Albany Park 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 home is a purpose-built house over three floors that accommodates up to 43 people. At the time of the inspection there were 40 people were living at the home.

This inspection took place on 23 and 24 January 2019 and was unannounced.

At our last inspection we rated the service as ‘requires improvement’ overall. However, safe was rated as ‘inadequate’. At this inspection we found that identified issues had been addressed. The service is now rated ‘good’.

At the last inspection in June 2018 we identified breaches of Regulations 12 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to people not always having access to their call bells to ensure they would be able to call for help; easy access to staircases which resulted in an incident of a fall and a person absconding. There was a strong smell of urine in the communal area chairs and 11 people’s bedrooms. We also found that some equipment and furniture was not in a good state of repair.

Due to the seriousness of the breaches found, we issued two warning notices to the registered provider Warning notices give the provider a specific time frame in which to improve in the areas identified at the inspection. At this inspection we found that these concerns had been addressed.

In addition, at our last inspection we also identified breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to a lack of structured activities and interaction, especially for those remaining in their rooms during the day and a lack of management oversight of the home and auditing processes. At this inspection we found that these concerns had been addressed.

There was a registered manager in post who was registered with CQC on 12 October 2018. 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.

New call bells had been installed in all rooms above people’s beds which were accessible. There was also a call bell that was next to the person. People had two types of call bell to ensure they could summon help.

The home was clean and fresh throughout the inspection. There was a plan of works in place including replacing carpets and furniture.

Activities had improved at the home. The activities coordinator had received further training since the last inspection.

There were improved systems in place for the registered manager to ensure oversight of the home. This included, a better auditing system and daily walk rounds by the registered manager.

Staff and relatives were positive about the changes since the last inspection.

People’s individual risks were well documented and there was detailed guidance for staff on how to minimise the risks.

Medicines were given safely and on time. There were systems in place to monitor medicines including regular audits.

Staff had received training in infection control and were aware of how to control and prevent infection.

Staff understood what safeguarding was and were aware if how to report any concerns if they had them.

Staff were recruited safely and appropriate checks conducted before commencing employment.

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

Staff received regular training supervision and appraisal to support them in their role.

We obser

Albany Park Nursing Home provides nursing care and accommodation for a maximum of 43 older people, some of whom are living with dementia. At the time of the inspection the service was supporting 42 people.

Our last inspection took place on 11, 12 and 14 July 2017 and the home was rated as ‘requires improvement’. However, over the last several months prior to the inspection we had received multiple concerns regarding the quality of care, safety of people, staffing and environmental issues. Due to these concerns we decided to inspect the home earlier than originally scheduled.

This inspection took place on 11, 12, 19 and 21 June 2018. On 11 June 2018 we conducted an early morning visit, arriving at 6.10am. On 19 June 2018 we completed an evening inspection at 8.45pm to look at some specific issues. We provided feedback to the manager on 21 June 2018. On the 13 June we contacted relatives to gain their feedback.

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. There was no registered manager in place at the time of the inspection. However, a new manager had been appointed and had been in post for one and a half weeks prior to the commencement of the inspection. The manager had applied to register with CQC.

At our last inspection we found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had not sustained improvements made following the last inspection.

People did not always have access to call bells both during the day and at night. People were not always able to summon help if they needed to.

The home was not always clean. Chairs, bedding and flooring was often malodorous with urine and on-suite bathrooms were not always clean. Furniture including bed rails and bedroom side cabinets were in a state of disrepair.

People had been placed at risk of harm as they were able to access staircases. The provider had not addressed this issue despite an incident in September 2017.

There were activities within the home. However, we found that there was insufficient stimulation for people. People that spent the majority of their time in their rooms were often left alone for long periods of time.

Staff were not adequately deployed during meal times to ensure that all people received the necessary support to have a safe and enjoyable meal time.

We received mixed feedback about the food provided at the home. People did not always have easy access to drinks.

Audits completed by the home had failed to identify the issues found at the time of the inspection.

Risk assessments gave staff detailed guidance and ensured that risks were mitigated against in the least restrictive way. Risk assessments were reviewed and updated regularly.

Medicines were managed safely and people received their medicines on time. There were systems in place to audit medicines and identify any concerns.

Staff had access to Personal Protective Equipment (PPE) to ensure that people were protected from the risk of infection.

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

Staff received regular, effective supervision and appraisal.

We observed some caring interactions between staff and people. However, we also observed some interactions that were not always caring.

Relatives involvement in planning and reviewing peoples care was inconsistent.

People’s care files documented that people had access to an advocate to help them make certain decisions if necessary.

People and relatives said that they felt that staff asked fo

This inspection took place over two days on 11, 12 and 14 July 2017 and was unannounced.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of 43 older people, some of whom are living with dementia. At the time of the inspection the service was supporting 38 people.

There was a registered manager in place. The registered manager was present throughout the inspection. 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 communal area was unclean with heavily stained furniture. Two bedroom carpets smelled strongly of urine. Some people’s bed linen had not been changed despite it being unclean.

We observed caring interactions between staff and people. However, on two occasions in the communal lounge, we observed periods of time where there was poor interaction between people and staff. Staff were often talking amongst themselves without taking to people and completing some care tasks without talking to the person.

Three staff had not been comprehensively assessed prior to employment. The home had not ensured that staff had appropriate criminal records checks in place.

There were detailed risk assessments in place that provided staff with clear guidance on what the risks were to that individual person and how identified risks could be mitigated. Risk assessments were reviewed and updated regularly.

Medicines were now safely managed. The home had employed a clinical lead who had addressed issues found at the last inspection. There were regular medicines audits completed. Staff that administered medicines had been signed off as competent and safe to administer medicines.

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

People and relatives were involved in end of life care planning. People experiencing end of life care were treated with compassion and empathy.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care.

Healthcare professionals and relatives were positive about the management of the home.

At this inspection, we found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This focused inspection took place on 20 September 2016 and was unannounced. During this inspection we looked at safe and effective following information received from the local authority on the management of pressure areas, medicines and nutrition and hydration.

This focused inspection took place on 20 September 2016 and was unannounced. During this inspection we looked at safe and effective following information received from the local authority on the management of pressure areas, medicines and nutrition and hydration.

An inspection took place on 26 January 2016. During the inspection the home was in breach of two legal requirements and regulation associated with the Health and Social Care Act 2008. People were not protected from the risks of receiving unsafe care as the provider had not made sure that safe recruitment practices were being followed. People were at risk as appropriate measures had not been taken to mitigate the risk of fire as fire drills had not taken place in line with the provider’s policy. During this inspection we looked at recruitment practices and fire safety arrangements to check if this was compliant.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of forty-three older people, some of whom may have dementia. There were 39 people living at the home on the day of our inspection.

The home had a registered manager in place during our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Risks assessments were being carried out to identify people at risk of skin complications. Action plans were not in place to minimise the risk of serious skin complications for people identified as high risk of skin complications. Some actions were not being carried out to support people with pressure sores such as repositioning regularly and using devices to relieve pressure.

Medicines were not being managed safely.

Comprehensive systems were not in place to calculate staffing levels contingent with people’s dependency levels.

Records did not show how the home supported nurses with their continuing professional development (CPD) and revalidation, which are part of the requirement of registration for nurses with the Nursing and Midwifery Council. We made a recommendation that support should be introduced for nurses in relation to their CPD and revalidation.

We did not find food was being monitored for some people at risk of malnourishment to ensure they had a healthy balanced diet. One person required weekly weight monitoring, we found the person’s weight was not being monitored and recorded weekly. Referrals were being made to health professionals for people at risk of malnourishment. Choices were offered for people during meal times.

Pre-employment checks had been made for new staff members to ensure they were of good character and were suitable for the role.

Appropriate fire safety arrangements were in place to protect people in the event of an emergency.

We identified breaches of regulations relating to medicines, risk management and nutrition and hydration. You can see what action we have asked the provider to take at the back of the full version of this report.

This inspection took place on two days 26 January 2016 and 16 February 2016 and was unannounced. When we last visited the home on 07 July 2015 we found the service was not meeting all the regulations we looked at. We found that people were not always protected from the risk of from unlawful or excessive control as the provider had not made suitable arrangements to address this by assessing people’s capacity to consent to care and having guidance on the when restraint could be used. The provider sent us an action plan telling us how they would address this.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of forty-three older people, some of whom may have dementia. There were 41 people using the service on the day of our inspection.

The home had 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.

We found two breaches of regulations at this inspection. People were not protected from the risks of receiving unsafe care as the provider had not made sure that safe recruitment practices were being followed. People were at risk as appropriate measures had not been taken to mitigate the risk of fire as fire drills had not taken place in line with the provider is policy.

People’s needs were met as a system had been put in place to ensure that staff were deployed consistently to care and support them.

People could choose to be engaged in meaningful activities that reflected their interests and supported their well-being.

The registered manager had a plan for the redecoration and refurbishment of the service that took into consideration the needs of people so that they were not disturbed whilst these redecoration were taking place.

Appropriate procedures were in place to protect people from abuse. Risks to people were identified and staff took action to reduce those risks. People were provided with a choice of food.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People were treated with dignity and respect. There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt confident to express any concerns, so these could be addressed.

People using the service, relatives and staff said the registered manager was approachable and supportive.

At this inspection there were breaches of regulations in relation to the need for fit and proper persons and good governance. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 7 July 2015 and was unannounced. When we last visited the home on 17 June 2014 we found the service was not meeting all the regulations we looked at. We found that people were not always protected from the risk of from unlawful or excessive control as the provider had not made suitable arrangements to address this by assessing people’s capacity to consent to care and having guidance on the when restraint could be used. The provider sent us an action plan telling us how they would address this.

Albany Park Nursing Home provides nursing care and accommodation for a maximum of forty-two older people, some of whom may have dementia. There were 41 people using the service on the day of our inspection.

The home had 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.

We found a number of breaches of regulations at this inspection. Staff were not always deployed so that they were available to meet people's needs. People who used the service may be at risk as the home's environment was not maintained and decorated in a way that met their needs. The majority of people had a DoLS in place but the provider had not formally notified the Care Quality Commission of this

Some areas for improvement were also identified. People were not consistently supported to engage in meaningful activities. Regular medicines audits had not been carried out to ensure that medicines were managed safely in the home.

People were kept safe from the risk of abuse. Risks to people were identified and staff took action to reduce those risks. People were provided with a choice of food.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People were treated with dignity and respect. There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt confident to express any concerns, so these could be addressed.

People using the service, relatives and staff said the registered manager was approachable and supportive.

At this inspection there were breaches of regulations in relation to the need for consent to care. You can see what action we told the provider to take at the back of the full version of the report.

The inspection team carried out this inspection consisted of an inspector and an expert by experience. During the inspection, the team work together to answer five key questions; is the service safe, effective, caring, responsive and well- led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We spoke to eight people who used the service and four relatives who told us they were consulted about their needs. One person's comment was typical when they said, "I feel I am properly cared for as staff know what I need." A relative told us they had been involved in the initial assessment of a person's needs. The relative said, "we discussed how the home could make it easier for my mother to settle."

There were arrangements in place to deal with foreseeable emergencies. Staff had been trained in how to respond to medical emergencies. For example, they had completed first aid training. Staff explained how they responded to accidents and incidents involving people who used the service in order to maintain their safety.

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. The manager was not aware of the recent Supreme Court decision regarding Deprivation of Liberty Safeguard (DOLs). A lock was in use on the front door which prevented people who use the service from leaving if they wished to. We looked at five people's care records and there were no capacity assessments relating to this restriction. People's capacity had not been assessed where they made decisions that affected their safety and well-being. One person's care plan showed that they regularly refused personal care, but there was no DoLs in place so that staff could intervene to support this person safely. People were at risk from unlawful or excessive control as the provider had not made suitable arrangement to address this.

Is the service effective?

We spoke with eight people who used the service. They were positive about the support that they received and felt that they were well cared for. One person said “my call bell is usually answered quickly.” Another person said that staff, “do everything that is needed.” We looked at five care records which contained initial assessments of people who had recently come to use the service. These contained information on People's care needs, dietary preferences and whether and how they wished to practice their religion. Initial assessments also recorded in people's life history and interests.

People who used the service were positive about the care they received. One person said, “staff here always help me.” People felt that staff knew how to meet their needs. We saw that staff understood people’s needs. The staff training matrix showed that staff had been trained in mandatory areas, such as manual handling, administration of medication and food hygiene.

Is the service caring?

People who used the service and their relatives told us that staff understood their needs. People's and relatives comments were, "the staff are supportive and caring," "the staff always helps me" and "they are gentle with me." We looked at five care plans and saw that these had been reviewed monthly. Care plans had been updated and changes to people's needs had been fully addressed.

Is the service responsive?

People who used the service said they could ask for things that they wanted. Three people said that staff anticipated their needs. One person said that staff were able to tell what he wants and that "they respond to that." People said that staff either sees when they need help or ask if it is needed. One person's comments were typical when they told us "the people here always help me."

Is the service well- led?

People and relatives we spoke with felt that they had the care and support they needed. One person’s comments were typical when they told us, “the care is better here than I was getting in my own home.” There were care plan audits for the last three months and these showed that a sample of care plans had been checked. Where any improvements were needed these were highlighted and a date for completion was recorded. We looked at care plans referred to in these audits and saw that these changes had been made.

This was a themed inspection programme to assess how people with dementia were cared for and how their needs were met. There were 40 people using the service on the day of the inspection, of which 30 people had dementia. We spoke to nine people who use the service and one relative. People and their relatives told us they had been involved in the initial assessment of their needs before coming to live at the home. However, initial assessments did not include information about the views gathered from people and relatives about their needs. This meant that information on how people wanted their personal care needs, dietary preferences and whether and how they wished to practice their religion were not part of these assessments or the care plans of people with dementia.

People and relatives spoken to felt that they had the care and support they needed. People and relatives comments included, "I am very impressed by the quality of care" and "the care is very good." However, care plans showed that care was provided in a way that was not sensitive to and promoted people's equality and human rights. For example, people's cultural and religious needs were not identified in their care plans. The five care plans we looked at had not been regularly updated and changes to people's needs had not been fully addressed. For example, one care plan (dated 25/04/ 2012) indicated that a person was diabetic. The care plan did not explain what foods they could eat. The risk factors resulting from the person's diabetes were not explained in the care plan or how staff should respond if the person became ill.

People and relatives told us they were given information about the care they received. Relatives told us that staff always informed them about any changes to people's needs. A relative said, "we just chat about things as they arise." People and relatives told us that care was delivered in a sensitive and supportive manner which made them feel safe in the home. One person said, "the care is good, lovely.”

People and relatives confirmed that the service made sure they had access to a range of medical professionals to meet their care and treatment needs. One person told us that, "I am seen by my general practitioner, I just ask the staff and they arrange it." People's care records showed that where they had been admitted to hospital an appropriate plan had been put in place when they were discharged to ensure they received the care and treatment they needed.

The manager told us that care plan audits had not been carried out. Care plans had not been reviewed regularly in line with the provider's policy. The five care plans we looked at were not always up-to-date and people's needs had not been responded to in a timely manner. People and relatives told us that staff were available when they needed them and had the skills to meet their needs. The manager explained that there were meetings with relatives and people with dementia so that they could give their views of their care and treatment. Relatives told us that they felt this provided an important way for them to express their views of the service.