Adam House

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 remained requires improvement. This meant people were not always safe and protected from avoidable harm.

The service was in breach of legal regulations in relation to safe care and treatment and good governance.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty, though relatives felt they could be kept better updated. They listened to concerns about safety and investigated safety events. Some lessons were learnt to continually identify and embed good practice. However, this was not consistent as not all learning had been embedded following our previous inspection.

People and their relatives seemed to suggest they felt able to communicate with the management and staff, but said they were not always kept up to date when things happened. One family member said, “[manager] isn’t good at getting in touch with relatives when things happen and getting back to us if we need to speak with her.”

Staff knew how to report concerns, and we were able to review examples of lessons learned shared in staff meetings, and after safeguarding’s. Accidents and incidents were being recorded, but not all necessary improvements were made following our last inspection meaning the learning culture was not always consistent.

Partners felt the provider worked with them, and took appropriate action when things went wrong.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People felt the staff team worked well together to ensure they received the care and support they needed. Relatives said their loved ones got to see healthcare professionals such as the doctor when they needed to, but one relative noted that they were not kept informed about this. We were able to see some examples where appropriate referrals had been made when people needed external support.

Staff spoke about information being shared at handovers and by senior care staff and managers. Handovers were in place to support sharing of information, to make sure all staff coming on to shift were aware of any concerns, or if anyone had been in distress. Staff spoke about how best to support people on the day depending on how the previous shift had gone.

Professionals felt the service supported safe transitions when going to new places. One professional told us, “The support workers accompany the service users to and from training, my observations believe they are interactive, and engaging throughout, I have also seen this great practice further, when the support worker accompanies the service user to the local shops etc.”

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

Safeguarding practices had improved. We saw examples of safeguarding referrals following incidents. Staff were knowledgeable about safeguarding. One staff member told us what safeguarding meant, they said “It’s to protect vulnerable (people) from neglect and abuse and to make sure they’re safe and their rights are protected.”

Staff were able to explain about mental capacity. A Mental Capacity and Deprivation of Liberty Policy and procedure was in place. The registered manager confirmed people could access advocates if they needed this support.

A signing in book was in place to ensure the service had an accurate record of any visitors which helped keep people safe. People told us they felt safe. One person said, “Yes (I feel safe).” The service had a safeguarding policy in place which detailed necessary information.

When restraint was used, people’s records indicated that the least restrictive option should be used. For one person, staff were restricted with the techniques they could use because of the persons health condition, and this was clearly documented.

The service did not work well to consistently understand and manage risks.

People’s relatives didn’t always feel risks or incidents were being appropriately shared. One relative told us, “They (staff) didn’t tell me (about an incident) and that could have happened at home. I need to be informed if there’s new risks.”

Necessary risks assessments relating to people’s health and potential risks were not always as detailed as they needed to be. For example, risk details relating to one person’s specific medication did not include what actions should be taken following any incident. The registered manager told us this risk assessment had been updated following our identification of this issue. For a person who was deemed to be at risk of choking their risk assessment did not detail what actions staff should take in the event of a choking episode. One person who was at risk of ligaturing had a generic assessment for their bedroom safety, which did not mention ligature risks. Similar issues relating to risk management and lack of detail was identified at our last inspection.

Staff knew where peoples risk assessments were located, and they spoke about how they manage people’s risks. We were able to see examples of environmental risk assessments in place to promote a safe environment, and we found appropriate personal emergency evacuation plans in place.

The service did not always detect and successfully control potential risks in the care environment. They did not make sure that the environment and facilities supported the delivery of safe care.

Fire safety needed to be improved, we found concerns with fire doors not operating as they should. These were similar concerns identified during our last inspection and also during a recent visit from Lancashire fire and rescue. Maintenance arrived on site to look at these issues after we flagged our concerns. Appropriate maintenance and oversight of this issue was not in place. The fire risk assessment had not been reviewed in line recommendations; this was actioned as soon as the issue was identified and the registered manager assured us that a new review had been conducted shortly after our visit.

Improvements in the environment had been made to promote safety but there was still some work to do in this area. We found a wardrobe was not secured to the wall, this was rectified immediately. Radiators did not always have necessary radiator covers in place. This was an issue identified during our last inspection and then the issue was resolved. However, following redecoration these had not all been re-instated. This issue had been identified some months ago by managers. However, this issue had not been rectified until we raised this on site.

People and their relatives generally felt they/their loved one was in a safe environment, though one relative felt the service was not always well maintained which echoed some of our findings.

Necessary safety certificates were in place to support safe environments in areas including gas safety, electricity and legionella checks. The registered manager said of the environment, "I think it’s about making it a homely environment. We try to make it relaxing and encourage friendships." Necessary window restrictors were in place and there was adequate signage around the service. The environment was neutral and there had been recent work done to upgrade the service, but oversight of this needed to be more robust.

The service did not always make sure records relating to staff on shift were accurate, though there were enough qualified, skilled and experienced staff on shift the number of new staff were said to have impacted people. Staff did receive effective support, supervision and development, but records around training were not always accurate.

People’s feedback on staffing levels was that there was generally enough staff, but one relative spoke about there being a lot of new staff which impacted on their loved one. Staff feedback on staffing levels was mixed. One staff member told us, “Most of the time there’s enough staff. There’s a lot of sickness and some people do an awful lot of hours and they’re tired.” Agency staff was being used to help ensure staffing levels were consistent, mainly at night. Rotas relating to this were not always clear and concise. The staff training matrix was not always up to date. However, on review of all training information shared, records indicated that staff training was mostly up to date.

Staff supervisions and appraisals were taking place in line with policy. Recruitment practices had improved and were now safe, with the necessary pre-employment checks being made. Staff told us they completed an induction when they started.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and records relating to cleaning were appropriately completed.

The home was clean and tidy and there was a dedicated area for laundry. People were encouraged to do their own laundry with staff support where required. Generally, people and their relatives felt the service was clean. Staff told us how they tried to prevent or control the spread of infection. One staff member said they could/would, “Sanitize door handles. Isolate people and use colour coded equipment.” Appropriate PPE (Personal Protective Equipment) was in place and cleaning records were up to date and were being appropriately completed.

The service did not always make sure that medicines and treatments were safely managed and met people’s needs.

Medicines and topical creams were not always safely managed. We found one cream in stock that had been discontinued in September 2025. This cream was not stored in its original packaging and looking back at records it appears it was not applied in line with manufacturer’s instructions. The manager removed this cream from current stock once we had identified this issue. We found one cream where the prescriber’s instructions differed to that on the medicines administration record.

Although fridge temperatures were being regularly taken, the daily minimum and maximum was not being recorded, as temperatures were taken from a standard thermometer they had put in the fridge. This means we were not confident recordings were correct. The registered manager told us the correct thermometer had been ordered to rectify this. One person’s eye drops were not dated when opened meaning we were not assured they were still safe to use. Some medicines can be ineffective when opened past the recommended time frames. We found examples where there were gaps in peoples medicines administration records.

Staff told us they had their medicines competencies checked. Pill counts did not always match medicines records and controlled drugs were not always safely managed. The controlled drug cabinet was not securely fixed to the wall. Records relating to controlled drugs were not always accurate. For example, the controlled drug record held incorrect information regarding administration. The recorded number of drugs did not match the actual number of medicines on site. This meant we were not assured this medication was always administered when recorded.

Appropriate guidance was generally in place for staff to follow and staff had received training in medicines administration. However, some medicine policies needed to be clearer. Medication policies also referred to the Royal Pharmaceutical Society guidance, which is no longer available. People’s protocols for when required medication did not always detail necessary information.

People and their loved ones said they felt they received their medication when they needed it. We were confident people were not being over medicated to control their behaviours. The registered manager told us that following the inspection they were implementing a daily medicines audit in the hope this would drive improvement in this area.