Adonai Healthcare Services Also known as Adonai Services Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Since our last inspection the registered manager had worked hard to address all the shortfalls we had identified and as such we found many improvements. However, some of these still needed to be embedded into daily practices and other systems and processes required further work to ensure they were robust. We found documentation and information held about people was not always up to date and, although this did not put people at risk because staff knew them well, it meant that the registered manager could not be assured that people’s records were contemporaneous. An auditing scheduled had commenced which enabled the registered manager to identify areas that required action, but although audits were regularly completed these did not always identify shortfalls. Staff had a shared desire to provide good care to people and worked with external agencies and professionals to provide this.

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.

The registered manager felt there was a shared drive within management and the staff team. They told us, “Our logo is to provide care with love, show dedication to what you are doing, own up to your mistakes. We are open and transparent.” A staff member said, “It is the health and wellbeing of the person and the safety of a human being in your hands.” A second told us, “Our clients are our priority.”

Management produced a newsletter giving information about the service. This was made available to people, relatives and staff. Staff were trained for their role and training included duty of candour and person-centred care.

The registered manager told us, “We have worked so hard and made many improvements since our last inspection. We engage a consultant to help us work through everything. We no longer use the consultant but we have agreed that we will have an external review regularly to ensure that we are keeping on track.” They added, “We have improved the communication between family members and service users. We are visiting regularly at any time.”

New processes and systems had been introduced since our last inspection to address the shortfalls we found. This had resulted in stronger governance arrangements being in place as well as a capable management team. For example, the care coordinator had identified the need to improve the staff rotas to ensure sufficient travelling time was included between calls. Despite this we identified some areas in people’s care plans and daily care notes that required improvement. Care notes focused on physical tasks and did not record wider information to show how people’s holistic needs were met. Where one person was found ‘weak’ and ‘on the floor’, despite staff calling for an ambulance, there was nothing further written in their care notes about this. This meant care notes may not always give an accurate or complete picture.

The registered manager encouraged staff voice. They told us, “I encourage them to do so (speak up), for people and for staff themselves if they have any concerns about practices or their colleagues. We are always telling staff to report anything and everything.” A staff member said, “If it’s confidential we can talk to them or just call and speak to the registered manager or HR.” A second told us, “We have staff meetings and everyone attends or the majority attend.”

Staff were encouraged to speak up through staff meetings and staff surveys. Analysis of the outcome of surveys was carried out by the registered manager and an action plan produced to address any negative feedback. Staff meetings were held regularly and gave staff the opportunity to discuss any concerns.

The registered manager told us staff underwent training in equality and diversity and we confirmed this through the training records. This meant staff understood the need to give everyone the same rights and opportunities and to value and respect people's differences. A staff member told us, “There are different means of communication for all members of staff regardless of status, age, colour; they are always open.” A second said, “I love my job. I love people always look forward to seeing you. Management support us well.”

Recruitment practices were inclusive. The registered manager recruited staff through a range of processes. This included recruitment via sponsorship. This meant prospective staff had the opportunity to work and live in the UK.

Improvements had been made to the service, but further work was needed so these improvements were fully embedded and sustained. For example, in relation to accurate and up to date risk assessments, daily notes and contemporaneous records. The registered manager told us, “ A lot has improved. The quality-of-care is not what we had then. We did not have an audit programme. But now, not only do we have audits these tells us straight away where the faults are. I should have had oversight.” A staff member said, “The registered manager does visit. They do it often. They call you to the office and speak to you about it gently and they put you through training. I have not been picked up on anything.”

Management had started to utilise their electronic system to make maximum use of it. They had introduced electronic medicine administration records (MARs) and had started a number of auditing processes, which included safeguarding processes, infection control, medicines records, care plans and complaints. Through these audits, management had identified one person had started to refuse to allow staff to apply their creams which enabled them to follow up on this. Yet, they had not identified other shortfalls that we had picked up on which meant care plans were not always totally up to date. For example, where one person’s MUST record had not been updated since September 2024, or their Waterlow risk assessment since June 2024 and where their care plan stated they had no swallowing issues, but actually this person had been referred to the GP as the family and staff were concerned about their reduced ability to drink and eat safely. Other care planning documentation contained contradictory information or did not include enough detail for staff, although staff did know people well which reduced the risk of people receiving inappropriate care. The registered manager had also not always made referrals to the local authority safeguarding team if people had bruising which was unexplained. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager carried out ad-hoc spot checks on staff whilst they were attending care calls. This helped them identify any poor practices and take action. We read one staff member had arrived late at their call and was not dressed in the appropriate company uniform. The registered manager held a meeting with the staff meeting to discuss this with them.

People told us staff offered them support to go into the community. Some people declined with one person saying, “I prefer to see the girls here.” However, another person said, “I go to a day centre three times a week and the carer will come in earlier.” The also told us they felt there was a good partnership between them and the manager. They said, “I had a meeting with [manager] and we set up a plan for me to have certain carers. I set up my care plan myself with the manager which we both agreed on.”

Staff worked with external agencies and professionals. The registered manager told us, “[Person’s name] had an occupational therapist assessment which resulted in a change in the way person slept at night. We were told their bed needed to be at its lowest point as this was the safest option for them.”

We did not receive any feedback from partners in relation to this evidence category as part of this assessment.

The registered manager had developed links with external agencies and professionals to help ensure people received holistic care. Where necessary and appropriate management made referrals to external professionals, such as the GP, dietician or a social worker.

The registered manager recognised they needed to improve. They told us, “One of things was that not many of the staff were having supervisions. Today, all of them have had supervisions. With regards to training, we had staff having training from different providers, we have streamlined now with one provider who brings it all into one place. We had complaints. We had more than three or four complaints in a day. Now, we don’t have any. We weren’t doing the monthly meetings. This has actually helped us to know staff concerns, what is going on in the field. It has helped us with our improvement programme. We took on a consultant to support us with improvements from last inspection.” A staff member said, “I was able to suggest comments to management that has worked, we need to keep learning.”

Following our last visit, a contingency plan had been developed which meant staff were now aware of how to access information on the system offline. This meant in the event of a systems failure, staff would still be able to read important information about a person’s care. Quality assurance surveys were carried out with people, their relatives and staff. These showed overall positive feedback about the care provided by the service.