Adelphi Residential Care Home

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to the area this home was located were commonly known as 'Tier Four Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

Staff, management and visitors were using personal protective equipment (PPE) correctly and there were procedures in place around the use of PPE. We noted good practices around the disposal of PPE and other waste.

The provider and registered manager had processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Processes when visitors entered the home were reasonably robust. Most visitors had to answer a short health and safety questionnaire but this was not raised with visiting health care professionals. This was corrected at inspection and will help to prevent people bringing infection into the home.

Where appropriate, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in 'Tier Four', these visits had been restricted and were only allowed in exceptional circumstances.

Visiting rules and process were communicated effectively to people using the service and their relatives. We saw alterations to the premises to facilitate a safe visiting area for people to meet their relatives and friends. This was a suitable way of allowing people to see their loved ones when guidance and legislation permitted.

Infection control policy and people's risk assessments had been considered and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home.

The provider insisted people were tested before admission and consistent with local guidance, people had not been admitted to the home for the most part of the pandemic. However, at the time of inspection, this position had been reviewed. In line with changes in restrictions and new guidance relevant to the geographical area, the service had started admitting people to assist with the wider health and social care position. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by use of social media and mobile devices so people could contact their relatives and friends. The registered manager said as people had come out of isolation and allowed into the 'wider' home, a programme of activities had been introduced and staff were encouraging people to participate.

Staff had knowledge of good practice guidance and had attended Covid-19 specialist training. This was refreshed every month. The registered manager and senior staff had attended a course where they learned about spotting the early signs of infection. The registered manager said that this had helped in supporting people and could potentially save lives.

There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

The home was clean and hygienic. A designated full-time cleaner was in post and additional staff could be used if this was required.

Staff had received Covid-19 related supervision and all had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Adelphi Residential Care Home provides accommodation and personal care for up to 27 older people. The home comprises two properties which have been combined into one and extended. The home has three floors with both lift and stairs access. People had access to a variety of communal areas. Bedrooms are mainly single and some have en suite facilities. At the time of inspection there were 19 people living in the home. Some shared bedrooms had been changed to single bedrooms where people had needed more space.

Peoples' experience of using this service and what we found

People told us they felt safe living in the home. People had been supported to the manage risks they faced in ways which protected their independence and human rights. The provider had good systems in place to protect people from the risk of abuse and avoidable harm. Staff we able to recognise concerns and knew how to raise them. The environment was safe, regular maintenance and safety checks were completed. Concerns raised in the previous inspection in relation to the premises and equipment had been fully resolved.

Peoples' needs had been fully assessed and plans of care developed to ensure their needs were met. Staff worked with other professionals including district nurses to ensure care provided was consistent. Staff had received training and supervision which supported them to fulfil their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Without exception people told us the staff were kind and caring. Staff were committed to creating a family feel within the home. Interactions in the home were friendly and polite. Staff supported people to maintain their independence and encouraged people to be involved in their daily care. People had been supported to maintain important religious needs and culturally significant events and practices.

People received person centred care which reflected their needs and preferences. Regular reviews and updates of care plans ensured peoples' care remained up to date. People had the opportunity to be involved in reviews and care planning. Staff supported people to engage in activities and events which reflected their interests.

The registered manager and staff team had a commitment to providing high-quality and person-centred care. There was effective leadership in the home. The management team were clear about their expectations and checked care practice and records regularly which helped ensure the quality of care was maintained. People had been consulted with and their views listened to. People had been able to make suggestions which the service had responded to.

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

Rating at the last inspection and update.

At the last inspection this service was rated as requires improvement. (published December 2018). We identified breaches in relation to safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Adelphi Residential Home is registered to provide accommodation and personal care for up to 27 older people. Accommodation is provided over three floors. At the time of our inspection there were 23 people living at the home.

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and we looked at both during this inspection.

At the last inspection on 6 and 7 June 2017, we found one breach of the regulations. This related to the provider’s failure to complete audits and checks to ensure the service was effective. We also made a recommendation about activities at the home. Following our inspection, the provider sent us an action plan and told us all actions would be completed by 4 July 2017.

At this inspection we found that the necessary improvements had not been made and the provider remained in breach of the regulation. The provider had not completed sufficient audits or checks of the service, to ensure that people were receiving safe, effective care. We also found a breach of the regulations relating to the safety and cleanliness of the premises. In addition, we have made recommendations about the need for legionella bacteria monitoring to be carried out at the home and for a programme of improvements to be put in place to update the home environment.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People living at the home and their relatives were happy with staffing levels and told us staff were available to support them when needed. Risks to people’s health and wellbeing were managed appropriately.

We saw evidence that improvements had been made to activities at the home and most people were happy with the activities available.

Records showed that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

Staff received an effective induction and their training was updated regularly. People who lived at the service and their relatives felt that staff had the knowledge and skills to meet people’s needs.

People told us staff were kind and compassionate and respected their right to privacy and dignity. We observed staff encouraging people to be independent.

People received support with nutrition and hydration and their healthcare needs were met. Referrals were made to community healthcare professionals to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how they liked to be supported.

Staff communicated effectively with people. People’s communication needs were identified and appropriate support was provided. Staff supported people sensitively and did not rush them when providing care.

The registered manager regularly sought feedback from people living at the home and their relatives about the support provided. We saw evidence that the feedback received was used to develop and improve the service.

People living at the service, relatives and staff were happy with how the service was being managed. They found the registered manager and staff approachable.

There was a registered manager in place who had been registered since 28 July 2015. 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 our inspection on 5 February 2016 we found several breaches of legal requirements. The systems for assessing and managing risk were not effective and did not always protect people using the service.

In addition, some people were unable to leave the home when authorisations preventing this were not in place in line with the Deprivation of Liberty Safeguards (DoLS). There was also a lack of understanding around the implications of the Mental Capacity Act 2005 (MCA) where people lacked capacity and the need to seek people’s consent for care and support.

There were issues with auditing and checking on the provision of care including safety of equipment in the home and medicines checks. There were also concerns around some of the furniture and fittings around the home that were old and needed replacing.

There were issues with staffing levels that were impacting on the level of care and support that was being provided and the system for the administration of staffing levels was not effective.

A recommendation was made that the service look into ways of engaging people who use the service and providing activities to enhance their wellbeing.

We asked the provider to make improvements in all of these areas and they kept CQC informed of the changes that had been made.

At this inspection we found that significant improvements had been made in these areas but improvement were still required in respect of the provision of activities especially around residents who were not living with dementia and checks the provider should be completing to ensure the service was operating effectively.

We found that people were not being deprived of their liberty inappropriately and DoLS applications had been made. The registered manager and staff were aware of the need to seek consent in line with the MCA.

Proper assessments were being made around ways of protecting people and action had been taken to support people with sufficient numbers of well-trained staff.

However, we still had concerns about the provision of checks to ensure that the service operated effectively and found that the provider was not completing any audits and was leaving responsibility for all checks with the registered manager. This has resulted in a continuing breach of legal requirements.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. Although improvement could still be made there was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The registered manager conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the registered manager but further support and input was required from the provider.

The service was last inspected on 29, 30 April 2014, when we found the provider was compliant with the regulations we assessed at that time.

The Adelphi Residential Care Home is situated in a quiet residential area, close to both Chorley town centre and Astley park. The home can accommodate up to 27 residents in a mixture of single and shared bedrooms, with some bedrooms having unsuited facilities. There are three shared lounges and a dining room which extends into a conservatory area. There is a small courtyard at the rear of the home, with a ramp for ease of access.

The service is registered to provide accommodation for persons who require nursing or personal care. There is a registered manager in post. 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.

We looked at how the service protected people from avoidable harm and known risk to individuals. We found that the registered person had not always protected people against the risk of unsafe care by means of the effective assessment and management of risks to their safety.

People who use the service did not have Personal Emergency Evacuation Plan (PEEP’s) in place.

We found evidence that not every person who used the service was free to leave the building if they wished to. The manager and some staff were not fully aware of their roles and responsibilities in relation to consent, as defined in the MCA 2005.

There was no activities programme in place at the service. People were not given the choice to join in any activities or social stimulation.

Although there were systems in place to audit some areas of the service theses were not always completed effectively so that the identified improvements could be made.

Risks associated with the environment and hazards had not been identified by the provider.

Safeguarding procedures were in place and we felt reassured by the level of staff understanding regarding abuse and their confidence in reporting concerns.

We saw evidence that the service was making the required referrals and seeking support on how best to meet people’s needs.

We looked at how the service provided a safe environment for people. We observed that the home was not following practice guidelines for the disposal of Personal Protective Equipment (PPE). Overall the cleanliness of the home could be improved. We have made a recommendation about this.

The registered manager had received completed residents’ and relatives’ surveys. However, these were not reviewed and used to improve the service we have made a recommendation around this.

We found that staffing levels was having a negative impact on the care and support provided at the service and we have made recommendations around this.

Throughout our visit we observed staff interacting with people who used the service and providing support.

The service had a registered manager who was available to people, relatives and staff. We were told by people who used the service and staff that the manager was approachable.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to: consent, safe care and treatment, safeguarding people from abuse, good governance, premises and equipment and dignity and respect.

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

Is the service safe?

People we spoke with who used the service told us they felt well looked after.

People told us that the staff were kind and responsive to their needs. Pre-admission assessments had been carried out by senior staff and care plans contained sufficient information to ensure staff had the correct information to provide safe and effective care.

Safeguarding procedures were in place and staff understood how to protect people they supported. People we saw were not being put at unnecessary risk and where possible, they (or their relatives) were able to make decisions about the care and support provided.

On the days we were present at the home we found there were sufficient numbers of staff to meet people's needs. Staff were deployed appropriately to ensure staffing levels were adequate to meet people's needs.

Is the service effective?

We observed staff interacted with people who used the service and saw that staff met people's needs in a friendly and relaxed manner. Relatives we spoke with told us that they were more than happy with the care provided at the home. One person said: 'It's all down to the care'.

The health and personal care needs of those who used the service had been thoroughly assessed.

We saw that people who used the service had been involved in the care planning process. Where required, consent to care had been obtained. We saw evidence that people who used the service and their relatives had been involved in reviews of care planning and risk assessments.

We saw evidence of visits by professionals such as district nurses, GP's and social workers. One visiting professional told us: 'They work with us very well'.

People who used the service received visits from other care professionals such as chiropodists and a hairdresser.

Is the service caring?

We spoke with eight people who used the service and five relatives who were visiting people who used the service. We asked about the care they or their relative received. Feedback was all positive. People who used the service told us staff were kind and caring towards them whilst relatives we spoke with had nothing but praise for the home and the staff.

Throughout our time at the home we observed staff treated people with dignity and respect. People who used the service were offered choices and care was provided in a relaxed and calm manner. Staff we spoke with were able to tell us about the individual likes and dislikes of people they cared for.

When we spoke with staff it was clear that they genuinely cared for the people they supported and they were observed speaking with people in a respectful and friendly manner.

We looked at care files for people who used the service and found that information was recorded in a person centred way. Risk assessments were in place and files contained sufficient information for staff to meet the needs of people who used the service.

Is the service responsive?

We observed that staff responded to people well by anticipating their needs appropriately. The service worked well with other agencies and services to make sure people received care in a consistent way.

Is the service well-led?

Where shortfalls or concerns were raised these were acted upon by the service. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

We found that service had effective monitoring systems in place so the quality of service provided could be reviewed and if necessary changed.

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We observed constant interaction by staff with people who used the service and their relatives. Relatives told us that they were always being asked for their opinion on the service.

Audit systems were in place to check the safety and quality of the service provided. All equipment was regularly serviced and tested. We noted a suggestion box was available for people to provide feedback and the home had an effective system for dealing with complaints.

Staff we spoke with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the manager of the service.

During this inspection we found that the home had made the required improvements.

We saw that thorough pre admission assessments were carried out prior to anyone being admitted to the home. A new care planning system was in place, which helped to ensure people's holistic needs were identified and met. Care plans and risk assessments were regularly reviewed and updated when people's needs had changed.

Staff told us the new care planning format was working well and that files contained sufficient information for them to know how to meet people's needs. One member of staff commented, 'We can't remember everything. Now if we aren't sure we can look it up in the care plan. They are very good.'

Measures had been put in place to protect people from the potential risks associated with using bed rails. Risk minimisation included the regular checking of the equipment against set criteria. These checks were monitored by the manager of the home.

The manager monitored care plans and risk assessments to ensure these were regularly reviewed and updated. The quality of the service was monitored. Audits and checks highlighted areas for improvement and action was then taken to address any shortfalls.

Some people used bed rails to prevent falling from bed. The risks associated with the use of this equipment had not been suitably assessed or managed. This meant there was the potential for people to receive inappropriate or unsafe care. People could be using unsuitable or unnecessary equipment and unidentified risks could exist.

People were cared for by staff that had been appropriately recruited and were trained for their role. The recruitment checks helped to ensure only suitable staff were employed at the home. People living at the home spoke favourably of the staff team. Comments included; 'They are easy to talk to.' And 'They come when I need them.'

We were told that the manager and staff were very approachable. However there was a lack of formal monitoring at the home. There were no structured systems in place to assess and monitor some potential risks.

People who lived at the home told us they were involved in decisions about their care. One person said, 'I can choose to do things for myself if I want or I can have help from the staff.'

People had care plans that identified their personal care needs. Parts of some of the care records were out of date. Risk assessments were not always done meaning that some safety risks may exist.

Staff said they received training and were supported to do their job.

The majority of residents had their own rooms and some people had personalised them with their own furniture and belongings. Carpets in some areas needed cleaning or replacing.

Residents were able to give their views about the service and these were always acted on.