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Adelaide House Residential Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 7 May 2019

During a routine inspection

About the service: Adelaide House is a care home registered to provide personal care and accommodation for a maximum of 23 older people. The home is located in a residential part of Leamington Spa and the accommodation is set out over four floors. There were 20 people living at the home at the time of our visit, some of who were living with dementia.

People's experience of using this service:

We last inspected Adelaide House in April 2018 when we rated the service as 'Requires Improvement’ in all key questions, together with breaches of the regulations. At this inspection we found improvements had been made in the key questions of ‘Caring’ and ‘Responsive’ which are now rated as ‘Good’. The key questions of ‘Safe’, ‘Effective’ and ‘Well-led’ remain ‘Requires Improvement’ and there are continuing breaches of the regulations.

There was a lack of clarity around the role and responsibilities of the management team. Quality assurance systems were not always effective and there were limited formal systems in place to audit the safety of the service.

Staff understood how to support people to keep them safe, but the provider and registered manager continued to demonstrate a lack of understanding of their safeguarding responsibilities. Environmental risks were not always identified and there was no effective system to audit adverse incidents that occurred in the home.

At the time of our inspection visit there were enough staff on duty to keep people safe, but staffing levels were not always maintained, especially at weekends. Staff had been given some training opportunities, but further improvements were required to ensure staff received support to maintain and develop their skills and knowledge.

People had access to the healthcare they required and were supported to access healthcare services. Medicines were given as prescribed, but improvements were required in the records to support safe medicines management. People’s nutritional needs were met in line with their preferences.

People told us they felt well cared for and staff demonstrated warmth and kindness in their interactions with people. People made decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

Systems were in place to manage and respond to any complaints or concerns raised.

This is the second consecutive time the home has been rated as Requires Improvement.

The registered provider was in breach of Regulations 12, 13 and 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Rating at last inspection: At the last inspection the service was rated as requires improvement. (The last report was published on 25 May 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service continues to be rated as 'Requires Improvement' overall.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

Inspection carried out on 18 April 2018

During a routine inspection

This inspection took place on 18 April 2018. The inspection was unannounced.

Adelaide House is a care home registered to provide personal care and accommodation for a maximum of 23 older people. People in care homes receive accommodation and 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. The home is located in a residential part of Leamington Spa and the accommodation is set out over four floors. There were 19 people living at the home at the time of our visit, some of who were living with dementia.

We last inspected Adelaide House in November 2016 when we rated the service as ‘Good’ overall. However, at that inspection we found some improvements were required in the leadership of the service. At this inspection we found improvements had not been made and a lack of proactive management and leadership had affected the quality of the service. Checks and audits were not effective which impacted on the safety, effectiveness and responsiveness of the care people received.

The service had a registered manager. This is a requirement of the provider's registration. 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.

The registered manager was also one of the providers and had acknowledged improvements were needed to ensure people received consistently high quality care. A new manager had been appointed, who was to apply to be registered with us and take over the management of the service.

There were enough staff to meet people’s needs and people told us they felt safe with the staff who supported them. However, the provider’s investigations into safeguarding incidents were not robust enough to ensure people were protected from the risks of harm. Where people had been involved in incidents or accidents, these had not been reviewed to identify patterns or trends across the service, or for individuals. People were not always protected from environmental risks or individual risks to their wellbeing.

People were supported to eat and drink enough to maintain their health and when a need was identified, they were referred to other healthcare professionals. However, medicines were not consistently managed and administered safely.

People’s mental capacity to consent to their care had not been assessed effectively and there was conflicting information in people’s care records about what decisions they could make. Some staff practices meant people were not given maximum choice and control over how they lived their lives. The physical environment was not supportive of people living with dementia because it did not enable them to move around the home independently.

Staff tried to work in a person centred way and shared information about changes in people’s needs. People demonstrated a high satisfaction with the caring nature and understanding attitude of staff, and we saw friendly and caring interactions between staff and the people they care for. However, staff lacked support and training to ensure they had the skills and knowledge to carry out their role effectively.

People felt able to share any concerns, but the process for obtaining people’s views needed to be improved so people were empowered to provide feedback and share their experiences to ensure the service met their preferred wishes. The new manager was open and transparent about the challenges and improvements required to ensure people received person centred care that met their individual needs and preferences.

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

Inspection carried out on 13 December 2016

During a routine inspection

Adelaide House provides care and accommodation to a maximum of 23 older people. The home is located in Leamington Spa in Warwickshire. On the day of our inspection there were 22 people who lived at the home. The home provides care and support to older people and people who live with dementia.

The service was last inspected on 18 December 2015. At that inspection we found a breach in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. The breach was in relation to good governance. The provider did not have effective systems and processes in place to monitor the quality and safety of the service provided.

We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. The provider sent us an action plan which detailed the actions they were taking to improve the service. The provider told us these actions would be completed by October 2016.

At this inspection on 13 December 2016 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken and there was no longer a breach in Regulations of the Health and Social Care Act 2008. However, further improvement was needed.

The service had a registered manager who had been in post since 2015. This is a requirement of the provider’s registration. 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.

The provider had developed systems to gather feedback from people, relatives and others so they could use the information to improve the quality of the service provided. Audits to monitor the safety of the service were being regularly completed. However, some audits were limited in detail and required further improvement.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed, but guidelines in place for people prescribed ‘as required’ medicines were not always clear. Action was taken to address this.

There were enough staff to meet people’s needs. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. However, some risks relating to staff recruitment had not been clearly documented. Staff told us they were not able to work until these checks had been completed.

The registered manager understood their responsibility to comply with the relevant requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care workers gained people’s consent before they provided personal care and knew how to support people to make decisions.

People told us they felt safe living at Adelaide House and staff understood how to protect people from abuse. Risks related to the delivery of care and support for people who lived at the home had been identified and staff understood how these should be managed. Some individual risks had not been documented. The registered manager took action to address this.

Staff respected and promoted people’s privacy and dignity. People were encouraged to maintain their independence, where possible. People told us care workers were caring and understood how people wanted their care and support to be provided.

People who lived at the home were supported to maintain links with friends and family who could visit the home at any time. Some people were supported to follow activities and hobbies which they found enjoyable and interesting.

Staff completed training considered essential to meet pe

Inspection carried out on 18 December 2015

During a routine inspection

This inspection took place on 18 December 2015. The inspection was unannounced.

Adelaide House is a care home registered to provide personal care and accommodation for a maximum of 23 older people. The home is located in Leamington Spa in Warwickshire. There were 18 people living at home at the time of our visit. 12 people at the home were living with dementia.

The service had a registered manager. This is a requirement of the provider’s registration. 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 refer to the registered manager as the manager in the body of this report.

The provider had not established effective procedures to check and monitor the quality and safety of the service people received, and to identify where areas needed to be improved. This meant that a number of shortfalls in relation to the service people received had not been addressed.

Risks associated with the delivery of care and support for people who lived at the home had been assessed. However, risk management plans and risk assessments had not always been up dated when people’s care or support needs changed and were not always followed by staff.

People’s care records were not always reflective of their care and support needs therefore did not provide staff with up to date information about how people should be cared for and supported. However, overall staff a good understanding of the needs and preferences of the people they supported. People and their relatives thought staff were caring and responsive to people’s needs.

People were not always supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, the manager worked alongside people at the home, and gathered verbal feedback from people during their day to day activities.

There were processes in place to ensure medicine was securely stored. However, medicine was not always stored at the correct temperature and the timing of medicine administration required improvement. People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing.

There were enough staff at Adelaide House to support people with care tasks. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence. People were given privacy when they needed it.

People and their relatives told us they felt safe living at the home and staff treated them well. Staff knew how to safeguard people from abuse, and were clear about their responsibilities to report concerns to the manager.

The provider had effective recruitment procedures that helped protect people, because staff were recruited that were of good character to work with people in the home. Staff had completed an induction. Some staff training was not up to date. However, the manager had identified this and was scheduling training.

People were supported in line with the principles of the Mental Capacity Act 2005 (MCA). People were able to make some everyday decisions themselves, which helped them to maintain their independence.

People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time. However, people were not always supported to take part in interests and hobbies that met their individual needs and wishes.

People, relatives and staff felt the manager was approachable. People and relative’s told us they knew how to make a complaint if they needed to. However, no-one had made a compliant regarding