people using the service, including those related to sexuality and faith. People’s individual preferences were identified through discussion with them or their relatives if appropriate. Their preferences were documented in care plans if they wished this information to be shared, and understood and respected by staff.

People received outstanding care from a dedicated staff team who were very kind, caring and compassionate, and who demonstrated they would go the extra mile for people when necessary. Staff had built very strong relationships with people. All staff demonstrated kindness for people through their conversations, interactions and observations. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

People were provided exceptional care to protect their wellbeing and their individual needs. People’s wishes for their end of life were clearly documented and the care and support provided was exceptional.

There were quality assurance systems in place to help monitor the quality of the service, and identify any areas which might require improve

The inspection took place on 13 June 2016 and was unannounced.

Albany house is a residential care home, which provides care and support for up to 18 people with a variety of mental health needs. At the time of our inspection there were 16 people living at the home.

Albany house is a detached two storey home. All bedrooms were single occupancy. There was a communal lounge, separate dining room and a garden, which included a designated smoking area. There was a kitchen, which was only accessed by staff. If people wanted to prepare their own food this was supported in the dining area.

There was a registered manager in place who was in day to day charge and worked alongside staff in order to provide care for people. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, 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.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People told us they felt safe at the home.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being, at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Accidents and incidents were accurately recorded and were assessed to identify patterns and triggers. Records were detailed and included reference to actions taken following accidents and incidents. Reference was also made to behaviours, observations and other issues that may have led to an accident or incident.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

Staffing numbers were adequate to meet the needs of people living at the home. The provider used a dependency tool to determine staff allocation. This information was reviewed following incidents where new behaviours were observed which might increase or change people's dependency level.

Safe staff recruitment procedures ensured only those staff suitable to work in a care setting was employed.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the MCA and DoLS. People at the service had capacity and the staff sought people’s consent about arrangements for their care.

Staff were skilled in working with people who had mental health needs. Training included behaviour management, mental health awareness and self-harming.

Food was produced using fresh ingredients, to a high standard and offered good choice. People could choose to eat in the dining room or other areas of the home. Drinks were provided at regular intervals and on request.

People's health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

Staff were caring, knew people well, and treated people in a dignified and respectful way. Staff acknowledged people's privacy. People commented that staff were understanding of their mental health needs and provided support during periods of distress. Staff had positive working relationships with people.

Care was provided to people based on their individual needs and was person-centred. People were fully involved in the assessment of their needs and in care planning to meet those needs. Staff had a good knowledge of people's changing needs and action was taken to review care needs.

Staff listened and acted on what people said and there were opportunities for

We spoke with five people who lived at the service and one relative. Everyone told us that they were happy with the support they received. For example, one person told us, "All the staff are lovely here. We are always doing things, getting out and about. They make sure my health needs are managed. I have regular check ups".

People also told us that they were happy with the environment that they lived in.

We also gathered evidence of people's experiences of the service by observing how people were supported by staff, looking at records and talking with members of the management team. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area.

People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered.

Everyone that we spoke with told us that they could approach the staff and management if they were unhappy or had issues to discuss. People told us that they were regularly asked for their views and opinions to make sure they were satisfied with the service they received. As one person explained, "We have house meetings and we are always been asked if we are happy. I love living here".

The evidence we gathered during this inspected supported the comments made by people.

We spoke with two people who use the service. They told us that they were happy living at the home and felt safe and well cared for. One person, who had lived at Albany House for several years, told us that it was a “home from home”.

We spoke with two relatives, both of whom always visited the home unannounced. They told us that the privacy and dignity of their relatives was maintained at all times. We observed that people’s own space, such as their bedrooms, was respected and staff did not enter without permission. One relative said that the care given was “really good” and that people were safe living at the home. Another relative told us that the food served was of a high standard and that staff were “very caring”. Both relatives felt that any complaints or suggestions they made to staff would be listened to.

People said that they felt staff were available whenever they needed assistance. They also said that staff were very pleasant.

To help us understand the experience of people using the service, we used our Short Observation Framework for Inspection tool (SOFI). This allowed us to spend time watching what was going on in a service and to record how people spent their time, the support they got and whether or not they had positive experiences. Using this, we found that staff had the necessary time and skills to care for people well.