The inspection took place on 10 November 2016. The inspection was unannounced and carried out by one inspector.

We last visited the service on 8 April 2016 to carry out a focused inspection where we looked at the questions, “Is the service safe” and “Is the service well-led.” We found that the provider was meeting all the regulations we inspected against.

Albury House is a care home and provides residential care for up to 12 people. It is located near the centre of Berwick upon Tweed and provides accommodation on two floors. There were 11 people living at the home at the time of the inspection.

The provider is a husband and wife partnership, Mr and Mrs Burn. Mrs Burn 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. The registered manager was supported by the assistant manager.

People told us that they felt safe at the service. There had been no safeguarding concerns. Medicines were managed safely.

Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. We saw that staff carried out their duties in a calm unhurried manner.

The premises were clean. Checks and tests had been carried out to ensure that the premises and equipment were safe.

Staff told us, and records confirmed that training was available. There was an appraisal and supervision system in place. This meant there was a system in place to ensure that staff were supported and competent to carry out their job role.

Staff followed the principles of the Mental Capacity Act 2005. People’s nutritional needs were met and they had access to a range of healthcare services.

We observed very kind and thoughtful interactions between staff and people. Staff were knowledgeable about people’s needs and could explain these to us. A computerised care management system was in place to plan, assess and review people’s care.

An activities programme was in place to help meet people's social needs. The provider had their own transport to enable people to access the local community.

There was a complaints procedure in place. No complaints had been received in the last 12 months. None of the people or relatives with whom we spoke raised any complaints about the service.

Audits and checks were carried out to monitor all aspects of the service. There was a refurbishment programme in place and continual improvements to the environment were being made. Staff told us that they enjoyed working at the home and said they felt valued by the provider.

The registration requirements of the service were met. The provider had notified us appropriately of any changes and events at the service in line with legal requirements.

The inspection took place on 10 March 2016 and was announced. We carried out a further announced visit on 8 April 2016 to complete our inspection.

At our last inspection in July 2015, we found that the provider was not meeting two regulations relating to safe care and treatment and good governance. We issued two warning notices and told the provider they needed to take action to improve.

At this inspection we found that action had been taken to improve and the provider was now meeting legal requirements. While improvements had been made, we have maintained the overall rating as requires improvement. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating at the next comprehensive inspection.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Albury House on our website at www.cqc.org.uk.

Albury House provides care and accommodation for up to twelve people. Some of whom have dementia related conditions. There were 11 people living at the home at the time of our inspection.

The provider is a husband and wife partnership, Mr and Mrs AG Burn. Mrs Burn is also the registered manager. The home has been open since 1990 and Mrs Burn has always been the registered manager. Their son, who we refer to as the assistant manager throughout the report, played an active role in the service. A registered manager is a person who has registered with the 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.

The premises were safe and well maintained. Checks, tests and assessments had been carried out on all areas of the premises. These included water, electrical installations and portable electrical equipment. No concerns were noted.

There were sufficient staff on duty at the time of our inspection to meet people’s needs. Night time staffing levels had been assessed to ensure that people could be evacuated safely in an emergency. There had been no changes in staff since our last inspection. Staff confirmed that safe recruitment procedures were followed.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. There were no ongoing safeguarding concerns. There was a safe system in place for the receipt, storage, administration, recording and disposal of medicines.

Comprehensive audits and checks were carried out to monitor all aspects of the service. These were carried out daily and covered areas such as medicines, accidents and incidents, infection control and health and safety.

Records relating to people, staff and the management of the service were stored safely and completed accurately. The provider used a computerised management system which they had personalised to record and store people’s care records.

The manager informed us that ‘residents’ and relatives’’ meetings were not well attended so they were looking at different ways to communicate with them. She said they were introducing an email survey to see if this would be more successful. She told us, and people and staff confirmed that she was always around and any issues were dealt with immediately.

Staff told us that morale was good and they enjoyed working at the home. They said they felt well supported by the management team.

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?

Below is a summary of what we found.

Is the service safe?

We found equipment was regularly serviced and tested to make sure it was safe and working effectively. There were enough staff on duty to meet the needs of the people living at the home. Staff personnel records contained information required by the Health and Social Care Act and this demonstrated people were suitable to work in the home. Staff received training to equip them with the skills to provide appropriate care and support to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff were aware of when an application should be made and how to submit one.

The provider had in place effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls or of developing.

We saw there were systems in place to ensure any repairs or failures in equipment were addressed promptly.

Is the service effective?

People told us they were happy with the care that was provided and their needs were met by the staff team. One person told us, “I am very happy living here. I find the staff are very kind and helpful. They know what support I need and respect my privacy and dignity." People’s health and care needs were assessed with them and they were involved in this process. We saw that particular needs were identified for example, skin care or dementia care in individual’s plans. Staff training was provided that took account of the needs of the people in the home. For example we saw training in dementia and catheter care had been provided.

Is the service caring?

We saw staff responded kindly and promptly to people. Care workers were patient and encouraging to people as they assisted them. People told us, “This is a small home and the staff are as well known to us as we are to them. This means we get good support and individual attention.” People’s preferences, interests, aspirations and diverse needs were recorded and staff were able to give examples of these when we spoke to them.

Is the service responsive?

We saw evidence that the care staff identified changes in people’s needs and acted to make sure they received the care they needed. For example, there was evidence that concerns about people’s health were quickly identified and action taken to seek and act on advice from health professionals.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person had their dog living with them and enjoyed daily walks either on their own or with a care worker if the weather was inclement.

Is the service well led?

The staff we spoke to were all aware of the complaints, safeguarding and whistle blowing procedures. All of the staff said they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this. Staff had regular supervision and staff meetings which meant they were able to feedback to the management of the home their views and suggestions. Staff we spoke with confirmed their views were listened and account was taken of them.

We spoke with three people to find out their opinions of Albury House. People spoke positively about the care and treatment they had received. One person said, “This is a wonderful place and the care staff are very good. They could not be better. They know exactly what I like, I suppose because the home is small they know us all really well.”

We saw relationships between staff and people were good and there was a relaxed atmosphere.

People’s needs were assessed and care and treatment delivered in line with their individual care plan.

People told us the food was good. We saw people were supported to be able to eat and drink sufficient amounts to meet their needs.

The home was clean and no odours were evident. People were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection.

We saw staff responded to requests for assistance promptly. There were enough qualified, skilled and experienced staff to meet people’s needs.

There were effective systems in place for assessing the quality of the service and these included the use of questionnaires completed by people who used the service. We were satisfied that people, their representatives and the staff were asked their views about the service and the provider took account of them.

People said staff had explained their care and treatment to them. They said staff always explained what they were doing and gave them time to consider their options. They said staff respected their decisions. They said that when they came to live at the home they were asked about their preferences and were able to make decisions about their care and support as well as about their daily routines. One person said, “The staff respect my right to make choices about my routines, care and treatment. I have been involved in contributing to my care plan.”

The inspection took place on 10 November 2016. The inspection was unannounced and carried out by one inspector.

We last visited the service on 8 April 2016 to carry out a focused inspection where we looked at the questions, “Is the service safe” and “Is the service well-led.” We found that the provider was meeting all the regulations we inspected against.

Albury House is a care home and provides residential care for up to 12 people. It is located near the centre of Berwick upon Tweed and provides accommodation on two floors. There were 11 people living at the home at the time of the inspection.

The provider is a husband and wife partnership, Mr and Mrs Burn. Mrs Burn 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. The registered manager was supported by the assistant manager.

People told us that they felt safe at the service. There had been no safeguarding concerns. Medicines were managed safely.

Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. We saw that staff carried out their duties in a calm unhurried manner.

The premises were clean. Checks and tests had been carried out to ensure that the premises and equipment were safe.

Staff told us, and records confirmed that training was available. There was an appraisal and supervision system in place. This meant there was a system in place to ensure that staff were supported and competent to carry out their job role.

Staff followed the principles of the Mental Capacity Act 2005. People’s nutritional needs were met and they had access to a range of healthcare services.

We observed very kind and thoughtful interactions between staff and people. Staff were knowledgeable about people’s needs and could explain these to us. A computerised care management system was in place to plan, assess and review people’s care.

An activities programme was in place to help meet people's social needs. The provider had their own transport to enable people to access the local community.

There was a complaints procedure in place. No complaints had been received in the last 12 months. None of the people or relatives with whom we spoke raised any complaints about the service.

Audits and checks were carried out to monitor all aspects of the service. There was a refurbishment programme in place and continual improvements to the environment were being made. Staff told us that they enjoyed working at the home and said they felt valued by the provider.

The registration requirements of the service were met. The provider had notified us appropriately of any changes and events at the service in line with legal requirements.