Adalah Residential Rest Home Limited

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 inspection 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.

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.

Staff knew how to record accidents and incidents however, the reports often lacked information and detail. Staff told us, “I would document any accident or incident and then relay it to senior staff. The senior staff calls for emergency ambulance if need be and they also inform the family.”

There were systems in place to record incidents and accidents which were reported by staff but these often-lacked information and detail. The registered manager reviewed incidents to identify where actions where needed but some care plans and risk assessments were not always updated accordingly. There was no formal record of lessons learnt following accidents and incidents. The registered manager completed a monthly audit for accidents and incidents but these lacked detail and were not analysed for themes and trends.

A relative told us, “Our [relative] is moving in today and we are happy with the way the home has managed the process. An assessment was carried out and we were given an opportunity to see the home and spend some time here.” While the people we spoke to expressed that they were generally happy with their admission into the service, our assessment found elements of the admission process did not meet the expected standards.

The registered manager told us they had several new admissions and a person's support needs had changed since the completion of the pre assessment. The registered manager told us they were unable to update and amend the pre admission in a timely manner and the care plan was not updated on their electronic system for staff to have accurate and up to date information. A member of staff told us, “We occasionally receive an email telling us the Wi-Fi is down so we do not have access to the system and are unable to upload information.” However, the registered manager told us, "We do not get emails from Log My Care to say that the wi -fi is down. If the internet goes down then the logs will go onto the system when it comes back on, the data will still be recorded. If there is any problems with the system then the Senior or Management will contact the team at Log My Care."

The systems in place for when people move between services were not always robust. We identified pre-admission assessments were not accessible at the time of admission and did not contain important information. No care plan or risk assessments were available for one person admitted who had specific care needs. This meant staff did not have accurate and up to date information to support this person safely with their transition to the service placing them at risk. Systems had not been established to ensure care and treatment was provided in a safe way for service users. This placed people at risk of harm. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were protected from the risk of abuse and said they felt safe living at the service. One person told us, “I feel safe living here.” A relative told us, “not only are they safe in the home but also when they go out on outings.” However, a relative told us, “For my [relative], yes, no issues at all but at some times I think the staff are quite stretched. We noticed a bruise and we’d not had a phone call and no explanation but we didn’t push it.” Another relative told us, “I don’t think [relative] is safe all the time, but its been better recently.”

Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people including informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to”.

During the inspection, we observed staff responded to support people promptly. Staff supported people to move safely using assessed equipment where required.

Safeguarding systems were in place to safeguard people from abuse. The provider had safeguarding policies and procedures in place and had a procedure for ‘whistleblowing’. Records we looked at showed when safeguarding incidents had occurred, the registered manager had reported these to the relevant safeguarding authority for investigation and notified us as is required by law. This meant people were protected from the risk of harm or abuse. The registered manager told us they shared information with staff in meetings to learn from any incidents. All staff had received training in abuse awareness. However, the safeguarding audit completed by the registered manager lacked information and detail. The audit did not include what date the safeguarding referral was sent, outcomes and if investigations had been completed.

Most relatives told us they felt involved in their relatives care. Not all relatives had seen or been involved in writing their care plans. Relatives told us, “I haven’t got anything bad to say. They keep you updated. Quick response to issues, GP called after he showed signs of COVID, a test was negative thankfully. Dad loves it – he had a bad experience at an earlier place.” However another relative told us, “[Relative] has a condition in both eyes. The only way to make it bearable for [relative] is scrupulous hygiene but when I go in to visit it’s clearly not happening and their glasses are always filthy, until I clean them. Two weeks ago I was ready to move her somewhere else.”

Staff had a good understanding of people's risks and how to safely support them. Staff had received training to support people safely. A staff member told us, “We all have mobile app so the care plan for each resident is right there to see, all carers have access and should see them.” Staff told us senior staff were verbally sharing information regarding new people who had recently moved into the service as there was no care plan or risk assessment in place.

Throughout the assessment, we observed people being supported to move using mobility equipment and this was done safely. A person was using a Zimmer frame to enter the dining room and staff supported them and were responsive to any potential risks.

Although there was limited impact for people using the service, not all risks to people's safety and wellbeing were assessed, recorded or provided enough detail as to how identified risks should be managed and mitigated. This placed people at potential risk of not having risks to their safety met in an appropriate and safe way. People's care plans and risk assessments were not always personalised, and support was not always in line with people's care plan guidance. Improvements were required to ensure completed care plans and risk assessments were person centred and included how risks to people were to be mitigated and reduced. Some information was generic and not personalised to the individual people using the service. Systems had not been established to ensure care and treatment was provided in a safe way for service users. This placed people at risk of harm. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People's and relatives' comments relating to staffing levels were variable and implied there were on occasions insufficient staff available to meet people's needs. A relative told us, “No issues at all but at some times I think the staff are quite stretched “. Another relative told us, “We see the manager from time to time but if we need anything, or have any issues, we just talk to the senior carer and things get done. Otherwise, there always seem to be enough people around.” Another relative told us, “There aren’t enough staff around at meal times. Sometimes the residents are expected to wait for up to 40 minutes for their meal to be served, after their meal they’re often left to wait for three quarters of an hour.”

Staff we spoke with told us there were enough staff. However, a member of staff told us, “We have had new residents move in and we have had lots of staff sickness and it makes it very difficult for us when we are running short on staff but we try to pull together to make sure the residents get the best care but is hard with the new admissions and staffing levels if we are running short.” Another staff member told us, “We have recently had an approval for 5 extra residents. Before that I believed we had enough staff and management said as soon as they have more residents and completed rooms they will get more staff. [Manager] makes sure if meant to be 4 carers on ground at particular time she does everything in her power to make sure there’s 4 careers on ground I believe that, we should have more carers now the rooms are occupied they’re awaiting new carers.”

On the day of the assessment, we observed there to be sufficient staff on duty. Throughout the visit, we observed staff were attentive to people’s needs and responded quickly to requests for support.

The registered manager had not always ensured staff were safely recruited. We saw gaps in recruitment files, such as incomplete application forms where forms had not been signed or dated and references received had not been verified or dated. Staff told us they were supported with an induction when they first started working. However, limited information was available on staff files to demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively. The induction on staff files comprised of one day and there was no evidence of shadowing. Staff did not receive regular support in the form of a supervision or appraisal. This meant there were no effective arrangements in place to monitor staffs' practice, performance and professional practice. Suitable arrangements were not in place to ensure all staff employed received appropriate training, a robust induction or regular supervision. This was a breach of Regulation 18 [Staffing] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

Staff confirmed they received infection prevention and control (IPC) training and felt confident to support people with their personal care. However, not all staff had completed their training as per the services training matrix. We were informed by all staff we spoke with that there was sufficient personal protective equipment (PPE).

Staff had personal protection equipment situated throughout the service giving them easy access to wear when needed. The service was clean and tidy with no odours and people commented on how clean they found the service.

The manager carried out regular audits to monitor the cleanliness of the service. However, the audits lacked detail and the information recorded on the audit did not have any dates for actions to be completed and there were no outcomes recorded. Details of who the actions needed to be completed by were also not recorded. A chiropodist was supporting people on the day of our visit in the communal lounge. This meant other people were at the increasing risk of cross contamination and the spread of infections. Pathogens can easily transfer from one person to another through surfaces, air and direct contact.

Staff told us only senior staff administered medication. They received regular training on medicines administration and management. This included an induction period followed by routine competency checks. Senior staff had carried out medication audit’s but these had not been signed off by the registered manager. This meant the registered manager did not have effective oversight of medication management.

The systems and processes in place to safely administer and record medicines use were not always safe. A person's medication care plan did not identify their current medication. We looked at the Medication Administration Records [MAR] for some people and found improvements were required to the service's medication practices. Gaps were identified on a MAR chart and the amount of medication remaining did not reconcile with the amount of medication that should have been taken. There was no rationale recorded for the omission. Guidelines were not in place for staff for a person receiving blood thinning medication. Medication audits did not identify the shortfalls we identified during this assessment. The medication audits were mostly a tick box exercise with limited information recorded.