About the service: Albany House is a mental health nursing home registered to provide accommodation with nursing and personal care for up to eight people who have mental health illness. A total of eight people lived at the service however one person was in hospital at the time of our inspection visit. The service specialises in providing 'aftercare services'; the care and support of people who have been detained under the Mental Health Act 1983 and then discharged from certain sections of the Act.

People’s experience of using this service:

•There were enough staff to meet people’s assessed needs and support their planned activities.

•Risks which affected people’s daily lives, both in the home and out in the community, were documented and managed by staff.

•Staff had completed safeguarding training and knew what to do if they were concerned about people’s well-being.

•Staff provided support for people to take the medicines they needed to remain well.

•Staff received training which enabled them to provide care and support in line with best techniques and current practice to meet people’s needs.

•People were supported to make daily living choices such as what they wanted to eat and how to maintain good mental and physical health.

•People benefitted from following their own interests and hobbies and staff helped people to become more socially involved and engaged within the local community.

•Staff were aware people’s needs could change, and understood when to seek advice and involve other health care professionals and services.

•People were encouraged and supported by staff to make decisions about their care and how this care was delivered to them. Staff knew people’s preferred ways of communicating, to assist people to make their own choices.

•People were treated with respect and understanding. Staff were aware of how their approach could affect people’s personalities and wellbeing. Staff took a genuine interest in people, knew them well and had a good understanding of their social and cultural needs.

• Staff encouraged and supported people to be as independent as possible.

•Care plans contained good and clear information for staff to help them provide good and consistent care to people. Plans were personalised and focussed clearly on maintaining physical and mental wellbeing.

•There was a manager in post at the time our inspection visit and they were in the process of registering with us.

•Plans were made to improve the interior and exterior of the home and staff and people living at the home, kept the home clean.

•People and staff’s feedback was sought to improve the delivery of service.

•Systems of audits were in place but further scrutiny was needed to make sure actions were taken when checks were completed or delegated to others.

We found the service met the characteristics of a “Good” rating in four areas and “Requires Improvement” in one area; For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. The last report for Albany House was published on 29 July 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had remained consistent.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 7 and 11 July 2016 and was unannounced.

Albany House is a mental health nursing home, registered to provide personal care, nursing and accommodation for up to eight people over two floors. At the time of our inspection, there were seven people living at the home.

A requirement of the service’s registration is that they 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. A registered manager was in post.

People told us they felt safe living at Albany House. Staff had received training on how to protect people from abuse and had an understanding of their responsibilities in relation to safeguarding people and keeping them safe. Care records demonstrated the provider had identified risks to people's health and well-being and how they planned to protect people and support their safety. Safety management plans were signed by people to encourage them to take some responsibility for managing risk themselves. People received their medicines from trained, experienced staff who were assessed regularly to confirm their on-going competency to give medicines safely.

Staffing levels were based on the needs of people living in the home. At the time of our inspection the provider was reliant on bank and agency staff to maintain staffing levels. A new member of staff had been recruited to ensure there were sufficient staffing levels to reduce the use of agency staff. The provider’s recruitment process ensured risks to people’s safety were minimised. Staff received an induction, training and support from managers to carry out their roles safely and effectively.

Staff understood the requirements of the Mental Capacity Act 2005. Staff worked with people to support them in making wise decisions, and to look at the consequences of making decisions which might be harmful to them.

Staff were aware of people’s dietary needs and encouraged people to eat a healthy diet which met their needs. There were regular multi-disciplinary meetings with external healthcare professionals to discuss the support needs of people who lived at Albany House.

Staff understood the importance of making time to listen to people. On the day of our inspection visit we saw staff gave good support to people to manage their feelings. People were involved in deciding how their care and support should be delivered, and were able to give their views on an on-going basis. Records demonstrated that people had been actively involved in discussions about their support needs and reviewing their progress against identified goals. Staff worked in partnership with people to manage people's mental health.

There were regular opportunities for people and staff to share their views about the service and raise any issues of concern. The provider monitored and audited the quality and safety of the service provided to ensure it was effective and remained responsive to people's needs.

On the day of our inspection the registered manager was not available. We talked with staff and looked in detail at the records for three people. We observed how people were being cared for and talked with two people who lived there. The home has eight beds but currently only three people lived there. We visited on a weekday and all three people were at home. The home has nine staff which includes a clinical lead and a registered manager who manages four sites. During our inspection we talked with three staff members one visiting professional, and a manager from a sister home within the organisation. We also spoke with two relatives. One relative commented “I think they are superb, I’ve been so impressed with their care, they’re wonderful.”

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

This is a summary of what we found;

Is the service safe?

People were treated with respect and dignity by the staff. People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. People told us they felt safe. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been made in accordance with these safeguards, proper policies and procedures were in place.

There were policies and procedures in place to make sure that unsafe practice was identified and people were protected. This included the correct administration of medication. Recruitment practice is safe and thorough. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

One person told us, “The staff try to make it good for me, they treat me well. The staff are always there for me.”

Is the service effective?

The home had a clear process of supporting people towards independent living, and assisting them with their ongoing recovery. The home had a person centred approach. Where possible, people achieved things they wanted to achieve and went to places of interest to them. People told us that they were happy with the care they received and how their needs had been met. One relative told us “They ring me and keep me up to date, if there are any concerns they tell me.”

It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

Is the service caring?

People were supported by kind and attentive staff. We saw that the staff showed patience and gave encouragement when supporting people. A relative said “The home go over and above and that’s typical of them. It’s been very friendly and caring.”

People’s preferences, interests, aspirations and diverse needs had been recorded and where possible their care and support had been provided in accordance with those wishes. We were told by a relative that one staff member had stayed in hospital overnight with a person who was anxious. This level of caring had been very much appreciated by the relative.

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us they had a lot of one to one time with the staff. People had access to activities that were important to them, and staff were aware that people’s wishes and choices changed regularly.

People knew how to make a complaint if they were unhappy. People had been supported to maintain relationships with their friends and relatives. People had regular one to one meetings with staff and used their residents meetings to raise any issues or concerns. People we spoke with felt listened to.

Is the service well-led?

The service worked quite well with other agencies and services to make sure people received their care in a joined up way. Staff told us they were clear about their roles and responsibilities. The service had a basic quality assurance system and they used their residents meetings and handover meetings to assure the quality of service delivery to people. This helped to ensure that people received a good quality service at all times. A visiting professional told us, “It’s quite homely here when I come in it feels quite relaxed.”

We spoke with two people who lived at Albany House about their experiences of the service. We observed the care that was given to people during our inspection as the other people who lived at Albany House did not wish to speak with us. We also spoke with a range of staff including the deputy manager.

People we spoke with told us that the care that was discussed with them matched the care that was provided to them. We saw that regular reviews of people's care and support plans described their progress towards their goals. We saw staff listened to people's input about their care needs and their wishes. We saw people's independence was promoted within their support plans and on the day of our inspection.

We saw that the care plans were person centred and reflected people’s individual needs. We saw the members of staff supported people as detailed within their care plans. We saw staff were compassionate and caring when supporting people.

People we spoke with told us that staff were friendly and supported their needs well. We saw staff knew what people's care needs were and how they needed to be supported.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We found the service was well led and had systems in place to monitor the quality of service being provided.

We spoke with three people who lived at Albany House, but they were not all able to tell us in detail about the care and support they received. We observed how people interacted with staff in the communal rooms, looked at two care plans and spoke with three staff about people’s care and support. Everyone appeared relaxed and comfortable with staff. One person told us, "It’s alright here, I like it here."

We found that people were encouraged and supported to keep the house clean and tidy for themselves. One person who lived at the home showed us their room, which was arranged to suit them personally. In the care plans we looked at, we saw that people had agreed their own, individual goals for learning life skills and developing their independence.

We found that staff were trained to keep and administer medicines safely for people, and to support people to manage their own medicines. Support staff checked each other to make sure medicines were administered appropriately.

Staff we spoke with told us they enjoyed working at the home. They said they were supported by their manager and had regular opportunities to talk about their work and personal development. One support worker told us, "It is a good team, we all get along very well."

The care plans we looked at were kept in a locked cabinet in the staff office, where staff could access them when they needed to. Confidential staff information was kept in a locked filing cabinet in the manager’s office.

During our visit to this service on 20 July 2011 we spoke with three people currently using the service, the manager and the staff on duty.

We were told that the service strives to ensure that people are at the centre of their recovery, which starts right from the point of referral and underpins the whole care and support planning process. One person told us, "I came here when I was just into my recovery and I’ve been involved in it all the way through."

We saw that people were involved in the day to day running of the service with one person telling us “we have fortnightly residents meetings where we discuss stuff”, which was confirmed by another person who told us that he was involved in the running of the residents meetings and chaired them sometimes. We were also told that people participate in daily chores to ensure that the home is clean and tidy for everyone.

We asked people if they felt safe in the service. They told us that they liked the staff and felt comfortable in the home, with one person commenting, “It’s a brill place, they look after you really well, I’ve got on great here, I would recommend it to anyone." Another person told us, “I’m not sure who my keyworker is but I can talk to anyone."

We saw that people appeared confident and comfortable making themselves snacks and drinks throughout our visit. One person said, “I keep myself to myself but I can make a sandwich or snack when I like."

One person we spoke with during our visit to the service told us that he had completed a survey about the care and support he received earlier in the year going on to say, “I’ve got on great here, I would recommend it to anyone."