Archived: Adelaide House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a positive culture of safety based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. However, processes to learn lessons and to identify and embed good practice needed to be improved.

There was a process to report and record accidents and incidents. One staff member explained the process, stating, “We do an accident form and then it will be recorded on the handover, so the next staff team know the person has had a fall. It is also recorded in their professional visits and in their care plan and their family are also informed.” However, there had been no overall analysis of accidents and incidents to identify any trends or patterns since August 2024. Whilst the registered manager assured us the level of accidents and incidents was very low, and action had been taken to keep people safe, they acknowledged this was an area that needed to improve.

Staff told us information about accidents and incidents and increased risks would be shared with them. One staff member told us, “This is a little care home, so you get to hear if anything goes wrong.” Another staff member gave an example of how learning had been taken in relation to the management of risks for a person who had started to walk with purpose at night. Where people had experienced accidents and incidents, referrals were made to external health professionals for review and guidance.

The provider needed to improve their processes to ensure continuity of care, including when people moved between different services.

People’s reasons for transitioning to Adelaide House were considered when their care was planned. However, when people needed to be admitted to hospital in an emergency, there was no formal process for sharing information about people’s risks and immediate needs. One senior member of staff explained, “The paramedics are informed of people’s needs before they go, whether they are on a pureed diet or thickener or whether they are mobile or whether they need to be transferred with a hoist.” A more formal process would ensure important information about people was not missed as they transferred between services.

Systems were in place to check if people’s needs had changed after they had received emergency support or were discharged back to the home from hospital. Relatives were involved in supporting their family members post hospital discharge.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us staff at Adelaide House looked after them well and that it was a safe environment. Comments included: “I can talk to them (staff) and everyone is lovely. I get on very well with all of them”, “I do feel safe here; it is the people, they look after us well” and “There are no concerns about safety in the service. [Name] is at ease with staff and doesn’t seem to have any concerns.”

The registered manager understood their safeguarding responsibilities, but staff knowledge of some safeguarding processes needed to be improved. Staff understood how to identify signs of abuse and told us they would not hesitate to report any concerns. One staff member told us, “I know the residents and chat to them every day. You look to see if anyone is quiet, and you see their body language. You ask questions and you do things with a conscience, you don’t let things like that go.” Staff told us they would escalate matters to the provider if any concerns were not promptly addressed. However, whilst some staff knew they could also contact CQC or the local authority safeguarding team, other staff did not demonstrate the same confidence about external organisations they could contact to share safeguarding concerns. The registered manager assured us they would provide staff with available and accessible information about external organisations and discuss processes in individual staff supervision meetings.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s views on how to manage their risks had been considered when their care was planned. For example, people had been asked if they wished specific tests to be undertaken to help them manage long term health conditions.

People’s care plans and risk assessments considered risks in relation to falls, choking, poor skin health, social isolation, smoking, specific health conditions and diet and nutrition.

Staff understood the risks people experienced. For example, one staff member explained how they helped to reduce risks by ensuring people received the correct texture of food and fluid, ensuring people’s skin was properly dried after personal care, and by walking at their side when they mobilised around the home. One healthcare professional told us how the specific risks around one person’s health condition had been managed well.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, and facilities supported the delivery of safe care.

The provider had a system of checks to ensure the safety of the premises and equipment. This included fire safety checks and personal evacuation plans if the home needed to be evacuated in an emergency. However, we found some checks needed to be more robust as we identified a defective sash window which could have been an entrapment risk, and some cleaning items were not locked away in 1 of the bathrooms. The registered manager gave us examples of improvements which had been made to the environment, such as the installation of a new boiler, and changing carpets in people’s bedrooms.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs.

People and their relatives told us there were enough staff and they benefited from a consistent staff team. A relative told us, “They have enough staff, and they are regular staff.” One person commented, “The staff are very good and there are just about enough of them.”

The registered manager explained staffing rotas were developed to ensure there was the right skill mix and experience on each shift and there was always a trained staff member to give people their medicines. Staff told us there were enough staff to care for people. We saw staff had time to check on people, chat with them and respond to their requests promptly. One healthcare professional told us, “It is one of the homes where it is really easy to find someone if you need help with something.”

The provider required staff to complete mandatory training which was regularly refreshed. Staff told us the training they received helped them develop the skills they needed to care for people. One staff member particularly spoke of the thoroughness of the face-to-face training and explained, “Training is really good. We have someone from outside come in every year who will do fire, moving and handling and first aid. It is full hands-on training, so, for example, you have to get on the floor and give CPR. She will get all the staff to use the equipment, so she is sure you are using it safely.” Another staff member told us about their induction, which had included safeguarding and fire training. The staff member said they had regular supervision during their induction period, which focused on areas where they were doing well, and areas where they needed support to develop further. Staff confirmed they had opportunities to discuss their role and responsibilities in regular meetings with their managers. Staff were not allowed to commence work until references and Disclosure and Barring Service (DBS) checks had been received.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Overall, we found the home was clean and tidy. However, we did identify some infrequently used communal areas were dusty and would have benefited from a deeper clean. Hand sanitiser was available in key areas and there was signage around the home reminding staff about good hand hygiene and the correct use of personal protective equipment. We spoke with a member of housekeeping staff who described how they followed national guidance when cleaning different areas of the home. They told us they were informed of any infections in the home so they could use appropriate personal protective equipment when entering people’s rooms. An external health professional told us staff knew how to escalate any infection control concerns.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines from staff who had received medication training and had their competency to give medicines assessed. People’s medicines were stored and administered safely.

People’s care plans provided guidance on the medicines they required and what the benefits of using the medicines were. Where people had medicines to be given on an ‘as required’ basis, there were guidelines in place informing staff when and in what circumstances they should be given. Guidelines were reviewed and signed by a healthcare professional to ensure they accurately reflected people’s needs. Some people received their medicines via a patch applied directly to their skin. There were processes to ensure these were managed as per the manufacturer's instructions, however there were some gaps in recording the application site. The deputy manager assured us they would immediately address this with staff.

People’s care records showed where expected medicines had not been prescribed this was promptly followed up with people’s GPs, so people would have the medicines they needed to remain well. Where relatives or staff had concerns about the medicines prescribed, this was reviewed with people’s GPs. Records demonstrated people were involved in discussions about changes in their prescribed medicines. A health and social care professional who regularly visited the home told us, “Staff know people well and know what medicines they are on.”