The comprehensive inspection visit took place on 29 January 2018 and was unannounced.

St Albans Nursing Home accommodates 33 people in one adapted building. Accommodation is on two floors with a passenger lift for access between the floors.

St Albans Nursing Home is situated in Knott End on Sea close to a regular bus route, shops and facilities and can accommodate 33 people. Accommodation is over two floors, with bedrooms, lounge and dining areas on both floors. Some of the rooms have extensive coastal views. At the time of our inspection 29 people lived at the home.

St Albans Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The inspection team consisted of an adult social care inspector and an expert-by-experience. The expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had a background supporting older people.

At the last inspection in September 2015, the service was rated ‘Good’. At this inspection we found the service remained Good and met the all relevant fundamental standards.

We found the registered provider continued to provide a good standard of care to people who lived at the home.

At the time of inspection, there was a manager in post who was in the process of registering with the Care Quality Commission. 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 service had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the commission when required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not commence in post until the management team completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles. One staff member told us, “The induction training included shadowing staff. It helped me get to know the residents and their routines.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and found it had been refurbished, maintained, was clean and a safe place for people to live. We found equipment had been serviced and maintained as required.

Medication care plans and risk assessments provided staff with a good understanding about specific requirements of each person who lived at St Albans Nursing Home.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

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 supp

We spoke with ten people who lived in the home; three relatives, the registered manager, provider and five members of the staff team. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at St Albans Nursing Home.

During our inspection we looked at how staff supported people to give their consent to their care and treatment, we looked at a sample of care plan records, how people were supported to take a balanced diet, the recruitment of new staff and the quality monitoring systems in place.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We looked at the care plan arrangements the service had in place. We found they had recorded information to ensure the people they supported were receiving the appropriate level of care. We saw the service had systems in place for staff to follow should a person be unable to give their consent to any aspect of their care and treatment. This would include undertaking a mental capacity assessment. This meant there was guidance in place for staff to follow regarding their responsibilities to support people with their consent to care and treatment.

Is the service effective?

In the kitchen we saw the catering team had information regarding people`s dietary requirements. They told us information was updated on a regular basis as and when people`s needs changed. Records indicated what nutritional requirements people had been assessed for, their food preferences, dislikes and any known allergies. We saw that information was well organised and readily available within the kitchen for staff to access for information and guidance.

We spoke with people and relatives regarding their experiences of the catering at the home. One person told us, “The food is very good although you can wait a long time.” A second person told us, “Its lovely food I really look forward to it.” One relative told us, “The staff are very patient with Dad. His health has improved over the last year and a half. He now eats and drinks which he did not do in hospital.”

Is the service caring?

We observed the care people received. Staff we met with appeared to be caring and helpful when supporting people. There was a friendly and welcoming atmosphere within the home.

Is the service responsive?

Care plan records were reviewed on a regular basis or when people`s needs changed. We saw the staff worked in partnership with a range of healthcare professionals to meet the assessed needs of people. We saw evidence of recent work with GP`s, social workers and community health liaison team.

Is the service well-led?

Since the last inspection the provider and the registered manager were developing the services to support the needs of people with dementia type conditions. Staff had been supported to attend relevant training to develop their knowledge and skills in dementia care.

The provider visited the home on a weekly basis. This meant they could offer guidance and support and closely monitor the developments taking place within the service. Information was maintained on a centralised computer system. This meant the provider had oversight regarding all aspects relating to the management of the home.

At our previous visit in May 2013 we found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Following this visit the manager sent us an action plan detailing how they were going to bring about improvement in medicines handling at the home. At this visit we saw that this plan was being acted upon and medicines handling had improved.

At our last inspection in May 2013 the provider had been assessed as non compliant because they did not have an effective system in place to regularly assess and monitor the quality of the service they were providing. At this follow up inspection we saw that those risks identified had now been managed. We looked at six care plan records and saw that risk assessments were in place to identify the potential risks posed to people and what actions were required to minimise those risks. We saw there was a range of systems in place for the manager to identify, monitor and manage the risks to people living, working or visiting the home.

There were twenty eight people living at St Albans when the inspection took place. On the day of the inspection the area manager told us there was a full staff team on duty. We observed the care and support people received. We saw people were treated with respect and dignity and were spoken with in a kind and sensitive manner. People were consulted and involved in their care and support. People had requested more activities and an activity co ordinator had been appointed.

Although we recognised improvements had been made in developing the care plan records, we noted that some information regarding people’s allergies and health conditions had not been fully completed. Some risk assessments were not in place and PRN guidance was put of date. We conducted a tour of the building and our checks confirmed that it was being maintained. Staff had received training to meet the needs of people who lived at St Albans nursing home and were being supported to provide care and treatment.

There was a new management team in place that included a newly created role of area manager. Although some audits and systems were being introduced to improve the quality monitoring, we noted that some care plan information had not been transferred over into the new records. Medication audits had not taken place and the guidance relating to the use of medication was out of date.

During our inspection we spoke with some people who lived at the home and observed staff delivering personal care support. We did not always see that people were treated with respect and dignity. We observed a group of people who were left sitting in wheelchairs in the lounge over a 2 hour period. Their care plans indicated they were assessed as being at risk of developing pressure sores. During that time there were very few staff interactions.

We observed one person in distress calling for staff support but as the care staff were elsewhere we called the staff ourselves.

We saw other people not being supported to eat their lunchtime meal.

When we spoke with people who lived at the home one person told us, `It’s nice here isn’t it`.

When we spoke with some visitors they had some positive comments and told us, The place is lovely, really nice and the staff are friendly and nice with the residents`.

We spoke with people living at the home and a number of relatives who were visiting. Without exception we were told that staff are polite, respectful and kind and we observed staff responding to people with patience and sensitivity.

People living at the home told us that they felt well cared for, that staff come quickly when needed and that they were satisfied with the support they got. We received many positive comments about the staff team, with one person telling us how kind staff had been and how well they had been looked after during a period of illness.

The relatives we spoke to told us that; a good standard of care is provided, health care needs are met, they are kept informed of any problems or issues and are always made welcome at the home.

We received much positive feedback about the staff team and we observed care staff carrying out their duties. The team appeared organised and there were sufficient numbers of staff on duty to meet the needs of residents. We were told that there is a very open atmosphere and that the manager and the staff team are all very approachable.

The inspection visit took place on 23 and 24 September 2015 and was unannounced.

At the last inspection on 23 July 2014 the service was meeting the requirements of the regulations that were inspected at that time.

St Albans Nursing Home is situated in Knott End on Sea close to a regular bus route, shops and facilities and can accommodate 33 people. Accommodation is over two floors, with bedrooms, lounge and dining areas on both floors. Some of the rooms have extensive coastal views.

There was a registered manager in place. ‘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 had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and showed us they understood their responsibilities to report any unsafe care or abusive practices. People who lived at the home told us they felt safe and their rights and dignity were respected.

The environment was well maintained, clean and hygienic when we visited. No offensive odours were noted on the day of the inspection.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff spoken with and records seen confirmed a structured induction training and development programme was in place. This included new staff having a mentor and being shadowed on their first shifts.

We found medication procedures in place were safe. Staff responsible for the administration of medicines had received regular training to ensure they maintained the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place. People told us they received their medicines at the times they needed them.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. We found staffing levels were sufficient with an appropriate skill mix to meet the needs of people. The deployment of staff was well managed and provided people with support to meet their needs.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

We found people who lived at the home and were living with dementia were supported to be as independent as possible. At lunch time we observed staff encouraging people to eat their meal independently. Mealtimes were relaxed, unhurried and sociable with varied conversation and the occasional song.

The service had policies and procedures in relation to the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS]. Discussion with the registered manager confirmed she understood when an application should be made and in how to submit one. This meant that procedures were in place so people would be safeguarded as required.

Care plans we looked at confirmed the registered manager had completed an assessment of people’s support needs before they moved into the home. We saw people or a family member had been involved in the assessment and had consented to the support being provided. People we spoke with said they were happy with their care and they liked living at the home.

People’s health needs were being met and any changes in health managed well. The people we spoke with said they had access to healthcare professionals when they needed them. This was observed on the day of inspection.

People told us they were happy with the activities arranged to keep them entertained. One person said, “Two girls in last week absolutely excellent, sing, dance, do anything.” A visiting relative said, “They have people coming in singing. They like that, they all join in.”

The registered manager used a variety of methods to assess and monitor the quality of the service. These included questionaires which were issued to people to encourage feedback about the service they had received. The people we spoke with during our inspection visit told us they were satisfied with the service they were received.