Archived: Adey Gardens Care Home

During the inspection in November 2015 we found the provider had taken no action to address these concerns. They had failed to replace the flooring to bathrooms or shared toilets. Bathrooms were in a poor state and one bathroom was very odorous. Clinical waste bins were sited near exposed concrete that could not be kept hygienically clean. Lifting equipment used by people (such as hoists) had a layer of debris on the legs and rust on the central column. Clean linen and bedding was stored on the floors in storage cupboards. The small kitchenette on the first floor was dirty and expired food was in the fridge. The laundry room was cluttered, with clothes trailing on the floor and damaged cupboards that could not be kept clean.

Adey Gardens is a two-storey purpose built home which is registered to provide care for up to 37 older people some of whom have nursing care needs. The first floor unit provides 12 places for people living with dementia. Some shared rooms had been converted to single occupancy so the total number of places in the home was 34. At the time of our inspection there were 24 people living at the home.

The home had a manager but they had not registered with the Commission and there had been no registered manager for over one year. 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.

There had been no routine checks of the safety of the premises, such as hot water temperature checks, since the end of July 2015. This meant the provider could not be sure that people’s health and safety was being protected.

The service did not make sure people’s rights under the Mental Capacity Act (MCA) 2005 were upheld. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

The provider had not made sure people were protected by deprivation of liberty safeguards (DoLS). This meant people were being unlawfully restricted because they were unable to leave the home without staff supervision.

Staff training did not include MCA or DoLS so staff were unaware of the impact of this or how to protect people’s rights. The gaps in supervision records indicated that some staff had not received an individual supervision session in the past year.

The care records about people were written in a personalised way but some records were incomplete and some guidance was missing. This meant people might receive care in an inconsistent way.

The provider had not made sure that required health and safety checks were carried out and any actions taken. The provider had not made sure the required six-monthly servicing of hoists and lifting equipment had taken place. This placed people at potential risk of harm.

The provider’s quality monitoring processes were not effective in managing risk or making sure people received a safe service. Shortfalls had been identified at the last inspection but no remedial action had been taken.

People received good support with their health and the staff worked well with community and specialist health services. Visiting health and social care professionals told us the staff were knowledgeable about each person people and were aware of their individual preferences.

People who could express a view, and their relatives, felt the staff were caring and friendly. People described the care staff as “kind” and “helpful”. Staff were caring and compassionate when supporting people. People were assisted in a way that promoted their dignity, and staff valued and respected them.

People and relatives had information about how to make a complaint. People and relatives felt the manager and staff were approachable and that the home had a friendly, welcoming atmosphere.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, they will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

We found the building was not well maintained and that people were not always accommodated in a safe environment. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining the safety and suitability of the premises.

People were assessed, using recognised tools, against the risks of poor nutrition and skin damage. The provider had systems in place to ensure people received their medication on time.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager understood the home's responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily unless it was in their best interests.

Is the service effective?

Not all staff had received regular supervision and annual appraisals with their manager. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the support and supervision of staff.

Information gathered during the initial assessment of people's needs was used to develop individual care plans. We found care plans clearly identified the specific needs and goals of the people who lived there.

Is the service caring?

We found that staff interacted positively with people and were caring. Staff assisted people in a way that supported them to retain their dignity. We observed care being delivered during lunch-time. We found that the mealtime was a pleasant experience with staff assisting and prompting people when required.

People who used the service and their family members all gave positive feedback about the service and the staff members who delivered the care. A relative commented, 'I am very happy with everything. The staff are friendly and polite.'

Is the service responsive?

We saw examples within people's care records of action taken to respond to people's changing needs, such as referring people to specialists including dietitians and the 'falls clinic'.

The home employed an activities organiser to support those people who could take part in a range of group activities.

Is the service well-led?

Some aspects of the service were not well-led. We were unable to find evidence of any completed audits or detail of an audit system for staff training, the premises or health and safety. We saw some work had been commenced in some areas for example, on infection control and health and safety, but not completed. We identified shortfalls with staff support systems and areas of the premises and safety which the provider was unaware of.

During this inspection we also checked what progress the provider had made to a warning notice we had issued about its quality assurance systems. We found the provider had improved the way it checked the quality and safety of the service.

We spoke with two visiting relatives who told us they were encouraged to discuss any suggestions or concerns they had with a view to improving the service.

We did not speak with people who used the service during this visit, but we observed the care provided to them. We saw people were well presented, and staff were engaging and supportive when assisting the people who lived there.

We spoke to five relatives on the day of our visit. Comments from relatives included "The managers door is always open if I need to check anything". "My ...x has put on weight since living here. The staff are lovely", "The staff are excellent", "Even though staff are busy they have a chat about my 'x".

People experienced care, treatment and support that met their needs and protected their rights.

We saw that people's personal records were accurate and fit for purpose.

However, we found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. In addition, they did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We found people who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

We spoke with people at Adey Gardens Care Home during our inspection. They did not provide any information of concern. We spoke with staff members and we also examined evidence which assisted us in our enquiries about services provided to people.

We looked at staffing rotas, and talked to staff and management to establish there were sufficient staff with the right knowledge, experience, and skills to support people.

Care plans were presented in a consistent format using an IT package. Each member of staff had their own secure login and password to access the system. As part of a transparent audit trail every input of information on peoples care plans left a record of who had input that piece of information and on which particular date.

Comments from relatives included, "I come here every day and I have to say the staff are great. My x is always well dressed and happy. "The staff always let me know what is happening" and "I chose Adey Gardens for my mum and I do not have any regrets."