Adelaide House Nursing Home

Adelaide House is a care home with nursing that is registered to provide personal and nursing care and accommodation. At the time of the inspection 32 people aged 65 and over were living at the service. The service can support up to 40 people. People living at the home had physical health conditions related to old age and frailty such as diabetes and sensory impairment. The property is an adapted building with accommodation on three floors, offices on the fourth floor and a lift connecting each floor.

The service had two beds that were purchased by the local authority for reablement called Discharge to Assess (D2A). This programme provides people with care and rehabilitation support for up to six-weeks following discharge from hospital. The aim is to enable people to regain skills and confidence, so they can return home with a package of care.

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

People told us they felt cared for and we observed friendly interactions between people and staff. A relative told us, “I can’t fault the staff, they are kind, caring and attentive, I visit often and see that people get plenty of attention, we can visit whenever we want and are always made to feel welcome. Mum couldn’t be in a better place.” People were supported to maintain relationships that were important to them.

At the last inspection we reported that maintaining people’s dignity was an area of improvement. At this inspection, we found that improvements had been made. People were treated with respect. People’s privacy was upheld, and their dignity was maintained. A visiting physiotherapist told us, “Staff are very aware of the importance of privacy, staff bring in privacy screens if a person receives support from me in communal areas.”

People had a range of activities available that met their needs and reflected their interests. People showed us art they had made and vegetables they had grown together in the garden. People spent time how they wished, we observed people reading a book, chatting with each other or doing a crossword puzzle.

Care plans guided staff about people’s needs and how to meet them. Relatives told us that staff had supported their relative to achieve good outcomes in communication, nursing needs and emotional wellbeing.

Staff, people and relatives told us they were given opportunities to give their views on the service such as through questionnaires and resident and relative meetings. People and relatives knew how to make a complaint and felt confident that their feedback was listened to and acted upon. A person told us, “ is great, he is always here. You can talk to him and he listens.”

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.

There were sufficient staff to meet people’s needs, to give the support they needed and to spend quality time with them. Staff told us they felt valued and took pride in the care and support they provided.

People’s medicines were managed safely. A pharmacist told us, “The staff are extremely efficient, courteous and helpful...their record keeping has always seemed excellent and the staff are well informed about the patients, their needs and medications.”

Before they came to live at the home, people’s needs were fully assessed to ensure that staff could meet their needs appropriately. People had access to a range of healthcare professionals and services.

Staff knew what action to take if they had any concerns about people’s safety or welfare. People’s risks were identified and assessed appropriately. No-one living at the home required end of life care at the time of the inspection, but people’s wishes, and preferences were recorded.

People were supported by staff whose suitability was checked through a robust recruitment process. Staff completed relevant training and were experienced in their roles to provide effective care to people. Staff told us they felt well supported, received regular supervisions and an annual appraisal.

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 Good (published on 12 August 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection there were 34 people living at the home and 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.

People told us that staff were caring, kind and attentive to their needs. One person said, “The staff are so nice, it’s a lovely happy atmosphere here.” We saw many examples of positive interactions between staff and the people they were caring for however, we did find some areas of practice that needed to improve. People’s privacy and dignity was not always respected. People were not always given their medicines in a discreet way to protect their privacy. Every person was receiving their drinks in a plastic beaker, one person said, “I have to use a baby’s cup now.” We have identified these as areas of practice that need to improve to protect people’s privacy and dignity.

In other areas of practice we noted that staff did respect people’s privacy and dignity. Confidential information was kept securely and people told us that staff were respectful. One person said, “They treat me nicely and make sure the door is closed before helping me to be undressed.” Staff spoke warmly about the people they cared for and demonstrated that they knew them well. People told us that they were involved in making decisions about their care and that they felt their views were listened to.

People told us they felt safe living at Adelaide House and that there were enough suitable staff to meet their needs. One person said, “There’s always plenty of staff around,” another said, “The staff make me feel secure here.” People’s medicines were managed safely and they received their medicines when they needed to. Staff had a good understanding of their responsibilities with regard to keeping people safe. Risks to people were assessed and managed and any safeguarding issues were reported in line with the provider’s policy.

People and their relatives had confidence in the staff. They told us that staff had the skills and knowledge they needed to be effective in their roles. A relative said, “The manager choses staff extremely carefully, even new staff know what they have to be doing.” Staff told us they felt supported in their roles and they had opportunities for training. A number of staff had received additional training in subjects relevant to the needs of people they were caring for, including dementia care and diabetes.

Staff were able to tell us about the importance of the Mental Capacity Act 2005 and its relevance to their role. One staff member said, “We have to assume people have capacity to make decisions, but if they lack capacity we have to make a decision on their behalf.” People’s consent to care and treatment was sought and documentation was thorough and demonstrated compliance with the MCA and DoLS.

People told us they were happy with the food at Adelaide House and that they had plenty to eat. People were offered drink and snacks throughout the day and there was a clear emphasis on ensuring that people’s nutritional and hydration needs were met. People were supported to access health care services and received ongoing health care support. A visiting health care professional spoke highly of the care provided saying, “The staff recognise when someone has deteriorated, they know what signs to look out for and call us quickly when they are worried.”

Care and support records were well personalised and detailed. Information included people’s preferences, their interests and past history and gave a clear sense of the person. Staff told us that they found this information useful when providing person centred care. People were supported to follow their interests. For example, one person told us that they liked birds and the staff had put a bird table outside their bedroom window. People were encouraged to take part in meaningful activities and there was a dedicated activities co-ordinator who arranged a programme of events and activities according to people’s preferences. People who were living with dementia were supported with a variety of occupations. For example, one person who had been used to doing intricate work was seen to be engaged in slotting coloured counters into a frame. Staff had recognised the importance for this person of a dexterous activity. People told us they had enough to do, one person said, “There’s plenty to do here, there’s no reason for anyone to be bored.”

People and relatives told us that they rarely raised complaints, but would feel comfortable to do so. One person said, “I always speak my mind and say what I feel about things.” People, visitors and staff spoke highly of the registered manager and said that the home was well- led. Their comments included, “The management is very good,” and “We are more than happy with it here, it’s very well run.” Staff were well motivated and spoke positively about team work, one staff member said, “I love working here, I am proud to be part of the team.” They spoke about an open culture where they were able to make suggestions and admit mistakes. The registered manager provided strong leadership and the vision and values of the home were understood by the staff and embedded within their practice. People, relatives, staff and visiting professionals that we spoke with described a “homely atmosphere” and people told us they were happy living at Adelaide House.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. The home could accommodate 40 people and, when we visited, there were 32 people living in the home.

We spoke with five people living in the home and with four of their relatives. We looked in detail at five care plans. At the time of our inspection the manager was on holiday and so we spoke with the deputy manager, who was in charge, a nurse and a carer. We also spoke with the cook, the activities coordinator, a GP and a Physiotherapist who were visiting.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The manager conducted pre-assessments to ensure the right level of care was available and staff were guided in their work by detailed care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff were trained and competent to deliver a safe level of care. This meant people were receiving a safe service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found staff had received appropriate training and regular supervision to ensure that their skills were up-to-date and appropriate to the needs of the people living at the home. This included regular updates in areas such as manual handling, first aid and fire safety. There was additional training in areas such as end of life care and leadership skills.

Staff were using effective practices, for example, to prevent falls. We also found care staff sought advice, where appropriate, from the qualified nursing staff at the home, the manager and from other external health care professionals. The home was providing an effective service.

Is the service caring?

We observed the interaction between care staff and people using the service and found care was delivered with compassion and consideration. One person who lived in the home said, "The staff are fabulous and care for me very well".

One relative we spoke with said, 'The staff are attentive and caring. We always find that there is somebody to sit with him.'

Is the service responsive?

We saw that staff responded promptly to call bells and helped people with eating, drinking and moving about the home. We found evidence in the care plans that staff contacted appropriate healthcare professionals when required and informed relatives of any changes in health or welfare.

The provider invited and listened to feedback and made changes where they were reasonably practical. Recent changes included the addition of a ramp leading to the garden from the home. People we spoke with said they enjoyed the food and drink and we saw that the food they received suited their individual needs. The provider was responsive to the needs of people living in the home.

Is the service well-led?

The home was well managed with a qualified team of professional care and nursing staff. The staff we spoke with said that they felt guided and supported in their work.

The provider conducted regular internal audits of the service and the care plans.There was also an annual survey to take feedback and suggestions from people who lived in the home, their relatives and other healthcare professionals. Feedback from the relatives we spoke with was positive and the people living in the home told us they were happy with the care and treatment.

During the inspection we spoke with six people who used the service, five care staff, the manager and three visiting professionals. People told us they liked living there. Comments included "Very caring", "Staff always come if I press the call bell" and "I like it here. Staff talk to you and we have a laugh". Visiting professionals said "The home is brilliant, fantastic", "Staff are kind and thoughtful" and "Management are open and honest".

We found that people were encouraged to make decisions for themselves. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. However, there were not always copies of the relevant paperwork in people's care records.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were kept up to date and nursing support was provided as described in care plans.

We observed that all parts of the home were kept clean. There were systems in place to make sure that hygiene and infection control was maintained to an appropriate standard.

Care staff got the support they needed to carry out their roles effectively. Training was kept up to date and staff had regular supervision meetings with a manager.

People were involved in decisions about their care. One person told us 'We discussed the help required and likes and dislikes.' A relative said that they 'have copies of the care plan at home. From time to time I ask questions and they answer them.'

The care needs of people were assessed and individual care plans were made that met their needs and minimised risks. People who used the service were happy and said they received the help they needed. One said they were 'very happy'content ' very much so.' A relative said 'the atmosphere is right.' The care staff understood how to provide dignified care and people told us they were treated with respect.

People's health was monitored and actions taken to maintain well-being. A GP said the staff were 'very good when residents are not quite right.'

The provider had not maintained the appropriate standards of cleanliness of some equipment. This presented a risk of infection.

The provider had undertaken all appropriate checks before staff began work. They ensured nurses maintained current registration.

The provider used a variety of methods to seek the views of people who used the service and other stakeholders. These were used to inform developments in the home. There were adequate checks and processes in place to ensure that the home remained safe.