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Adelaide Care Home Requires improvement

Reports


Inspection carried out on 24 October 2019

During a routine inspection

Adelaide Care Home is a residential care home registered to provide personal and nursing care for up to 76 people living with dementia, sensory impairment or a physical disability across four separate units, each of which has separate adapted facilities. There were 69 people using the service at the time of our inspection.

People’s experience of using this service and what we found

The provider failed to involve some people, their relatives and professionals where relevant and had not maintained a record of decisions made in their best interests, in line with the Mental Capacity Act 2005. The provider had made DoLS reauthorisation application for six people to the supervisory body but had not followed up with them for over a year. As these had not been authorised at the time of the inspection. The provider had not always identified issues that we found at this inspection and acted upon in a timely manner.

The service had a positive culture, where people and staff told us they felt the provider cared about their opinions and included them in decisions. The registered manager had knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements through periodic meetings. The provider had worked effectively in partnership with a range of healthcare professionals.

People and their relatives gave us positive feedback about their safety and told us that staff treated them well. The registered manager and staff understood what abuse was, the types of abuse and the signs to look for. Staff completed risk assessments for every person and they were up to date with clear guidance for staff to reduce risks. There were enough staff on duty to support people safely and in a timely manner. Staffing levels were consistently maintained to meet the assessed needs of people. The provider carried out comprehensive background checks of staff before they started work. Medicines were managed safely.

Staff kept the premises clean and safe. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.

Staff carried out pre-admission assessments of each person’s needs to see if the service was suitable and to determine the level of support they required. Staff received appropriate support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach their line manager, and the registered manager, at any time for support. Staff assessed people’s nutritional needs and supported them to have a balanced diet. People told us they had enough to eat and drink. The provider had strong links and worked with local healthcare professionals in a timely manner. The provider met people’s needs by suitable adaptation and design of the premises. Staff completed health action plans for everyone who used the service and monitored their healthcare appointments.

Staff asked for people’s consent, where they had the capacity to consent to their care. Some 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 support this practice. Staff showed an understanding of equality and diversity. They supported people with their spiritual needs where requested.

Staff involved people or their relatives in the assessment, planning and review of their care. Staff respected people’s choices and preferences. People told us staff treated them with dignity, and their privacy was respected.

Staff recognised people’s need for stimulation and supported them to follow their interests and take part in activities. People responded positively to these activities. Staff had developed care plans for people based upon their assessed needs. Care plans were reviewed on

Inspection carried out on 23 August 2018

During an inspection looking at part of the service

This focused inspection took place on 23 August 2018 and was unannounced. This inspection was partly prompted by an alleged incident which had a serious impact on a person using the service and this indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of the specific incident, which we are aware the police are investigating, we did look at associated risks. This report only covers our findings in relation to two of the questions we ask providers, is the service Safe and is the service Well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Adelaide Care Home on our website at www.cqc.org.uk.’

At our last comprehensive inspection of the service on 30 and 31 March 2017 we found the service to be meeting regulatory requirements and was rated 'Good'. Adelaide Care Home 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 both were looked at during this inspection. Adelaide Care Home provides residential, nursing and dementia care for up to 76 older people. At the time of our inspection there were 73 people using the service. There was 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.

Risks to people were assessed, recorded and managed safely by staff. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take to ensure peoples safety and well-being. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were on duty to meet people’s needs in a timely manner. There were effective systems in place to monitor the quality of the service provided. The provider recognised and celebrated staff performance and achievements. The service worked in partnership with other professionals to ensure people received appropriate care and support that met their needs. People and their relatives were encouraged to share their views and to provide feedback about the service.

Inspection carried out on 30 March 2017

During a routine inspection

This inspection took place on 30 and 31 March 2017 and was unannounced. At our last inspection of the service, on the 14 and 15 April 2016 the service was rated as good overall and requires improvement in well-led.

Adelaide Nursing and Residential Care Home provides residential, nursing and dementia care for up to 76 older people. The home is located in Bexleyheath, London borough of Bexley. At the time of our inspection there were 71 people living in the home.

There was a registered manager in place at the time of our inspection. 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 this inspection we found the previous concerns in relation to maintaining up to date records of people using the service, staff and the monitoring and documentation relating to accidents incidents had been addressed and significant improvements had been made.

Risks to the health and safety of people were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and their support needs and risks were identified, assessed and documented within their care plan. Interactions between staff and people using the service were positive and people told us staff were kind and supportive. People were provided with information on how to make a complaint. People using the service and their relatives were asked for their views about the service.

Inspection carried out on 14 April 2016

During a routine inspection

This inspection took place on 14 and 15 April 2016 and was unannounced. A new provider had taken over the management of the home and this is their first inspection since they registered with the Care Quality Commission in November 2014.

Adelaide Nursing and Residential Care Home provides residential, nursing and dementia care for up to 76 older people. The home is located in Bexleyheath, London borough of Bexley. At the time of our inspection 71 people were using the service.

There was no registered manger in post. The previous manager left their post two days before our inspection. A new manager had been appointed in March 2016 and they were in the process of registering with the Care Quality Commission, they were in post at the time of this inspection. 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 found a breach in legal requirement because the provider did not always maintain up to date records of each service user and staff. Accidents incidents were not always recorded which meant risks were not always assessed, monitored and mitigated to improve the quality and safety of the service provided.

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

People and their relatives were complimentary about the service and said they or their loved ones were safe living at the home. The provider had safeguarding and whistleblowing policies in place. Staff knew of their responsibility to safeguard people in their care knew of the whistleblowing procedure. Staff told us they were confident the current management team would take action if any concerns of abuse were brought to their attention. Risk to people had been assessed and appropriate action plans were in place to ensure identified risks were prevented or minimised. The provider had appropriate recruitment and selection process in place to ensure staff were suitable to work in social care. There were safe management of medicines practices at the home. There were arrangements in place to deal with unforeseeable emergencies.

There were adequate numbers of suitably qualified, experienced and appropriately trained staff to meet people’s needs in a timely manner. There were processes in place to ensure staff new to the home had appropriate skills and knowledge to deliver care and treatment for the role which they had been employed to undertake. Both care staff and the management team demonstrated a clear understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. People were supported to eat and drink suitable and sufficient amounts for their wellbeing. Where required, other healthcare professionals were involved in people’s care to ensure their needs were met.

People and their relatives told us staff were kind, caring and respectful towards them and their loved ones. People’s privacy and dignity were respected and their independence promoted. People’s likes and dislikes and their life history were recorded in their care plan to ensure staff were aware and provide adequate support. People and their relatives were involved in making decision regarding their care and treatment. People were encouraged to maintain relationships with their friends and family. Staff understood people's needs in regards to their race, religion and sexual orientation and supported them in a caring way. People and their relatives were provided with appropriate information about the service. Where required, people were supported with end of life care.

Each person using the service had a care and treatment plan in place which was specific to their needs. People were engaged in various activates of their choice including accessing the local co