We inspected this service on 15 March 2018. The inspection was unannounced. Since our previous inspection in January 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from effective to safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

Albemarle Rest Home is a residential care home for up to 24 people, who may live with dementia. 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.

The accommodation is arranged over three floors, with a lift to the first floor, to support people to move around the home safely. At the time of this inspection, seventeen people were living at the home.

At our last inspection we rated the service as ‘good’ overall, with a rating of ‘requires improvement’ in well-led. At this inspection we found the evidence continued to support the rating of good and the improvements required in leadership and governance of the service had been made. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. 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.

Improvements since our previous inspection included support for the registered manager to access the management information that was kept securely in the provider’s office. The registered manager now had access to the internet, which enabled them to understand their professional responsibilities and to keep up to date with any changes in the legislation and guidance for providers.

Premises risk assessments were included in the registered manager’s daily checks and any repairs were planned for and undertaken promptly. People and relatives assured us their views were welcomed and taken into account for any planned changes and improvements in the service.

Improvements had been made in supporting staff to attend training and to obtain nationally recognised certificates and qualifications in health and social care. The registered manager and senior staff conducted daily checks of medicines administration to ensure they were managed and administered safely.

Staff were trained to understand, recognise and report any safeguarding concerns, and this reduced the risks of people being harmed. The registered manager checked staff were suitable for their role before they started working at the home and made sure there were enough suitably skilled, qualified and experienced staff to support people safely.

Risks to people’s individual health and wellbeing were assessed and their care was planned to minimise the risks. People’s needs were assessed using recognised risk assessment tools and staff were trained in subjects that matched people’s needs. People were supported to eat and drink enough to maintain a balanced diet that met their needs and preferences.

People were supported to maintain their health and were referred to healthcare professionals when their health needs changed. People continued to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

People, relatives and st

The inspection took place on 5 January 2016 and was unannounced.

The home provides accommodation and personal care for up to 24 older people. Twenty-two people were living at the home at the time of our 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.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies. The registered manager assessed risks to people’s health and welfare and people’s care plans included the actions and equipment needed to minimise the risks.

There were enough staff on duty to meet people’s care and social needs. The registered manager checked staff’s suitability to provide care during the recruitment process.

The provider’s medicines policy included training staff and checking that people received their medicines as prescribed, to ensure people’s medicines were administered safely.

People received care from staff who had the skills and experience to meet their needs effectively. Staff read the care plans and new staff shadowed experienced staff until they knew people well and understood their needs and abilities. Staff were supported and encouraged to reflect on their practice and to develop their skills.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people with complex needs, their families and other health professionals were involved in making decisions in their best interests.

Risks to people’s nutrition were minimised because staff knew about people’s individual dietary requirements. People were offered a choice of foods and were supported to eat and drink according to their needs.

People were cared for by kind and compassionate staff who knew them well. Staff knew about people’s individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health and when their health needs changed.

People were supported to spend time in their preferred way and there were opportunities to socialise with other people who lived at the home and engage in pastimes they enjoyed.

People and their representatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed.

People and relatives told us care staff were kind and respected their privacy and dignity. They were confident any complaints would be dealt with promptly and effectively.

The provider’s quality monitoring system included regular reviews of people’s care plans and checks on medicines management and staff’s practice. Staff were guided and supported in their practice by a registered manager they respected.

Improvements were required in making sure people’s views were known and taken into account for planned changes and any improvements in the service.

Improvements were required in supporting the registered manager to access relevant management information, to access information about their professional responsibilities, and to keep up to date with changes in the legislation.

We spoke with four people who lived at Albemarle Rest Home about their experiences of the service. We also spoke with two relatives and a friend of a resident about people's experience. We observed the care that was given to people during our inspection. We spoke with a range of staff including the manager.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. We found there was a cleaning schedule which staff followed and we saw checks were made to review the cleanliness of the home. 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.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One relative told us, "I am very pleased I chose Albemarle” for their family member. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this and care staff responded promptly to people's requests. One visitor told us “I have never needed to prompt staff to care for X." A relative told us, "I can walk out of the front door and know Y will be alright."

Is the service responsive?

People’s needs had been assessed before they moved into the home. We found records confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. We found that the manager worked with other health professionals, such as GPs, ensure people's care needs were met.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. We found the manager undertook a number of checks on the home to ensure people's needs were met.

We spoke with four people who lived at Albemarle Rest Home about their experiences of the service. We also spoke with two relatives about their family member's experience. We observed the care that was given to people during our inspection. We spoke with a range of staff including the registered manager.

People and relatives we spoke with told us that the care planning was discussed with them regularly. We saw that people or their relatives were involved with the care planning of their care.

We found that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

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

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

We spoke with four 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 there was not a robust system in place to monitor the quality of service being provided.

We spoke with four people who resided at Albemarle Rest Home about their experiences of the service provided to them. We also spoke with two members of staff who were supporting people and the deputy manager.

People we spoke with told us that the care that was discussed with them matched the care that was being provided. People also told us that they liked living at Albemarle Rest Home and the staff were supportive to their needs.

People we spoke with told us that staff explained their care plans, if they were unable to read or understand the plan. We saw that care plans were signed by people using the service. This meant that people had consented to the care they were receiving.

People we spoke with told us that relatives had consented on their behalf, if they were unable to sign the care plan themselves.

We spoke with staff who told us how they obtained consent from people using the service. Staff told us how they would explain people's care plans to them.

People’s care plans were accurate and fit for purpose. We saw that the records for the people whose care we reviewed were accurate and updated on a regular basis.

Records were kept securely and could be located promptly when needed. We saw that records were stored securely in an office away from the public area.

When we visited Albemarle Rest Home we met with each person using the service and spoke with three people in more detail about their care. We met and spoke with two relatives, three members of staff, the registered manager and a healthcare professional who was visiting the care home at the time.

People using the service told us they liked living at the care home and felt well cared for. They told us, “Staff are lovely”, “I feel safe here”, “ Staff are very good, they care for you.”

Some people were not able to talk to us about their care because of their dementia, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and had a choice. Relatives told us that staff offered people drinks regularly through the day. We found people's dietary needs were detailed in their care plan.

We observed people being supported with their medication and we noted this was done sensitively and discreetly when other people were present. Staff explained what the medicine was and gave people the time they needed to take their medication.

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. When they had a concern they told us they were able to talk to the manager and staff about this and were confident it would be looked into. Relatives we spoke with were happy that staff kept them informed about the healthcare of their family member when they were unwell.

We found that staff knew people as individuals and understood their personal needs and ways of communicating those needs. Staff treated people kindly and respectfully and included them in conversation. We saw that people were relaxed and at ease with staff and within the home environment.

We looked at the care planning documentation for four of the people using the service to see how their care was provided and managed. We found that this was generally well detailed and up to date but sometimes it was not. We talked with staff who demonstrated they were aware of people's care and support needs. Staff said they were trained to help them understand how to meet people's needs and give the support they needed.

We spoke with two people who were using the service and observed the care that was being delivered to them.

One person we spoke with told us in detail about the care provided. They said this was 'good’ and they felt ‘comfortable’ with care staff. They told us they were asked by what name they wished care staff to use when talking with them and that staff always referred to them by this name. They told us that staff were polite and respectful, adding, ‘I go at my own pace and staff ask if I need help. Staff always knock on my bedroom door before entering’.

One person we spoke with found it difficult to talk for long periods but told us that care was ‘okay’. During the afternoon of our visit we spoke with this person again and they told us it was very ‘noisy’ in the lounge, they told us they wanted to be in a ‘quieter’ room.

We read comments from family members written in letters of ‘Thanks’ for care given, comments included;

‘It was such a comfort to know Mom was well cared for’.

‘We were always kept involved with Mom’s care’.

‘Thank you for XX’s care, especially for the last days when leaving hospital and returning to the home – she was made to feel so comfortable’.

We observed care staff speaking with people at the correct pace and in a way that was not undermining of their age and ability.

We asked care staff how they involved people with the care they delivered and they told us about some of the ways they did this. They said;

‘I offer a choice, for example, when choosing which clothes to wear’.

‘Each person is so different with their communication needs. To involve people with their personal care I encourage them to touch and feel the soap and flannel’.

‘I always let people know what I am going to do’.

We asked care staff about how they were kept informed about people’s changing needs and they told us that each time they started their care work they attend a meeting when any change was communicated to them. They also told us that information about changed needs was documented in a ‘Handover Book’. Care staff we spoke with felt they had sufficient opportunity to develop the skills and knowledge necessary to meet people’s care needs. They told us;

‘’The provider and manager talk to me about my work and my training needs to do my job’.

‘I am doing an NVQ Level Three and am booked to do some Dementia Care training’.