Adonai Healthcare Services Also known as Adonai Services 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

At our last inspection, we were concerned that people may not receive safe care as there was a lack of information in people’s care plans around their health needs and risks associated with those. At this inspection, we found improvements in this area, however the registered manager did not always update people’s care plans to ensure that staff had the most up to date information. People felt safe in the presence of staff. Staff and the manager had received training in how to recognise and respond to allegations of abuse. Some people were supported by staff with their medicines and they told us they received the medicines they were prescribed. People were cared for by a sufficient number of staff who, in the main, arrived on time, stayed the time allotted and were not rushed during their care call. Staff followed good infection control practices and met people’s requirements in the personal protective equipment they wore. Where accidents and incidents occurred, these were recorded, investigated and lessons were learnt from them.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Where incidents occurred people and relative’s raised these and these were responded to. A relative told us, “Someone tracked oil or grease on the carpet. We brought it up and now all the staff wear shoe covers.” A second relative said, “There was an incident right at the beginning and they (management) were right on it.”

The registered manager was able to demonstrate they took accidents, incidents and learning from them seriously. They told us, “Staff will always call the office when something happens and then they complete an electronic incident form which management are instantly alerted to. We will review the incident and then take any follow-up action needed. Any lessons learned from these are shared with staff and there is a standing item on the staff meeting agenda to discuss learning. A staff member told us, “It is shared (learning), we have training on it.” A second said, “We have a policy. We have to fill in the incident form and details.”

Systems were in place for prompt reporting of accidents or incidents. The service used an electronic reporting system which enabled staff to complete an incident form online. This raised an instant alert for management who took any appropriate follow-up action, such as raising a safeguarding concern, carrying out an investigation or contacting family members. We saw evidence of suitable responses to accidents and incidents and how the registered manager carried out monthly reviews of the same to look for themes or trends, although we did identify two potential safeguarding concerns which had not been reported.

People felt things had improved with the service with their systems. A relative said, “Maybe not at the beginning. It took a while to get settled. But now everything works fine for us.” A second relative told us, “It was better when we transferred (to Adonai). Our last agency mucked us about.”

The registered manager told us they had improved their systems around assessing people for the service. They said, “We have taken no one new to the service since the last inspection. However, one person did go into respite care and returned to our care package. Before we took them back, we visited them and carried out another assessment to check we could still meet their needs. We would always do that even if someone had been into hospital.”

Since our last inspection, the local authority had not commissioned with Adonai Healthcare Services and as such no new clients had needed to be assessed by the service or transferred into their care.

Systems were in place to share information between external agencies and Adonai Healthcare Services prior to a care package being agreed. Once agreed, information on that person, together with their needs was circulated to all staff to help ensure that whoever carried out a care call understood how to care for that person.

People and relative’s felt safe in staff hands. One person told us, “I am safe with them.” A relative told us, “[Care co-ordinator] gets on the phone if they see marks and bruises, or if she banged her armed when she was walking about. They raised a safeguarding. Even though they told me about them they took it seriously. They will investigate and take it seriously.”

The registered manager was aware of their responsibility in relation to raising any safeguarding concerns. They told us, “We follow the guidance we have in the office which is like an algorithm and determines whether we need to raise a referral. We recently raised a concern which was immediately closed by the local authority, but we felt it was appropriate to send a referral. In another instance, I had to tell someone that I had a duty to raise a safeguarding concern even if they did not want to take the matter further.” But we found they had not always reported concerns. The registered manager told us all staff received safeguarding training. They said, “At the beginning of our improvement plan we did one to one training with staff and now we have introduced Skills for Care training.” A staff member said, “It might be physical, emotional, verbal abuse. I would report it the moment I have noticed. It is something you cannot overlook.”

There was a system in place where staff, in the first instance, would report any concerns to management and the registered manager was able to demonstrate where this process had been followed by staff. The registered manager held a safeguarding spreadsheet where they recorded the concern, actions taken and lessons learnt. However, despite this system, we identified two instances when unexplained bruising was found on one person and these had not been reported as potential safeguarding concerns. Although, we did see that staff had raised them as incidents and management had discussed them with family members.

We received no concerns about this aspect of people’s care. People told us, “They (staff) make sure I don’t fall” and, “They stand behind me and hold me, first thing in the morning I can be wobbly.” A relative told us, “There have been no problems whatsoever with regard to potential risks. They’re brilliant.” A second one said, “They will tell me if she is not drinking enough, or if she has sores.” We found some people may be at risk however.

The registered manager felt information around risks to people had improved. They told us, “We have introduced risk assessments now for everyone. These are reviewed regularly and updated when necessary.” They went on to say, “When one person was diagnosed with diabetes, [care co-ordinator] visited them as they were nervous about their new medicines and unsure of how their diagnosis would affect them. We reassured her and updated her care plan and risk assessment.” A staff member told us, “We were emptying a commode in a small space so we did a risk assessment and changed it.” Despite these comments, we found risk assessment required further improvement to ensure people were always kept safe. The local authority had also found some risk assessments lack information on how level of risk was calculated and most were not person-centred but generic.

Systems for assessing risks had improved. But risks assessments were not always updated when there was a change in need. One person’s risk assessment had not been updated to show that although they were at risk of choking, mitigating actions had taken place. This person required repositioning, ‘to a secure and safe position’ but there was no further information for staff on what this may look like. Staff were asked to record their urine output, but there was nothing to indicate what amount may be a cause of concern for staff. People who slept on a low beds and had a catheter had no risk assessment relating to the risk of their catheter due to being sleeping low to the ground. This person’s fire risk assessment had also not been updated to record they now had staff with them overnight. Risk assessments for some people consisted of information copied and pasted from the internet only and one person, who had had previous pressure sores, had little information on how staff could help reduce the risk of these reoccurring. Despite these shortfalls in documentation, risks to people were reduced as the service was small and both staff and management knew people well and health professional input had been sought when necessary. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Relatives told us they were happy with external agencies involvement in ensuring their family member’s environment was safe. A relative said, “We had occupational therapist involvement and an assessment on the house.”

The registered manager told us, “We now have premises risk assessments in place. We include information about people’s pets and we also use a ‘blacklisting’ system whereby we can list any staff that cannot attend to that person. For example, we have a staff member who is allergic to dogs and they are on the ‘blacklist’ so the system will not put them on the rota to provide care to anyone who has a dog.”

Information in relation to people’s environments had improved. The registered manager had introduced premises risk assessments for each person. This include fire risk assessments as well as information if people had pets.

We received positive feedback on staffing with people telling us they saw the same carers frequently; staff were rarely late and they stayed the time expected of them. One relative said, “The carers we get are the same carers most of the time. They ring me if they’re going to be late. They have never not turned up.” A second told us, “She generally sees the same four to six staff” and a third reported, “I could count on one hand the number of times they’ve been late.”

The registered manager told us they had sufficient numbers of staff to meet people’s needs. They told us, “We have set a trend on the rota now, so we know who goes where and when. This means people see the same staff. It is only in an emergency that different staff are used. It is good for us and good for the service users.” They told us the system would alert them if a staff member did not arrive at a call and also they were able to check staff logging in and logging out times for accuracy. Staff told us, “If there are challenges in timing, we escalate to the office and why we need it changed.”

Staffing arrangements had improved at the service. Since our last inspection, management were using the electronic care management system in more depth. This enabled them to set rotas, check staff timings and ensure travelling time was set between calls. Through the system, management was able to track staff members and check they were attending care calls in line with their rota. Where staff failed to do this supervision meetings were held and action taken. Where people required two staff to hoist, reposition or transfer them this always happened. Recruitment practices had improved since our last inspection and staff were recruited through robust processes. This included prospective staff providing proof of ID and their right to work in the UK, performance at their last employment and suitable references. Staff underwent a Disclosure and Barring Check (DBS) to help ensure they were suitable to work at this type of service.

We received no concerns in relation to this aspect of people’s care. One person said, “They wear clear aprons and blue gloves.” Relative’s told us, “Staff wear aprons” and, “They have a mask and always have gloves on and aprons.”

The registered manager told us cleanliness and presentation was very important to them. They told us, “Dress code has been picked up through a spot check. I invited the staff member into the office to discuss this. It is important for staff to look tidy and well-presented and they should be wearing the personal protective equipment (PPE) appropriately. Staff are told of the importance to wash their hands and also to hand sanitise. I am thinking about asking people if they would like a small stock of PPE to be held in their home as this may assist staff.” Staff told us, “We carry it (PPE) with us.” A second told us, “I carry it with me – hand gloves and shoe covers.”

Staff received training in infection control and were provided with suitable PPE equipment such as aprons, face masks, and gloves. Where people requested staff wear shoe covers this was done. Supplies were held at the office for staff to collect. There was information around infection control in people’s care plans although we noted nothing was mentioned in one person’s care plan around them having a catheter and what extra precautions staff may need to take which may cause a potential risk if staff were not following good practice.

People and relatives were happy with this aspect of their care. One person told us, “They (staff) bring them (medicines) out from the kitchen. We put them in the pots for the day. Before leaving they remind me (to take them).” Relative’s said, “Staff administer the pills. They are made up from the chemist” and, “They do all the medication. As far as I can see that is being administered correctly. We were doing it, but agreed it is easier if they did the administering of the pills.”

Since our last inspection, medicine administration records (MARs) had been introduced. The registered manager told us, “We have a MAR for anyone who we dispense the medicine to. People have medicines in blister packs. This makes it easier for staff and there are less mistakes.” Staff told us, “We do medicines training and competence in medicine admin and the registered manager checks on us from time to time.” However, we found further improvements were needed to ensure medicines systems were robust.

Medicine records had improved since our last inspection. Electronic MARs were kept for people and these were audited weekly by management. Where any issues were identified these were raised and investigated. For example, where a medicine had not been signed for on the MAR by the staff member who had dispensed it.’ We reviewed the MARs for some people and saw no gaps which indicated people received the medicines they had been prescribed. However, we found some medicine information was not up to date in people’s care plans. For example, one person had been stopped a particular medicine by their GP, but this was still showing on their MAR as well as in the list of medicines they took in their care plan, although there was a note on the MAR that it was no longer being given. Staff were trained in medicines management and competency assessments were carried out. The registered manager said, “I do the competency checks for staff. We used to use two different training providers for staff, but have now consolidated this, so all staff receive their medicines training through Skills for Care.”