Adelfi Care Services

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider told us they shared any learning with the staff team such as learnings from an incident or an accident or a change in a person’s condition or circumstance. They anonymised names and discussed the learning event as a hypothetical situation. Staff were asked to confirm they had read and understood the information and this was monitored for compliance.

Staff told us, “Relevant training may be refreshed if deemed necessary. For example, if there was a medication error we may be asked to redo the training to refresh” and “There is an accident and incident form in the [App] on my phone, which I can access when needed. I would write down any details immediately in my work notebook… I understand that there would definitely be discussion following the report, with any learning a key factor.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider worked well with partner agencies, for example when people new to the service were transferring from a different provider. In addition, the provider worked alongside relatives and other professionals contributing to people’s overall support. One staff member told us, “After a client has been in hospital we would get in touch with the hospital and occupational therapist to ensure that measures are put in place to cater for the new needs of the client.”

Staff told us all the information they required was detailed in peoples care plans and risk assessments. Through shadowing other staff, talking to the person and keeping up to date they were able to deliver safe and relevant support to people who were new to them.

People’s decision of whether they wished to be resuscitated in the event of an emergency were recorded in their care plan. A copy of the care plan was available at people’s homes for important information sharing with emergency services.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us the support they received from staff made them feel safe and they had no concerns. One relative commented, “They treat her well and she feels safe.”

The provider had implemented a new senior care role to the staffing structure between the care staff and managers to encourage more feedback to be given. This meant that staff had additional support and choice over who they felt comfortable speaking to.

Safeguarding was an area regularly discussed within the service. People using the service were given access to a handbook with contact numbers and the safeguarding policy if they wanted to raise any safeguarding concerns. We saw that safeguarding was part of staff meetings agenda where staff were encouraged to raise and talk through any concerns.

Staff had received training in safeguarding and demonstrated a good understanding of their role and responsibility in ensuring people were kept safe from potential harm or abuse. Staff we spoke with told us, “Safeguarding means that a person has the right to be treated with care, respect and dignity and to be safe from verbal, psychological or physical abuse. If I saw or suspected mistreatment, I would report this clearly to my manager as soon as possible. If urgent and necessary I would retreat to a safe place and call the police” and “...I would report any suspicion to management immediately. I would call the police if I saw and physical harm come to an individual.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that were safe, supportive and enabled people to do the things that mattered to them.

We found some incidents warranted initial contact with health services for a medical opinion. People’s risk assessments stated staff were to call 111/999 ‘if medical assistance was required’, but it was not clear under which circumstances staff would need a medical opinion. For example, one person who was found on the floor when staff arrived. They were assisted to stand using equipment. There was no visible sign of injury, but the fall was unwitnessed, and the person complained of pain. Due to the person still being in pain 48 hours later, staff called the GP who arranged admission to hospital. Another person was found on the floor when staff arrived. The person’s relative assisted the person up from the floor but later informed the provider they had been admitted to hospital.

Accident and incident logs did not always show the outcome of any injury or hospital admission, they did not show if a legal notification or safeguarding referral was required or submitted.Following our inspection the provider took action to ensure full details of incidents are recorded.

Staff had received training in slips, trips and falls, moving and handling techniques and specific health related conditions and how these may affect the person physically.

The provider encouraged and implemented positive risk-taking measures for the people they supported. For example, a specific risk assessment and support measures were put in place for one person at risk of falls, who wanted to go outside to improve their mental well-being and quality of life.

The provider had acquired equipment and developed processes to assist them in supporting people who had an accident or incident requiring help. These included safe lifting and reassurance following a fall. The provider told us, “Lying on the floor for extended periods after an incident can have a detrimental impact, discomfort, pain, dehydration, pressure sore. The [equipment and protocol] allows assessment, if the person is safe to lift following a fall. The [equipment] then allows staff to support the person up without injury to themselves, so no physical lifting. This has transformed how we respond to falls and how people feel about their independence and safety.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risk assessments identifying environmental hazards, both in and outside of the home had been completed and formed part of the person’s care plan. Risk assessments included who was at risk, the risk rating and measures to take to reduce the risk. Each risk assessment included a review date and any changes completed at that review. One staff member told us, “As part of my role, I regularly update risk assessments, ‘environment risk assessment’ being one of them.”

The provider had an emergency situation policy and guidance for staff in place. This covers what to do in case of gas leaks, electricity supply interruption, water leaks, break ins and fire safety in people’s homes. The provider told us staff report concerns about people’s home environment safety. They would visit and review the risk assessment and find ways to mitigate the risk. For example, issuing torches where homes had poor external lighting.

The provider’s office was open and located in a private office building. Care plans and confidential information was all stored electronically and within a lockable space in the office. The area was well lit with off road parking for staff. The provider had a lone worker risk assessment in place.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were robust and safe recruitment practices in place to ensure staff, were suitably experienced, competent and able to carry out their role. Staff spoke positively of the induction they had received into the service stating, “I received an induction pack with lots of documentation including code of conduct, employee handbook, health and safety, recognising and understanding abuse. I feel I was provided with lots of information to gain a good understanding of what was expected of me.”

Staff retention was good; there was consistency of regular and familiar staff to support people with a contingency of the management team who would step in if needed. Agency staff were not used. One relative told us, “Mum always has regular staff which is good. I think the recruitment process is good.”

We reviewed the electronic call data that monitored visit times and duration. We saw that staff arrived promptly and stayed for the required duration. One person told us, “They always stay their allotted time. They are pretty much always on time impressively considering the traffic. It is very rare that they are late.”

Staff received the support they needed to deliver safe care. This included supervision, appraisal, spot checks and support to develop and improve practice where needed. Staff received training that was relevant and appropriate to their role. Staff were complimentary about the training they completed commenting, “I think the training is amazing, much more than you used to get, it’s nice you can do it online as and when and that they pay for you to do this” and “..I found the trainings most insightful and helpful, including being able to discuss elements of training with my managers and colleagues.”

There were measures in place to ensure staff remained safe when undertaking care visits. This included conducting lone worker risk assessments, providing staff with first aid boxes and torches and a system to log in and out of when commencing and finishing visits. There was an out of hours line to call which was monitored internally so assistance could be provided if needed.

We saw that not all staff had completed training in supporting people with a learning disability and autism awareness which has been a mandatory requirement since 2022. The service was not supporting anyone with these needs at the time of our inspection, and had identified in their quality audit, this training was delayed. The provider was responsive in taking steps to address this issue during this inspection and confirmed all staff had completed the first part of the Oliver McGowan training with seven remaining staff needing to complete the second part. The provider discussed some of the issues staff had experienced in trying to access the second part which they were working on to resolve quickly.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had infection control policies in place. There were effective infection, prevention and control measures to reduce the risk of infection for people being supported and for staff.

Staff were trained in safe infection control practices, which they were able to fully describe. Staff told us equipment was readily available and they knew how to dispose of used PPE safely in sealed bags. People and relatives confirmed the staff used gloves and aprons and were able to manage catheter care hygienically and safely.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medicine care plans and risk assessments were in place where needed. We found that the recording of medicines at times lacked clarity and consistency which could increase the risk of potential errors.

We saw that one person was supported with a medicine that needed to be administered 12 hours apart. The times that staff were recording on the medicines administration record (MAR) did not adhere to this timeframe. The staff were not actually administering at the times recorded, instead they were leaving the medicine out for the person to take at a time of their choosing. Although this was documented, the risk assessment had failed to outline the necessary actions for staff if the person missed their medication or were not aware of the timing of their first dose.

There was no evidence to show that the service had sought medical advice to ensure this person’s medicine was still effective or safe to be given outside of the prescribed time frames on a regular basis. Following our inspection the provider took action to ensure this information is now included within this person’s risk assessment.

For medicines that were prescribed to be taken when required (PRN) we saw that there was information about this recorded in care plans. However, on the MAR’s and daily visit notes we saw that staff did not record the reasons that this had been given each time and the effectiveness outcome of this as stated in the provider’s own medicines policy. Following the inspection the provider sent further information to show PRN reasoning was recorded. However, this still did not record the effectiveness of the PRN medicine in line with the medicine's policy.

Staff completed medicines training annually and a competency observation to ensure their practice remained safe. Staff told us they had also recently completed a medicines quiz to refresh and test their knowledge base around supporting people with their medicines administration.