Adam House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant there were shortfalls in service leadership. Leaders had not been able to drive all necessary improvements to assure the delivery of consistent high-quality care.

The service was in breach of legal regulation in relation to the governance of the service.

This service scored 61 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff spoke about the visions and values of the service. One staff member said they thought it was “To promote independence.” The service adopted a positive culture which was easy to see during communication we witnessed between staff and people. Various policies were in place to support an open culture.

Although leaders understood the context in which the service delivered care, treatment and support, improvement was not always successfully driven. This made it difficult to ascertain if they had the appropriate knowledge and experience to lead effectively, though we did witness they tried to lead with integrity, openness and honesty.

The registered manager was quick to start to resolve some issues as they arose during our inspection, though some of these concerns were re occurring issues from our last inspection, which had not been fixed prior to our arrival. One relative said of the services manager, “I have a chat with her occasionally. She’s very, very hard to get hold of.”

The servcie did put some focus on how they could enable people to live a good life. We found the management team approachable and compassionate throughout our inspection and staff spoke positively about the management of the service.

The service fostered a positive culture where people felt they could speak up, and their voice would be heard.

Staff knew how to whistleblow and felt confident to speak up should they need to. One staff member told us “It (whistleblowing) means if I see something, abuse or harshness or treating someone with disrespect, report it. (I’ve) Not had to yet! All of the managers are approachable. I’d tell the main manager at the house.” The provider had a whistleblowing policy available to staff. Staff were able to raise any concerns in team meetings.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff told us the management was approachable and fair to all staff. One staff member said, “Yes (she is approachable), and I love [manager]. She’s amazing and she gets right on our level.” An equality and diversity policy was in place which set out how the service supported equality and diversity. The service employed a diverse range of staff.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, it was not clear how this was shared with others when appropriate.

Multiple audits and oversight tools were in place, but these were not always being consistently completed. Audits did not always identify issues, and actions were not always taken when issues were identified. Multiple audits had failed to drive improvement. For example, care plan reviews had not been regularly completed and had not identified the issues we found as mentioned in this report. We found examples where maintenance issues had been reported, and no action had been taken for months. We found examples where medication issues had not been identified. Where issues were identified in an October medicines audit, no action had been taken by the time of our inspection.

Provider oversight needed to be more robust. The registered manager was completing Registered Provider visit forms each month. These site visits did not always identify the issues we found. For example, issues relating to an out-of-date fire risk assessment had not been picked up, and where issues were found in relation to things such as a radiator cover not being in place, this had not been promptly rectified as this was still an issue on day 1 of our inspection. These visit records did not include any review of medication.

Various policies were in place, but not all policies were being followed including the end of life and advanced care planning policy, care and support plans policy,oral hygiene policy and warfarin and the anticoagulant therapy policy.

Some records were not always appropriately or accurately completed. For example, we found rotas were not always up to date. We also found records relating to allergies were contradictory which was an ongoing issue from our last inspection.

Policies were not dated and had no version control, so it was not clear when they were last reviewed. Records relating to training were not always accurate and up to date. During our inspection we found multiple courses on a training matrix were not updated with actual completion rates, which initially made it difficult to understand where staff training was up to.

Staff felt the service was well managed.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

People and their loved ones felt they were supported to attend or engage with the local community and events. One relative said, “Yes, they’ve (staff) tried a couple of things with [person] (to try and support the person to engage with the community) and some things work, some don’t. Depends on their (persons) mood.” The registered manager told us how they worked in partnership with/and involve external professionals in discussions during our assessment. We saw examples of the service working with various organisations.

Feedback from partners was positive, they felt the service worked in a collaborative way with them. People could gain access to advocates when needed

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research.

The service had failed to drive all the necessary improvements despite CQC’s previous ratings and enforcement actions. As audits were not always identifying the issues we found and in cases where some audits did identify issues, improvement had not always been made. This made it difficult to understand how the service consistently drove improvement, identified concerns and how they consistently learned and acted upon them.

The registered manager told us about their electronic recording system where relatives can log on (if consent was given by people), allowing them to see what their loved ones had been up to through photos that were taken and uploaded. Leaders told us of some of the tools they had in place to drive improvement. They told us they use "Audits and QR codes for visitors to raise things if they want to suggest improvements." One professional told us, “When I deliver training, I see the activities being organised to help service users (people using the service) development and learning. The staff put a great deal of time, effort and care into this preparation, they seem to take great pride in this area.”