Archived: Adelaide House

Overall summary Adelaide House provides accommodation and personal care, including nursing care, for six people who are living with a brain injury and have complex health needs.

We carried out an unannounced comprehensive inspection of this service on 20 and 21 May 2015. A breach of legal requirements was found. People’s medicines were not always managed safely. There were no written guidelines for staff about a person’s ‘as required’ medicines. There was a risk that the person may not have always received these medicines when they needed them. In addition, stocks of ‘as required’ medicines were not monitored and there was a risk they may not be available when people needed them. In addition, people’s care records did not include information about how their medicines were reviewed to ensure they were still safe and appropriate for them.

We issued the provider with a warning notice to ensure improvements were made. We undertook this inspection on 19 August 2015 to check whether the service now met legal requirements in relation to the administration of people’s medicines.

At this inspection we found improvements had been made. People’s records included detailed guidance for staff on how to support people to receive their ‘as required’ medicines’ safely as prescribed.

A member of staff showed us a recent audit of stocks of medicines. There were adequate stocks of all the medicines people had been prescribed. A senior manager told us about the arrangements which were now in place to review people’s medicines.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Adelaide House’ on our website at www.cqc.org.uk

Adelaide House provides accommodation and personal care, including nursing care, for six people who are living with a brain injury and have complex health needs. The service was last inspected on 31 January 2014. It met all the regulations we checked at that time.

This inspection was unannounced and took place on 20 and 21 May 2015. Six people were using Adelaide House when we inspected it.

The service had a registered manager at the time of the inspection. 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.

At this inspection we found that people’s medicines were not always managed safely. A person was prescribed medicines to be taken ‘as required’. Due to their communication needs the person could not ask staff for support to receive these medicines. We were told the nurse on duty made a decision about when to prescribe the person’s ‘as required’ medicines. However, there were no written guidelines for staff and there was a risk that the person may not have always received these medicines when they needed them. In addition, stocks of ‘as required’ medicines were not monitored and there was a risk they may not be available when people needed them. People’s care records did not include information about how their medicines were reviewed to ensure they were still safe and appropriate for them.

Systems to monitor the quality of the service, for example in relation to the administration of medicines, were not sufficiently robust to ensure it fully complied with CQC regulations. The service was not always well-led. The registered manager had not informed CQC of Deprivation of Liberty Safeguards (DoLS) applications and their outcome.

There were breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and CQC (Registration) Regulations 2009. The action we have asked the provider to take is at the back of this report.

Risks to people were assessed and managed to ensure they were safe. There were enough experienced staff on duty to meet people’s needs. Staff understood how to protect people from abuse and neglect. People received their regular medicines as prescribed.

Staff received training on meeting the needs of people living with a brain injury. They understood how to apply this knowledge to meet people’s needs. Staff supported people to eat healthily and keep their medical appointments. People were treated in accordance with the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Staff were caring and polite towards people. They knew people well and understood their dislikes and what was important to them. People’s privacy and dignity were upheld by staff. Staff involved people and their relatives as much in making decisions about their care.

The registered manager had ensured the service had up to date plans in place in relation to delivering people’s care and support. People had some opportunities to follow their hobbies and interests. Some relatives and professionals said that sometimes people appeared bored at the service. People were asked for their views of the service and actions were taken in response to improve the service. Relatives told us the registered manager responded to any concerns they raised with her and took action in response.

Staff told us the registered manager was open to their ideas on improving the service and was supportive. Staff said the registered manager promoted good working relationships in the staff team.