Adelaide House Residential Care Home

Adelaide House Residential Care Home is a residential home providing personal care for up to 23 people in one adapted building. Some people who live at Adelaide House have dementia or a cognitive impairment. At the time of our inspection there were 18 people using the service.

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

Risks to people’s health and safety were assessed and improvements had been made to risk management plans. However, some care plans contained incorrect information. We found improvements had been made to medicines practice and record keeping. However, further improvements were needed to ensure these were administered as prescribed and stored safely. The registered manager took action in response to safeguarding concerns and updated people’s care plans as necessary.

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. However, some people assessed as lacking capacity to make decisions about their care and treatment had also signed their consent to certain aspects of their care and treatment, rather than being signed in their best interests, by a person legally authorised to do so.

Audits of care practice and systems to monitor the safety of the premises and environment were in place. However, further improvements were needed to ensure these provided robust oversight and scrutiny of care practice standards. There continued to be no formal system to gather the views of people and relatives regarding their experiences of care and whether they had suggestions for improvements. However, we continued to receive positive feedback from relatives regarding Adelaide House and that management were visible and approachable.

Staff were trained in safeguarding and understood their responsibilities to report potential safeguarding concerns. There were enough staff to ensure people’s needs were met safely and in a timely way. Feedback from people and staff confirmed this. We were assured by the provider’s infection, prevention and control practices. Visiting to the care home aligned with government guidance.

New staff received an induction and completed the Care Certificate. The registered manager worked with trusted assessors and social workers to ensure any admissions from hospital or the community could be supported safely. Staff understood people’s individual dietary needs and prompted people to eat and drink more, when needed. People were able to access health professionals and medical treatment when needed. The provider adapted the design and decoration of the building to meet people’s mobility and social needs.

Important events and incidents were notified to CQC, and the latest CQC rating was displayed in the home as per regulatory requirements. The provider worked with external health and social care professionals to ensure people had access to services they needed, in response to changes in their health and to improve their health outcomes.

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 August 2021) and there were two breaches of regulations. 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 found the provider remained in breach of regulations.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

Why we inspected

We carried out an unannounced focused inspection on 6 July 2021. Breaches of legal requirements were found. The provider was issued with a Warning Notice and completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, that they had followed their action plan and to confirm they now met legal requirements. The overall rating for the service has not changed and remains requires improvement. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Adelaide House Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Adelaide House Residential Care Home is a residential home providing accommodation and personal care for up to 23 people, some of whom are living with dementia or a cognitive impairment. The service was providing support to 18 people at the time of our inspection visit.

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

The provider’s audits were either not effective or had not been carried out which meant shortfalls in service provision had not been identified. This included shortfalls in fire risk management, health and safety and medicines management.

Improvements were needed to maintain oversight of staff training and practice and to provide staff with formal opportunities to discuss their role and responsibilities.

The provider had failed to demonstrate learning had been taken from previous inspection visits to improve risk management and governance processes. There was no effective system to audit adverse incidents that occurred in the home.

There were enough staff on duty to meet people’s needs. Staff understood their responsibility to keep people safe and report any concerns to managers.

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.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. Staff understood people’s nutritional risks and knew those people with nutritional risks who needed to be encouraged to eat and drink more.

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 June 2019) and there were two breaches of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

At our last inspection of this service breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance in the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led.

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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Adelaide House Residential Care Home on our website at www.cqc.org.uk.

Enforcement

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.

We have identified two breaches of the regulations in relation to the safety of people's care and the management of the service.

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 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.

People's experience of using this service:

We last inspected Adelaide House in April 2018 when we rated the service as 'Requires Improvement’ in all key questions, together with breaches of the regulations. At this inspection we found improvements had been made in the key questions of ‘Caring’ and ‘Responsive’ which are now rated as ‘Good’. The key questions of ‘Safe’, ‘Effective’ and ‘Well-led’ remain ‘Requires Improvement’ and there are continuing breaches of the regulations.

There was a lack of clarity around the role and responsibilities of the management team. Quality assurance systems were not always effective and there were limited formal systems in place to audit the safety of the service.

Staff understood how to support people to keep them safe, but the provider and registered manager continued to demonstrate a lack of understanding of their safeguarding responsibilities. Environmental risks were not always identified and there was no effective system to audit adverse incidents that occurred in the home.

At the time of our inspection visit there were enough staff on duty to keep people safe, but staffing levels were not always maintained, especially at weekends. Staff had been given some training opportunities, but further improvements were required to ensure staff received support to maintain and develop their skills and knowledge.

People had access to the healthcare they required and were supported to access healthcare services. Medicines were given as prescribed, but improvements were required in the records to support safe medicines management. People’s nutritional needs were met in line with their preferences.

People told us they felt well cared for and staff demonstrated warmth and kindness in their interactions with people. People made decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

Systems were in place to manage and respond to any complaints or concerns raised.

This is the second consecutive time the home has been rated as Requires Improvement.

The registered provider was in breach of Regulations 12, 13 and 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Rating at last inspection: At the last inspection the service was rated as requires improvement. (The last report was published on 25 May 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service continues to be rated as 'Requires Improvement' overall.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

Adelaide House is a care home registered to provide personal care and accommodation for a maximum of 23 older people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in a residential part of Leamington Spa and the accommodation is set out over four floors. There were 19 people living at the home at the time of our visit, some of who were living with dementia.

We last inspected Adelaide House in November 2016 when we rated the service as ‘Good’ overall. However, at that inspection we found some improvements were required in the leadership of the service. At this inspection we found improvements had not been made and a lack of proactive management and leadership had affected the quality of the service. Checks and audits were not effective which impacted on the safety, effectiveness and responsiveness of the care people received.

The service had a registered manager. This is a requirement of the provider's registration. 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 was also one of the providers and had acknowledged improvements were needed to ensure people received consistently high quality care. A new manager had been appointed, who was to apply to be registered with us and take over the management of the service.

There were enough staff to meet people’s needs and people told us they felt safe with the staff who supported them. However, the provider’s investigations into safeguarding incidents were not robust enough to ensure people were protected from the risks of harm. Where people had been involved in incidents or accidents, these had not been reviewed to identify patterns or trends across the service, or for individuals. People were not always protected from environmental risks or individual risks to their wellbeing.

People were supported to eat and drink enough to maintain their health and when a need was identified, they were referred to other healthcare professionals. However, medicines were not consistently managed and administered safely.

People’s mental capacity to consent to their care had not been assessed effectively and there was conflicting information in people’s care records about what decisions they could make. Some staff practices meant people were not given maximum choice and control over how they lived their lives. The physical environment was not supportive of people living with dementia because it did not enable them to move around the home independently.

Staff tried to work in a person centred way and shared information about changes in people’s needs. People demonstrated a high satisfaction with the caring nature and understanding attitude of staff, and we saw friendly and caring interactions between staff and the people they care for. However, staff lacked support and training to ensure they had the skills and knowledge to carry out their role effectively.

People felt able to share any concerns, but the process for obtaining people’s views needed to be improved so people were empowered to provide feedback and share their experiences to ensure the service met their preferred wishes. The new manager was open and transparent about the challenges and improvements required to ensure people received person centred care that met their individual needs and preferences.

You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected on 18 December 2015. At that inspection we found a breach in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. The breach was in relation to good governance. The provider did not have effective systems and processes in place to monitor the quality and safety of the service provided.

We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. The provider sent us an action plan which detailed the actions they were taking to improve the service. The provider told us these actions would be completed by October 2016.

At this inspection on 13 December 2016 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken and there was no longer a breach in Regulations of the Health and Social Care Act 2008. However, further improvement was needed.

The service had a registered manager who had been in post since 2015. This is a requirement of the provider’s registration. 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 provider had developed systems to gather feedback from people, relatives and others so they could use the information to improve the quality of the service provided. Audits to monitor the safety of the service were being regularly completed. However, some audits were limited in detail and required further improvement.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed, but guidelines in place for people prescribed ‘as required’ medicines were not always clear. Action was taken to address this.

There were enough staff to meet people’s needs. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. However, some risks relating to staff recruitment had not been clearly documented. Staff told us they were not able to work until these checks had been completed.

The registered manager understood their responsibility to comply with the relevant requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care workers gained people’s consent before they provided personal care and knew how to support people to make decisions.

People told us they felt safe living at Adelaide House and staff understood how to protect people from abuse. Risks related to the delivery of care and support for people who lived at the home had been identified and staff understood how these should be managed. Some individual risks had not been documented. The registered manager took action to address this.

Staff respected and promoted people’s privacy and dignity. People were encouraged to maintain their independence, where possible. People told us care workers were caring and understood how people wanted their care and support to be provided.

People who lived at the home were supported to maintain links with friends and family who could visit the home at any time. Some people were supported to follow activities and hobbies which they found enjoyable and interesting.

Staff completed training considered essential to meet people’s needs safely and effectively. Refresher training for some staff was out of date. However, training had been planned. Care workers completed an induction when they joined the service and had their practice regularly checked by a member of the management team. Staff felt well supported by the management team.

People were encouraged to eat a varied diet that took account of their preferences and received the support needed to maintain their health and wellbeing. People had access to a range of health care professionals when they needed.

People and relatives were involved in planning and reviewing their care, were appropriate. New style care plans contained relevant information for care workers to help them provide the care and support people required.

Everyone we spoke with told us the registered manager was available, supportive and approachable. People knew how to make a complaint if they needed to and complaints were managed in line with the provider’s procedure.

Adelaide House is a care home registered to provide personal care and accommodation for a maximum of 23 older people. The home is located in Leamington Spa in Warwickshire. There were 18 people living at home at the time of our visit. 12 people at the home were living with dementia.

The service had a registered manager. This is a requirement of the provider’s registration. 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. We refer to the registered manager as the manager in the body of this report.

The provider had not established effective procedures to check and monitor the quality and safety of the service people received, and to identify where areas needed to be improved. This meant that a number of shortfalls in relation to the service people received had not been addressed.

Risks associated with the delivery of care and support for people who lived at the home had been assessed. However, risk management plans and risk assessments had not always been up dated when people’s care or support needs changed and were not always followed by staff.

People’s care records were not always reflective of their care and support needs therefore did not provide staff with up to date information about how people should be cared for and supported. However, overall staff a good understanding of the needs and preferences of the people they supported. People and their relatives thought staff were caring and responsive to people’s needs.

People were not always supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, the manager worked alongside people at the home, and gathered verbal feedback from people during their day to day activities.

There were processes in place to ensure medicine was securely stored. However, medicine was not always stored at the correct temperature and the timing of medicine administration required improvement. People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing.

There were enough staff at Adelaide House to support people with care tasks. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence. People were given privacy when they needed it.

People and their relatives told us they felt safe living at the home and staff treated them well. Staff knew how to safeguard people from abuse, and were clear about their responsibilities to report concerns to the manager.

The provider had effective recruitment procedures that helped protect people, because staff were recruited that were of good character to work with people in the home. Staff had completed an induction. Some staff training was not up to date. However, the manager had identified this and was scheduling training.

People were supported in line with the principles of the Mental Capacity Act 2005 (MCA). People were able to make some everyday decisions themselves, which helped them to maintain their independence.

People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time. However, people were not always supported to take part in interests and hobbies that met their individual needs and wishes.

People, relatives and staff felt the manager was approachable. People and relative’s told us they knew how to make a complaint if they needed to. However, no-one had made a compliant regarding the home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.