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Inspection carried out on 14 May 2019

During a routine inspection

About the service: The Adelaide is a local authority owned service which provides both a short stay residential respite and re-enablement service, day care service and an outreach community re-enablement service including personal care for people living in their own homes. At the time of the inspection 17 people were receiving a residential based service and 25 were receiving a community-based service.

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

Inspection carried out on 22 September 2016

During a routine inspection

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 dementia. At the time of our inspection there were 11 people living at the home.

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 understoo

Inspection carried out on 24 & 26 June 2015

During a routine inspection

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.

Inspection carried out on 9 December 2013

During an inspection to make sure that the improvements required had been made

During our previous inspection, which was carried out over four days between 17 and 20 September 2013, we found the provider had failed to ensure there was a system in place to regularly monitor the quality of service provided. We issued a warning notice which required the provider to become compliant by 15 November 2013.

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.

Inspection carried out on 17, 18, 19, 20 September 2013

During a routine inspection

We spoke with six of the 22 people receiving care from the Reablement Service. They told us they were satisfied with the care they received and were complimentary about the care workers. One person told us “they are all really lovely”. Another person said “they are always helpful”. Staff we spoke with appreciated the need to gain people’s consent before providing personal care and we saw records which showed when people had refused care.

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.

Inspection carried out on 22 August 2013

During a routine inspection

We spoke with five people who used the service. They all told us staff sought their consent before they delivered any care. They said they were very happy with the level of care provided and staff understood their needs. One person said “My diabetes is up and down so they make sure I have carbs if I need them”. Another person told us “when I press my buzzer it is answered in less than a minute. The staff here are first class”. We looked at eight care plans and saw they were individualised and included the necessary information to inform staff as to the specific care people required. We saw these were renewed for each period of respite care. We observed care in the communal areas of the home and saw staff interacting with people in a positive way.

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”.

Inspection carried out on 1 February 2013

During a routine inspection

We spoke with three people who used the service and one family member they told us that they were happy with the level of care provided and that staff were always available when needed. One person told us “I am very happy here. I would rather be at home but if I have to be away from home then here is a nice place”. We observed staff providing care and saw that people looked happy and relaxed. We saw staff speaking with people, some of whom were engaged in activities and others were sitting quietly or engaged in conversations.

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.

Reports under our old system of regulation (including those from before CQC was created)