Adlington Manor

Adlington Manor is a residential care home providing personal and nursing care to up to 70 people. The service provides support across two units, with one unit providing general nursing care, and the other units providing specialist care for people living with dementia. Each unit has single occupancy bedrooms across two floors with a variety of communal areas, adapted bathrooms and outdoor areas. At the time of our inspection there were 61 people using the service.

People’s experience of using this service and what we found

Risks to people were not always fully assessed and mitigated and we noted areas for improvement to ensure lessons were learnt when things went wrong. People’s views of staffing levels were mixed, and further work was necessary to address our previous recommendation about the induction and introduction of agency staff to the service. People generally felt safe, and staff understood their roles in keeping people safe. Medicines were securely stored, although improvements to care planning and record keeping were required. The home was clean and tidy.

Governance systems needed further embedding to ensure they were robust and drive quality and improvement in the home. A variety of checks were completed but these did not always lead to improvement across the wider setting. Meetings were held and people and families were generally happy with how they were supported. Staff felt able to raise ideas and told us communication was good.

Families and professionals spoke positively about how people were supported at end of life although further work was required regarding record keeping in this area. The quality of person-centred care planning varied. People generally felt they had choice and their communication needs were being met. People wanted more activities in the home and the registered manager had recently recruited a driver to help people access the community.

People were treated well by staff and generally felt involved in their care where possible, and that their privacy and dignity was respected.

People were supported to access healthcare services as needed. People were supported by staff who had the training and support they needed to do their role. People’s feedback about the quality of food varied, but the chef would offer alternatives if people did not like the menu options. People who required additional support to eat and drink received this and adapted equipment and utensils were used to promote independence.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 October 2021). The service remains rated requires improvement. This is the second consecutive inspection where the service has been rated requires improvement.

The provider completed an action plan after the last focused inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection in the related key questions of safe and responsive we recommended that the provider ensures that all agency staff have an appropriate introduction and induction to the service; and recommended the provider considers current guidance of future care needs and updates this practice accordingly. At this inspection we found some improvements, but further development was required.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to the assessment and mitigation of risk, and systems of oversight to ensure the quality and safety of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were effective measures in place to minimise the risks around COVID-19. Personal protective equipment (PPE) was used effectively to safeguard staff and people using the service and current government guidance was being implemented.

The environment was clean, well maintained and hygienic. Cleaning schedules and audits were in place. High touch points within the home were cleaned regularly. This helped to help minimise the spread of infection.

People and staff were tested regularly for COVID-19, in line with government guidance. All staff employed at the home had been vaccinated, to help keep people safe from the risk of infection.

The service had risk assessments and policies and procedures in place to manage the risks of COVID-19. There was a dedicated visiting pod in the garden for visitors and clear information on contacts and visiting preferences for each person. There were no concerns around visiting at the time of the inspection and essential care givers and visitors of people at end of life were visiting the home.

Adlington Manor is a residential care home providing personal and nursing care to 59 people aged 65 and over at the time of the inspection. The service can support up to 70 people. Care is provided in two units: Rowan Unit which provides specialist care for people living with dementia and Cedar Unit which provides general nursing care.

People’s experience of using this service and what we found

Risks to the health and safety of service users were not always safely assessed. People had not always received oral healthcare, nailcare or footcare in keeping with their identified need. Bathrooms were not always clean and tidy. Medicated creams were not stored appropriately in people’s bedrooms.

Health and safety checks were carried out. People, relatives and a healthcare professional gave positive feedback about the service with the exception of one complaint received before the inspection.

There were enough staff on duty on the day of the inspection. However, agency staff did not always have an appropriate induction so they could familiarise themselves with people’s needs. We have made a recommendation about staffing.

Manager audits had not identified the concerns we found during the inspection. Complaints were not always captured on the complaints register. The management team did not respond with all the information we requested following the inspection. Staff appeared to be motivated and had a positive attitude about their roles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 05 December 2019).

Why we inspected

We received concerns in relation to falls management and the supervision of residents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Adlington Manor on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, infection control and leadership at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Adlington Manor is a care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 88 people. Care is provided in two units: Rowan Unit which provides specialist care for people living with dementia and Cedar Unit which provides general nursing care.

People’s experience of using this service and what we found

People were supported by staff who had been trained to identify and report safeguarding concerns. People were safe because potential risks to their health and wellbeing had been mitigated and were being managed effectively. Staffing levels were appropriate. People were safely supported to take their medicines. We have made a recommendation about medicines management.

People's healthcare needs were monitored and access to a variety of health care professionals was made available where required. People were seen to eat and drink well. People were offered choice and where people had assessed specialist dietary needs, staff knew these and supported people accordingly. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives were positive about the service and said staff were kind and caring. Staff developed caring relationships with people and were sensitive to their individual choices. People were treated with dignity and respect and their right to privacy was upheld. The service could provide people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People were encouraged and supported to be as socially active as they wished. In addition to group activities, one to one activities were provided. The service had good links with the local community. The provider and registered manager kept records of actions taken in response to complaints, investigations undertaken and the feedback given to complainants, in line with the complaints procedure.

There was a positive and open culture. Staff roles and responsibilities were clear. The service worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed. Staff felt well supported by the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 04 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Adlington Manor is part of the Barchester Healthcare Homes Limited and is registered to accommodate people who require nursing care and support with personal care. Care is provided in two units: Rowan Unit which provides specialist care for people living with dementia and Cedar Unit which provides general nursing care. Both units, as well as common areas to the home have undergone extensive redesign and refurbishment. The home is located in a rural part of Cheshire between Macclesfield and Poynton.

The service was last inspected in December 2015. The inspection in December was to follow up on a number of concerns that we had found at our inspection in March 2015 when the provider was in breach of seven regulations. In March we served warning notices asking the provider to ensure they were compliant with the regulations by 17 August 2015. In December 2015, we found that improvements had been made within the service, however we still found the provider to be in breach of three regulations and we requested an action plan of how they would address these issues. In December, they were not meeting the required standards in relation to safe storage and management of medications, providing person centred care and keeping accurate, contemporaneous records. At this inspection we found that the provider was meeting all the regulations and had made significant improvements to the service, however we found there was still some areas for continued improvement.

The home has 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. At the time of our inspection there were 61 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. There had been significant improvements in the home since the existing registered manager had been in post; both in the standard of care and the home environment.

We saw that the administration and storage of medication was safe. We saw that the service was now auditing and correctly accounting for medication in order to pick up any discrepancies to ensure that people were receiving medication safely.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We saw that the service correctly followed safeguarding procedures and accurately recorded and reported where issues had arisen. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. The registered manager told us they booked agency staff well in advance to ensure consistency of staff and were actively recruiting to the vacant posts that remained.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was very good and their preferences were accommodated.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant that staff were able to help and support people who had difficulty in making decisions and ensured that plans were put in place in the person’s best interests. We saw that applications had been made appropriately. We saw that in some instances the paperwork could be clearer to record best interest decisions and we asked the registered manager to address this.

People living in the home told us that the standard of care they received was good. Comments included, “The staff are very nice and approachable “ and “I love it here, nothing is too much trouble”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they were confident that their relatives were safe and well cared for. One person told us, “Interaction with residents is excellent”. Some relatives also gave us examples of staff going the extra mile and providing very personalised care to their relatives in the home.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist staff to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’. We found there were some occasions when records were not being completed accurately and this needed further improvement.

Staff members we spoke with were positive about how the home was being managed and felt that the managers were supportive and approachable.

There was a comprehensive internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. Staff were recognised and rewarded for demonstrating good practice by the provider.

The home was well-maintained and clean and provided a calm, relaxing atmosphere. There were a number of maintenance checks being carried out regularly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting.

We talked with five people who used the service and to four carers or family members who were visiting people who lived in the home. We visited people in their bedrooms and spoke with them in private. On person told us 'I'm happy here, and the food is good. The staff are lovely'. We talked with six members of care staff as well as the manager of the home and three of the supervisory staff. We spent time observing the way that care was provided throughout the home.

We found that there were sufficient staff available to meet the needs of the people who used the service. Staff told us that they enjoyed working at Adlington Manor. One member of staff said 'We give good care here. I really love my work and my job'. We checked the records that were kept by the home and found that these were mainly up to date and accurate and supported the provision of safe and appropriate care.

We spent time looking around the building and talked to staff. We looked at the care records relating to the people who lived in the home. At the time of our inspection we found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. However we found that people's personal care records were not always complete.

We saw that there was a positive relationship between the staff and people who used the service, that the staff were smart and in uniforms, the majority wore name badges, and there were sufficient staff for the number of people using the service. The atmosphere in the home was quiet and calm with no excessive noise.

We spoke to a relative who was visiting the home who said that they were very happy with the service and care provided over the last year to their parent. Another relative told us 'the manager and his staff do listen'.

During our inspection we saw that the home received support from a GP nursing home scheme which had been introduced by the former local primary care trust. This meant that people had access to medical advice and treatment from a medical practitioner who visited the home twice a week.