Aadamson House Care Home

Aadamson House is a residential care home in the Preston area providing personal care to 22 people at the time of the inspection. The service can support up to 32 people. There are two floors with lift access to the first floor.

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

We found medicines were administered safely. A staff member said, “We have good systems with experienced trained staff on medicines.” Risks to people were assessed and managed to ensure correct information was available for staff to deliver support for people. We found procedures for the recruitment of staff to be thorough. Staffing levels were sufficient during the 24-hour period with a mix of care, management and domestic staff. One person said, “They [staff] always come when I ask for assistance quickly.” Maintenance checks were in place and up to date. Staff were seen to wear appropriate personal protective equipment (PPE) as latest guidance stated. Safeguarding training was provided, and staff spoken with confirmed this. Staff were aware of the processes to follow to enable people to be safe.

The registered manager had a training programme to support staff to improve their skills and knowledge. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The registered manager had good systems in place to reduce the risk of malnutrition and monitor people’s food and drink intake. People were complimentary about the quality of meals. One person said, “Cannot grumble with food the cook is fine and you can have a choice, always plenty.”

The provider was clear about their responsibilities to notify CQC of incidents that occurred at Aadamson House. People told us they had confidence in the registered manager and management team who were open and transparent. They sought people's views in various ways. Staff spoke positively of the management team and felt supported in their role.

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 25 March 2022.)

Why we inspected

We received concerns in relation to the management of home, quality assurance systems, the environment and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

We found no evidence during this inspection that people were at risk of harm. Please see the safe, effective and well-led sections of this report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow Up

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

Aadamson House is a residential care home in the Preston area providing personal care to 16 people at the time of the inspection. The service can support up to 19 people. There are two floors with lift access to the first floor.

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

The management of notifications to inform Care Quality Commission (CQC) had improved. The provider was aware of their responsibility to inform CQC of notifiable incidents. People told us they felt safe and protected from the risk of abuse and or neglect. Safeguarding processes were followed.

Improvements had been made since the previous inspection. People were now supported to have maximum choice and control of their lives and staff consistently supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did fully support this practice.

Aadamson House was clean and hygienic. One person said, “The cleaning staff do a great job.”

They had an infection prevention and control policy in place and were following the latest Covid-19 guidance. There were sufficient staff to meet people’s care and support needs. Staff were employed following a robust recruitment process. One staff member said, “I have only just started, the induction was very good, with shadow shifts. Training included, safeguarding, ‘food & hygiene’ and moving and handling, all done before I commenced my first shift.”

People’s safety was at the centre of care delivery. Risks were assessed and carefully monitored to ensure individuals safety. People received their medicines safely.

There was a programme of staff training and regular updates were documented for staff to attend courses. This was confirmed talking with staff. People’s care records contained social hobbies and likes and dislikes in food choices. During the Covid-19 pandemic people had been supported to maintain contact with their friends and relatives by use of IT devices, window visits and phone calls. People told us they were satisfied with the efforts made by staff to keep them connected with family and friends. People received support with their healthcare and nutritional needs. Comments from people were positive about the quality and choice of meals provided and included, “You can have what you like they never refuse any food or snacks.” And, “The food is lovely.”

The management team had auditing systems to maintain ongoing oversight of the service and make improvements where necessary. Quality assurance processes ensured people were able to give their views of the service. One person told us, “The staff and manager involve us in any ideas to improve the home. I just completed a survey giving my opinions.”

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 19 April 2021).

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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider ensure any incidents that required CQC should be notified were completed. At this inspection we found improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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

We found no evidence during this inspection that people were at risk of harm. Please see the safe, effective and well led sections of this full report.

Follow Up

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.

Aadamson House is a residential care home providing personal care to 9 people at the time of the inspection. The service can support up to 19 people.

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

People were not consistently supported to have maximum choice and control of their lives and staff did not consistently evidence that they supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not fully support this practice.

The management of accidents and incidents had improved. However, the provider failed to notify us when people had sustained an injury. People told us they felt safe and protected from the risk of abuse and or neglect. Safeguarding processes were followed.

Medicines management processes had significantly improved. Staff received training in the safe administration of medicines and checked for competency. Staff recruitment processes were safe. Staff consistently told us they did not always understand their role and responsibilities and felt at night time staffing levels were insufficient. The provider assured us they would gain feedback from staff and support them to be clear about their role and responsibilities.

People were protected from the risk of transmission of Covid-19 and other infectious diseases. The environment was clean and well maintained.

Staff told us they were supported by the interim managers. Staff received training in subjects to help keep people safe for example; moving and handling, medicines management, safeguarding and fire awareness. Staff were supported and observed by senior managers to ensure their practices when supporting people at the service were in line with best practice standards and person-centred.

Record keeping in relation to people’s needs and preferences had significantly improved. Risk assessments were accurately completed and support plans guided staff to support people in a person-centred and safe way. Since the last inspection there had been improvements around liaison with external health care professionals and keeping professionals and relatives involved in people’s care and treatment informed of changes in their health and wellbeing.

People told us staff supported them in a kind, dignified and respectful way. We saw staff engaged with people in a person-centred way and had built trusting relationships. People were encouraged to maintain their independence. People’s care plans showed planned goals and aspirations. During the Covid-19 pandemic people had been supported to maintain contact with their friends and relatives by use of IT devices, window visits and phone calls. People and their representatives told us they were satisfied with the efforts made by staff to keep them connected.

There had been a significant improvement in governance and quality assurance systems. After the last inspection the provider engaged a consultancy team to take over the interim management of the service. We found the provider had listened and taken direction from the consultants and this had allowed improvements which now need to be sustained. We received very positive feedback about the interim manager from people, relatives and external professionals.

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 inadequate (published 18 November 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 we found improvements had been made however, the provider was still in breach of regulations.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 breaches in relation to consent to care and treatment and failure to notify us of serious incidents at this inspection.

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

Aadamson House is a residential care home providing personal care to 13 people at the time of the inspection. The service can support up to 19 people.

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

People were not always protected from avoidable harm. The provider failed to ensure people’s care and treatment was adequately assessed and planned in line with their needs and preferences. For example, risks associated with choking, mobility, bedrails, falls and nutrition.

The provider failed to ensure people were consistently protected from transmission of infectious disease including Covid-19.

People’s medicines were not always managed in a safe and effective way. The provider failed to ensure robust systems were in place for the storage, administration and recording of people’s medicines. This placed them at risk of avoidable harm.

Accidents and incidents were not always adequately investigated, and the provider failed to ensure lessons were learnt. Duty of candour processes were not consistently followed, and this meant people’s representatives were not always updated when they were involved in an accident or incident.

Staffing levels were not always sufficient to keep people safe. At the start of the inspection the provider failed to ensure enough staff were deployed at night time to enable timely support for people. Five people needed two members of staff to support them to move and reposition at night time, only one member of staff was deployed. The provider took action when we told them people were not safe at night time and increased staffing levels.

Staff recruitment processes were not always safe. The provider failed to ensure staff were checked for good character before they were employed to work with vulnerable adults. Safeguarding processes were not always followed and we found incidents had not been reported to the Local Safeguarding Authority.

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; the policies and systems in the service did not support this practice.

There was a lack of information for staff to follow in relation to best practice standards in care homes and the guidance available throughout policies and procedures was outdated. People were not assessed in an effective way to ensure they reached their goals and abilities.

Staff had not received sufficient training and support to enable them to carry out their roles and responsibilities.

There was a lack of quality assurance processes, the provider and registered manager failed to identify the shortfalls as outlined in this report. During the inspection the provider employed an interim manager and the registered manager resigned. The provider acknowledged they had failed to understand requirements providers need to meet and told us they were committed to ensure improvements were made.

People and their representatives told us they were satisfied with the food and drinks provided. We observed people choose their preferred food and drinks. People told us they were supported in a kind and dignified way and had built trusting relationships with staff and managers. During Covid-19 people were supported to keep in touch with their close friends and relatives. We observed visitors engage with people using window visiting procedures and staff facilitated them to feel comfortable and welcome.

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

Rating at last inspection

This service was registered with us on 05/07/2019 and this is the first inspection.

Why we inspected

We received concerns in relation to the management of Covid-19 and staffing levels. We reviewed the information we held about the service and decided to undertake a focused inspection. Because of areas of concern were identified in the other key questions we widened the scope of the inspection to include all key questions. This also meant we could rate the service for the first time.

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 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 breaches in relation to safe care and treatment, governance, staffing, staff training, person-centred care and consent to care and treatment at this inspection.

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 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.