Archived: Adelaide House Care Home

Adelaide House provides care and accommodation for up to 30 people; some have nursing and physical needs and some people are living with dementia. On the day of our inspection 25 people were living at the service.

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

There were sufficient staff at the service to support people safely however staff did not have time to spend with people. The registered manager has confirmed staff levels have increased since the inspection.

Staff were aware of the risks associated with people’s care and ensured that people were provided the most appropriate care. People received their medicines when needed. 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 this practice.

Staff received appropriate training in relation to their role and were encouraged to progress. Staff were valued and had opportunities to give their feedback on the running of the service. People were supported with sufficient nutrition and hydration. External professional were involved with people health needs.

People and relatives told us that staff were kind, caring and respectful towards them. We saw examples of this during the inspection. People were supported and encouraged to remain as independent as possible and were involved in decisions around their care.

There were sufficient activities and outings for people. People who were cared for in their rooms had one to one activities provided and were protected from the risk of social isolation. Care plans were planned around people’s health care needs. There was a robust system in place to assess the quality of care provided. People and relatives knew how to complain and were confident that complaints would be listened to and addressed. People, relatives and staff thought the leadership of the service was effective.

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 April 2021).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the inspection in November 2019.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

About the service

Adelaide House provides care and accommodation for up to 30 older people; some have nursing and physical needs and some people are living with dementia. On the day of our inspection 18 people were living at the service.

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

There were sufficient staff at the service to support people with their needs. Staff were aware of the risks associated with people’s care and ensured that people were provided with the most appropriate care. People received their medicines when needed and the management of medicines was safe.

People felt safe with staff and staff knew what to do if they suspected abuse. Incidents and accidents were reviewed, and actions taken to reduce further occurrences.

There was a robust system in place to assess the quality of care provided. People, relatives and staff thought the leadership of the service was good and felt supported by them. Notifications were sent to the CQC where it was appropriate to do so.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 20 October 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection sufficient improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced targeted inspection of this service on 4 September 2020 and breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they were now meeting legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Adelaide House provides care and accommodation for up to 30 people, some have nursing and physical needs and some people are living with dementia. On the day of our inspection 23 people were living at the service.

People’s experience of using this service:

People did not always receive care when they needed as there were not sufficient staff deployed at the service including care and nursing staff. Medicines were not always being managed in a safe way which put people at risk.

There were audits taking place however these were not always robust, particularly around the monitoring of staff levels. People and staff did not feel there was a strong leadership presence in the service.

The service was clean, and staff adhered to appropriate infection control measures.

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

Rating at last inspection:

The last rating for this service was requires improvement (published 27 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we identified continued breaches in relation to the deployment and numbers of staff, and the lack of robust quality assurances at the service.

Why we inspected:

We undertook a targeted inspection due to concerns we received relating to staff levels and medicine errors that had occurred, and to review the progress made by the service to become compliant with the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers findings in relation to risk associated with staff levels, medicines, infection control and quality assurance. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement:

We have identified continued breaches in relation to staffing, the safety of care around the management of medicines and the quality assurance of the service. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner. We will continue to work with the local authority to monitor progress.

Adelaide House Care Home is registered to provide accommodation, nursing and personal care for up to 30 people who may have a disability or may be living with dementia. There were 14 people living at the service at the time of our inspection.

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

There were not always enough staff deployed at the service which left people at risk. This also meant that staff were not always able to spend meaningful time with people. Risks associated with people’s care was not always being managed in a safe way including where people were at risk of malnutrition. Incidents and accidents were not always being reported or investigated to reduce the risk of reoccurrence.

Staff had received training and supervision however this was not always effective in ensuring good practice. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. There were not sufficient meaningful activities for people and people fed back they would like to go out on trips.

Quality assurance was not always effective. Where shortfalls in care had been identified with staff this had not been addressed robustly. The leadership needed to be more effective in ensuring staff were able to deliver the most appropriate care.

Pre-assessments of care and care plans were detailed with information about people’s care and staff understood people’s needs. People and relatives knew how to complain and were comfortable doing so. People had access to health care professionals to support them with their care. People and relatives told us that staff were caring and respectful and we saw examples of this throughout the day. Relatives and visitors were welcomed as often as they wanted. People enjoyed the meals that were offered at the service.

Previous Inspection

The last rating for this service was Good (Report published 4 August 2017.)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The last inspection took place on 21 July 2016 before BUPA (The provider) changed their legal entity to BUPA Care Homes Limited. At that inspection although the home was rated as providing good care, we suggested improving the way staff were informed about people’s medical needs and how activities were organised to meet everyone’s needs. At this inspection people had more choice of individual activity and staff were well informed about their needs.

The home provides accommodation, personal and nursing care and treatment of disease, disorder or injury for up to 30 older people some of who may be living with dementia. At the time of this inspection there were 24 people using the service.

On both days of our visits 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. The registered manager greeted us at 06.00 on the first day as they had been at the home since 04.30 carrying out checks to ensure people were receiving the care they needed at night.

There were enough nursing and care staff during the day and at night to meet people’s needs. However, we discussed with the registered manager and provider how they could adjust staff working times to provide care at the times people preferred. This was most relevant in the mornings when staff were busier and may not have been able to assist everyone to get up when they wanted to, but people were receiving personal care within a reasonable time. The registered manager was going to review this and make improvements.

There were systems in place to protect people from the risk of fire, or from leaving the building unnoticed. Staff had been trained and all fire doors had an alarm to alert staff if they opened.

The risks people may have been exposed to had been assessed and staff knew what actions to take to minimise them. This included for nutritional risk, skin integrity, mobility and health. People who had capacity to make their own decisions were enabled to do so. Those who may lack capacity to make important decisions had been assessed and where needed, best interest decisions had been made. Deprivation of liberty applications had been submitted to the local authority. This meant people had their rights protected from unreasonable or unlawful restrictions.

People had their medicines as prescribed and these were stored and administered safely. People had their health care needs met by competent nurses who requested health care advice or treatment as required.

People liked the food and said there was plenty to eat and drink of their choice. The chef and staff knew peoples nutritional needs and risks and met these.

People were cared for by staff that showed they had compassion for each person. They knew people well and interacted with kindness and affection. People’s privacy, confidentiality and dignity were maintained.

Visitors were welcomed and included in the home. People’s rooms were individual and they contained personal belongings that mattered to them. The home was adapted to help people living with dementia find their way, with signage and colours. People had the equipment they needed to remain as independent as possible.

Staff responded to people’s needs but there is a need to improve how staff offer people a choice of baths or showers and how often. There was already action taken by day two of the inspection following our feedback to the registered manager on day one. A new form had been introduced to remind staff to ask every day.

Staff received training to enable them to carry out their roles. People said staff had been trained and they could tell this because staff gave them the care they needed in a competent and confident manner. Staff received support and supervision so they could discuss their roles and any training or development they needed with their manager.

There had been and improvement in the range of activities that people could choose from. Some of these had really met individual wishes, including a visit by a pony to someone who loved horses.

People knew how to, and felt confident to make a complaint or a suggestions and there were a number of ways they could do so. Staff knew how to report and respond to complaints. Any complaints had been investigated and responded to and a full record kept. There had been several recent compliments about the care.

The home was well managed by a committed manager who led a staff team that felt well supported. People were asked for their feedback and this was responded to and quality checks were carried out leading to improvements.