We carried out a review of the data available to us about The Adelaide on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Adelaide, you can give feedback on this service.
The Adelaide is a residential care home providing personal care for people over the age of 18 years with a physical disability or dementia. The service can support up to 24 people and predominately provides a re-ablement service following discharge from hospital. The Adelaide provides all single bedrooms, some with ensuite facilities, suitable communal areas and access to outdoor spaces. At the time of the inspection there were 17 people at the home.
People’s experience of using this service and what we found
People all gave us positive feedback about The Adelaide and told us that staff were kind and caring. Privacy and dignity were promoted and independence was actively supported.
Individual risks were assessed and managed appropriately. People had access to any necessary equipment where needed, which helped ensure people were safe from harm.
There were appropriate policies and systems in place to protect people from the risk of abuse and the management team and staff understood the actions they should take to keep people safe.
People were supported to take their medicines safely and as prescribed. They were able to access health and social care professionals if needed. Infection prevention and control measures were in place and followed government guidance.
Appropriate recruitment procedures helped ensure only suitable staff were employed. There were enough staff to support people's needs. Staff had received training and support to enable them to carry out their role safely.
The management team carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities. People and external professionals said the management team were approachable and supportive. Staff were also positive about the management team.
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 requires improvement (published 23 July 2019).
Why we inspected
We inspected this service as a review of the information we hold indicated improvements had been made. We were supporting the potential of increasing capacity in the local system.
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. This included checking the provider was meeting COVID-19 vaccination requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Adelaide on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
People’s experience of using this service:
People told us they felt safe when they were receiving a residential or community-based service from The Adelaide.
Quality assurance processes had not always been effective. An external consultant had completed a comprehensive audit of the service shortly before this inspection. This had identified significant areas for improvement and the provider had ensured work had been undertaken in respect of the priority areas. Further work to improve the service was ongoing. We identified some areas for improvement and senior managers responded positively acting where needed.
People's needs were met in an individual and personalised way by staff who were kind and caring. Independence was promoted, and the service goals of re-enablement were understood by all staff.
People's rights and freedoms were upheld. People were empowered to make their own choices and decisions. They were involved in the development of their care plans which were designed to promote people's recovery and independence (re-enablement). Staff acted in the best interests of the people they supported.
People felt listened to and knew how to raise concerns. They, and healthcare professionals told us they would recommend the service to others. Staff respected people's privacy and protected their dignity.
There were enough staff who had recently received all necessary training, worked well together and arrangements were now in place to ensure staff received formal and informal supervision from senior staff.
The residential service environment was safe and suitable for people staying there.
The service has been rated Requires Improvement as it met the characteristics for this rating in two of the five key questions. More information is in the full report, which is on the CQC website at: www.cqc.org.uk
Rating at last inspection: The service was rated as Good at the last full comprehensive inspection, the report for which was published in November 2016.
Why we inspected: This was a planned inspection based on the previous inspection rating.
Follow up: We will continue to monitor the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The Adelaide also provided a reablement service for a limited period in a person’s own home that included personal care; help with activities of daily living, and practical tasks around the home. At the time of our inspection they were supporting 19 people in their own homes, four of which were considered to have ‘long-term needs’ and were waiting to be passed on to a private care agency
There was no registered manager in place for the service. The previous registered manager had retired three weeks before our inspection. A new manager was in post but had not yet registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
People told us they felt the home was safe. Staff and the manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.
The risks relating to people across the whole service were personalised and provided sufficient information to allow staff to protect people in the least restrictive way whilst promoting their independence.
There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner. People were supported by staff who had received an induction into the service and appropriate training, professional development and supervision to enable them to meet people’s individual needs.
There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.
Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.
Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.
People were supported to have enough to eat and drink. In the residential part of the service mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.
Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when engaging with people who had difficulty in communicating verbally.
People and, when appropriate their families, were involved in discussions about their care planning, which reflected their assessed needs.
There was an opportunity for people and their families to become involved in developing the service and they were encouraged to provide feedback about the service provided. This was both on an informal basis speaking to people and through a survey completed by people using the residential part of the service at the end of each period of respite. People supported in their own homes completed the survey when they were discharged from the service.
People told us they felt the home was well-led and were positive about the manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the service. They were also supported to raise complaints should they wish to.
There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.
The Adelaide is a local authority run care home for short term respite and reablement support. Reablement is a way of helping a person to remain independent by giving them the opportunity to re-learn or regain some skills for daily living that may have been lost as a result of illness, accident or disability. The home provides accommodation for up to 24 older people, including people living with a cognitive impairment, such as dementia. At the time of our inspection there were 12 people living at the home.
The Adelaide also provided a reablement service, for a limited period, in a person’s own home. This included personal care; help with activities of daily living, and practical tasks around the home.
The last inspection of the home took place on 23 August 2013 and no concerns were identified. However, an inspection of the community reablement aspect of the service between the 17 and 20 September 2013 identified breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action and required the provider to make improvements.
This inspection, which was unannounced and carried out on 24 and 26 June 2015, looked at both aspects of the services provided by The Adelaide. During the inspection we found the provider had completed all the actions they told us they would take in respect of the community reablement aspect of the service.
People told us they felt safe. However, not all risks to people using home had been identified, which could impact on their health and wellbeing. Risks relating to people using the community reablement service had been identified and were effectively managed.
The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The MCA provides a legal framework to assess people’s capacity to make certain decisions, at a certain time. Although staff were aware of the principles of the MCA, they did not have access to sufficient information to enable them to understand the ability of a person living with a cognitive impairment, such as dementia to make specific decisions for themselves. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. We have recommended that the provider seeks advice and guidance on adopting the latest best practice guidance in respect of mental capacity assessments for people living with a cognitive impairment.
There were suitable systems in place to ensure the safe storage and administration of medicines. All medicines were administered by staff who had received appropriate training. Healthcare professionals such as GPs, chiropodists, opticians and dentists were involved in people’s care where necessary. Staff were aware of, and responsive to, people’s needs and preferences as to how they wanted to be cared for.
People and relatives told us they felt the home was caring. Staff were sensitive to people’s individual needs, treating them with dignity and respect, and developing caring and positive relationships with them. People were encouraged to maintain relationships that were important to them. Staff also checked that people consented before supporting them.
People were complimentary about the quality of the food and were supported to have enough to eat and drink.
People were supported by staff who had received the appropriate training, professional development and supervision to enable them to meet their individual needs. There were enough staff to meet people’s needs. Recruitment procedures were safe and appropriate checks were completed before staff were employed.
Staff and the management team had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.
People and relatives told us the service was well-led. The provider had a clear vision for the service. Staff understood their role in delivering that vision and were encouraged to become involved in developing the service.
There were systems in place to monitor the quality of the service provided to people. The provider sought feedback from people using the service and their relatives in respect of the quality of care provided and had arrangements in place to deal with any concerns or complaints.
During this inspection we saw there was now an effective quality assurance process in place to regularly monitor the quality of the service people received. The manager told us 'I feel I know what is going on now and have the autonomy to direct the service'. We also saw there was a process in place to capture feedback from people who used the service.
The provider had a published complaints procedure, which was centrally managed. Informal low level complaints were recorded in an issues log and responded to by the manager.
We found care plans had not been put in place for the majority of people using the service and risk assessments had not been carried out. Staff were not given sufficient information about the needs of people before care provision began in order to ensure they had the skills to provide appropriate care.
Staff demonstrated an understanding of the signs of abuse. However, the process for reporting potential abuse was not robust and it was unclear who was responsible for the reporting and following up of potential safeguarding incidents.
Sufficient numbers of staff were employed to ensure people received the care they required. However, the management structure was not sufficiently resourced to carry out assessments of people's needs. Staff supervisions, spot-checks and appraisals were not carried out regularly.
The service did not have effective quality assurance systems in place.
We saw the home was clean and well maintained. The manager told us the responsibility for overseeing infection control was delegated to an assistant manager, who was the infection control lead. We spoke with four members of staff and the manager, all of whom said they had received infection control training. Everyone we spoke with told us the home was always clean. One person said 'everywhere is perfect. Cleaning ladies are always popping in [to my room] and asking if they can just hoover or clean the bathroom'.
Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. We found the provider had an effective quality assurance system in place and sought the views of service users through regular surveys. We spoke with a visiting health professional and two care managers who told us they did not have any issues regarding the quality of the service provided. One care manager told us 'I have no concerns. I use the Adelaide all of the time'.
We spoke with four members of staff and confirmed that they had received appropriate induction training and had the skills necessary to carry out their duties. Staff had received safeguarding training and were able to say what action they would take if concerns were raised or observed. We saw that there was an effective system in place to manage medication.
We saw that records were well maintained and stored in secure locations. We were told that there was an appropriate destruction policy. We spoke with a visiting health professional and a care manager who told us they were happy with the care provided at the home. They said that there was good communication and they were kept informed of changes in people's condition.