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. We identified breaches of legal regulations. Whilst the manager and staff showed some understanding of safeguarding, incidents were not always shared appropriately. Although staff knew how to report accidents and incidents, we found paperwork to support learning following incidents was not in place. Handovers took place at the beginning of each shift and were detailed, people had hospital passports in place should they need to go to hospital, however the information detailed on these was not always accurate. People said they 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. However, risks were not always being appropriately managed. The environment was not managed safely. The provider failed to monitor and address concerns around fire safety, health and safety of the premises. The home was clean and tidy, though the environment required some aspects of maintenance to be completed. Recruitment procedures were not robust enough to ensure staff were suitable to work with vulnerable people. Appropriate numbers of staff were in place to support people. Staff said they felt supported and had access to an induction, training and regular supervisions were taking place. Medicines were not managed safely. We identified a number of issues with the management of medicines, including safe administration, recording and auditing systems and policies and procedures were not being followed.

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.

We asked people’s relatives if they felt there was a positive learning culture and they told us “Yes”. While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards as lessons were not being learned following incidents.

Staff were knowledgeable about how to report accidents and incidents. One staff member said, “I would report it (an accident or incident) to the manager and document everything.” The registered manager told us they completed lessons learned after incidents. Although staff were able to describe the correct processes we found these were not being followed.

Although we were told that lessons learned were taking place following incidents, no paperwork could be provided to support this process. The registered manager told us they would implement lessons learned documentation without delay. Regular feedback was sought from people, and this was mostly positive. There had been no analysis of the negative feedback but this was explained to us during the inspection.

Most relatives felt the staff team worked well together to ensure their relative received the care and support they needed, but one relative did wish they were kept more up to date.

Staff spoke about how they get to know new admissions; one staff member told us “We have pen profiles and pre assessments.”

Professionals told us how Adam House worked with people and their partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. Comments included; “Staff support [person] with any health care visits and such. They have managed to get her to appointments that she has never attended before” and “Adam House staff have recognised the value of working in collaboration with other services to gain support around maintaining a good standard of safe systems of care.”

Hospital passports were in place for people, though these did not always detail the necessary accurate information. During our inspection the registered manager told us they had made necessary improvements to this paperwork. Staff completed handover at the beginning of every shift with the staff leaving shift, handover sheets were in place to document this, and each person had their own section of the handover which was discussed.

People said they felt safe and made comments such as, “I feel safe.” People’s relatives felt their loved ones were safe at Adam House, though we did receive some mixed feedback around this subject and one relative told us that “(I think the staff) sort of (care and are kind), but I think they look after themselves first.” People’s relatives knew who to speak to if they had any concerns regarding the safety of their loved one.

Staff told us they had access to safeguarding policies and had completed safeguarding training. They gave examples of things they may report as a safeguarding, one staff member told us, “I would report any sort of abuse and anything that is not safe.” Staff were knowledgeable about mental capacity and were able to talk to us confidently about this. However, we found staff were not applying this knowledge.

During our inspection we witnessed interactions between staff and people. People seemed calm, staff appeared kind and considered and people seemed settled. On arrival, guests (including inspectors) were allowed access through keypad coded and locked doors, we were asked for our ID and were asked to sign into the home to make sure the home had a record of any visitors, which helped keep people safe. Although we observed no issues during our inspection regarding safeguarding, on observing records, we did find examples where appropriate safeguarding practices had not been followed.

Processes to make sure people were protected from abuse and neglect were not robust. Not all necessary safeguarding alerts had been raised. This meant people were not always being safeguarded from abuse or neglect. The registered manager was not acting in line with their safeguarding policies. People’s capacity had been assessed and necessary Deprivation of Liberty Safeguards (DoLS) applications were in place to deprive people of their liberty, though one person’s DoLS had expired before reapplying, which caused a delay in re authorisation, meaning that they did not have an authorised DOLS in place.

People’s relatives felt that people were involved in managing risks and that the service managed risks well. People told us they were able to do what they want and were able to make choices. While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards.

Staff spoke about how they manage risks and how they try to de-escalate situations when needed. Staff told us how they support people with their healthcare needs and their diet in relation to risk. The manager recognised that risk assessments and record keeping were not always accurate and this meant people’s risk were not always appropriately mitigated.

During our walk around we found examples where risk was not always safely managed, for example, one person (who was at risk of ligaturing) had multiple items in their bedroom that could be used to cause harm.

Whilst risk assessments were mostly in place and there was some evidence that people were involved in these risk assessments, they sometimes lacked detail. For example, one person had epilepsy, and this was not covered in appropriate detail, whilst another person’s ligature risk information was conflicting. This meant staff may not always be aware of how to manage risk appropriately. During our inspection the management worked to improve these records. Restrictive practices were used, though we found an example where using restraint caused further injury. Paperwork relating to lessons learned following restraint was not in place.

No concerns were raised by people or relatives around the safety of premises. People’s relatives felt their loved one was in a safe environment, one relative said “(they are) Probably (safe) in the house yes, in things like the kitchen they seem to be aware of risks.” However, we saw people’s environments were not always safe for them. While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards.

Staff told us they did not have any concerns about the environment or the safety of the people living at the home. Most staff told us they attended fire drills, though one night staff member told us they had not attended a drill. Staff said they had completed fire safety training. Staff and leaders had not identified or mitigated the risks we saw in the environment.

People were at risk of environmental hazards. The environment was not always safe, we found examples where radiators that were very hot to the touch did not have covers on. During our inspection the management were working to implement improvements. The environment required various aspects of maintenance, for example various fire doors were not safe or effective and the ceiling in the cellar did not promote safe compartmentalisation in the event of fire. These issues had been flagged during previous fire risk assessments, but during our inspection we found this to be a recurring issue. A fire extinguisher was required on a communal landing and this was not in place. Various walls required attention due to damage. During our inspection the management were working to implement improvements. We found window restrictors were in place and wardrobes were secured to the wall. At our last inspection we made a recommendation about managing risks to people's wellbeing and safety, and although they were different environmental risks identified to this inspection, we found there we still some concerns around environmental risk management.

People were not cared for in a safe environment. Weekly maintenance checks were not regularly being completed. Fridge and freezer temperatures were out of range some days, and this had not been reported. A food hygiene chart was not consistently being completed. The stated aims of the fire safety policy and the fire risk assessment did not align. The environmental risks to people had not been mitigated. A legionella risk assessment was required to be completed by a competent person and this had not been done. A staff meeting from April 2024 echoed our concerns about the maintenance of the environment.

People’s relatives felt for the most part that staff supported their loved one safely. People felt there was enough staff, one person told us, “The staff are all brilliant.” While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards.

Staff told us they completed an induction when they started and that they felt they had the appropriate training for their role. Staff told us they received their rotas in advance, and they felt the home had enough staff. One staff member said, “The staffing levels are ok.” Staff told us they received regular supervisions, one staff member said, “Yes, I have had them (supervisions) regularly.”

Staffing was in place that was in line with the rotas provided, and there was enough staff in place to meet people’s needs during our inspection. Although we observed no issues during our inspection regarding staff numbers, on observing records, we did find examples where appropriate recruitment practices had not been followed.

Safe recruitment practices had not been followed. Various staff did not have Disclosure and Barring Service (DBS) checks in place, which provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. One person had gaps in employment that had not been addressed. The manager was appointed as a cleaner and there was no interview or application form on file in relation to their promotion to manager. During our inspection the registered manager told us they were now implementing the necessary paperwork and checks to support safer recruitment. Staff received regular supervisions, though we found the managers supervisions were regularly being completed by their relative. There appeared to be an appropriate number of staffing in place during our inspection and staff told us they received rotas ahead of time. Staff training was up to date, though the manager had no management experience or qualifications, though they were looking to enrol on a management course. A variety of training courses were available for staff to complete, and staff were largely compliant with this. This included training in areas such as learning disabilities.

People’s relatives felt the home was clean. One person told us, “I clean my own room, I dust and hoover.”

Staff were able to tell us how they try to minimise the spread of infection through appropriate use of PPE. One staff member said, “We use PPE and wash hands regularly. We sanitise areas regularly.”

The home was clean, had no foul smells and there was a dedicated area for laundry. Appropriate PPE was in place.

The safer food better business file was not always being completed, but bathrooms had cleaning records in which were signed and up to date.

Relatives felt their loved ones received medication when they needed it and were aware of the type of medication their loved one received. While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards.

Staff told us they had their medicines competency checked and spoke about how they would document if medication was refused. The registered manager told us, “We do staff competencies, only with people who do medicines, they are not pre-arranged they are ad hoc so that staff are not expecting it.” However, as staff were not following processes properly these competencies were not effective and staff understanding was not embedded.

Medicines were not always managed safely. Records relating to the application of one person’s cream was not clear or concise. There were some missing gaps in some medicines administration records, meaning some medication was not given in line with prescriber’s instructions. Record relating to ‘as and when required’ mediation was not as detailed as it should have been, meaning staff may not always know what to look out for when administering this medication. During our inspection the registered manager told us they had improved the guidance relating to this. The homes medication policies were not always being followed. We observed a medicine round taking place, during which we witnessed one medication not being given in line with the prescriber’s instructions. Medicines audits were not robust and were not identifying the concerns we found during our inspection.