Aadamson House Care Home received a Good overall rating following a focused inspection of Safe, Effective and Well-Led key questions on 25 April 2023, with Caring and Responsive ratings carried forward as Good from the previous inspection. No regulatory breaches or failure themes were identified; the service demonstrated consistently safe medicines management, robust safeguarding, effective governance, and a positive person-centred culture.
Strengths
· Medicines were administered safely with robust auditing processes and experienced trained staff.
· Sufficient staffing levels across the 24-hour period with thorough recruitment and pre-employment checks.
· Effective safeguarding processes with regularly updated training for all staff.
· Strong infection prevention and control measures including appropriate PPE use and safe visiting arrangements.
· Good governance with multiple auditing systems, lessons-learned reviews, and open candour culture.
Quality-Statement breakdown (14)
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Adapting service, design, decoration to meet people's needsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
Aadamson House improved from Inadequate to Requires Improvement overall following significant progress across most areas with support from an interim management consultancy, and was removed from Special Measures. Ongoing breaches remain in relation to Mental Capacity Act compliance and failure to notify CQC of serious incidents.
Concerns (7)
criticalConsent / capacity: “the provider failed to ensure people were assessed in line with the MCA before asking them to provide written consent to various decisions around their care and treatment.”
criticalConsent / capacity: “People who lived with an impairment of the mind or brain had not been assessed for any potential restrictions to their liberties in line with DoLS.”
criticalIncident learning: “the provider failed to notify the Care Quality Commission about serious injuries.”
criticalGovernance: “During the inspection we identified a number of incidents which should have been notified to CQC but were not.”
moderateStaffing levels: “Staff told us daytime staffing levels were sufficient however they felt at night time more staff were needed.”
moderateStaff competency: “We could not be sure the interim manager and senior staff had enough understanding of the MCA to ensure the principles of the Act were met in a person-centred way.”
minorOther: “some staff told us they had been asked to undertake non-care based duties when employed as a support worker which included domestic and decorating duties.”
Strengths
· Medicines management had significantly improved; staff trained and checked for competency in safe administration.
· Accident and incident analysis improved with risk mitigation strategies evidenced in care records.
· Staff supported people in a kind, dignified and respectful way, with trusting relationships and person-centred engagement.
· Record keeping, risk assessments and support plans had significantly improved since the last inspection.
· Infection prevention and control measures were robust and COVID-19 safety assured.
Quality-Statement breakdown (18)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experience
Aadamson House improved from Requires Improvement to Good overall, with Safe, Effective and Well-led each rated Good following a focused inspection. Previous breaches around MCA/DoLS and CQC notifications had been addressed, and people reported feeling safe, well cared for and engaged in the running of the home.
Strengths
· Robust staff recruitment with pre-employment checks and shadow shifts during induction
· Medicines managed safely with regular audits; local authority audit found no concerns
· Effective safeguarding processes with staff trained and confident in reporting concerns
· Improvements made to MCA/DoLS practice; service no longer in breach of regulation 11
· Good infection prevention and control practices including PPE use, testing and safe visiting
Quality-Statement breakdown (16)
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcareGood
effective: Adapting service, design, decoration to meet people's needsGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
well-led: Managers and staff being clear about their roles; continuous learning and improving careGood
well-led: Promoting a positive, person-centred, open and empowering cultureGood
well-led: Duty of candourGood
well-led: Engaging and involving people, the public and staffGood
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Good
effective: Supporting people to eat and drink enough; working with other agencies; supporting people to live healthier livesGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; promoting privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting relationships, activities and improving care in response to complaintsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture; duty of candour; engaging people and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood