Adeline House 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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Accidents and incidents were recorded, and the management team checked to ensure they had been reported appropriately. However, there was no analysis of accidents and incidents and therefore trends and patterns were not identified to mitigate future risks. The management team told us they were in the process of devising a process to ensure lessons were learnt to improve practice.

The provider 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. Documents were in place to pass on information to relevant others such as the hospital staff. These were clear and detailed how people preferred to be supported and gave information about their medical needs. Details of people’s prescribed medicines were also part of the information contained in the emergency pack.

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. The management team and staff were knowledgeable about recognising and responding to safeguarding concerns and were keen to ensure people were kept safe. Staff received training in safeguarding and understood the process of escalating concerns in a timely way. The principles of the Mental Capacity Act 2005 (MCA) were understood by the registered manager and there were processes in place to review people’s capacity in line with the MCA.The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA.

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. Risks associated with people’s care were identified and managed to keep people safe. We found people had risk assessments in place regarding things such as falls, pressure care, moving and handling and nutrition. Staff we spoke with were knowledgeable about risks and were able to explain how they kept people safe. One staff member said, “We always react to red (guidance to help carers recognise people at risk and take steps to prevent pressure sores developing). If a resident starts to mark, then they will be placed on 2 hourly repositioning. If residential patients have any pressure sores the district nurses come to dress them regularly. We have wound care plans in place and update the pictures regular to see the progress.” Some relatives raised concerns regarding sensor equipment and were unsure whether sensor mats were always plugged in. We raised these concerns with the manager who told us this was checked on their daily walk rounds.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. We carried out a tour of the home with the manager and identified some environmental risks. We identified 2 occasions where cleaning product were left accessible; some windows without restrictors and some radiators without covers. On 2 occasions we found thickener [prescribed to thicken fluids] left accessible, posing a risk of choking. The manager removed these items. We also identified a fire escape between the laundry and main kitchen, obstructed by items of laundry and equipment, which posed a fire safety risk. The manager told us they would address this safety concern. We found general maintenance checks of equipment and the building were carried out in line with best practice and guidance.

The provider had systems in place to ensure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. The provider had a tool in place to calculate the number of staff required to meet people’s needs Staff were available in line with this process. Relatives we spoke with told us they did not always feel there were enough staff available. One relative said, “There’s not enough staff in the evening. The evening is a bit hectic.” Another relative said, “We keep saying there’s not enough staff.” There was a staff training record in place, but this showed some gaps in staff training. We spoke with the manager about these statistics and were told the training record required updating to reflect staff who had left the company and new starters. The manager told us some training was planned, and an online training system was available to staff. The provider had a recruitment system which assisted them in the safe recruitment of staff. The provider completed pre-employment checks such as references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

The provider did not always assess or manage the risk of infection. We carried out a tour of the home with the manager and found the home to be predominantly clean. However, we found some areas in need of deep cleaning. For example, the cupboards and work surfaces in the dining room and drinks trolley were unclean and we found a toilet brush and holder which needed to be cleaned. These issues were addressed on the day of our visit by the manager. Staff told us they received training on infection prevention and control, and we saw staff were working in line with good infection control practices. People and relatives, we spoke with told us staff wore personal protective equipment as required. One relative said, “They [staff] wear gloves and aprons for personal care.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People predominantly received their medicines as prescribed. However, 1 person was prescribed medication in the form of a patch, but records showed this was not always rotated in line with recommendations. Protocols were in place for medicines prescribed on an ‘as and when’ required basis, often known as PRN. These protocols were specific in identifying how people may present if they required their medicines. Temperatures were taken of storage facilities where medicines were kept.