Adam House

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. We identified breaches of legal regulations. We found issues relating to the culture in the service. Governance was not robust and policies and procedures were not always being followed. Recruitment practices and supervision were not always being conducted appropriately. It was not always clear how learning, improvement and innovation was taking place. However, morale at the service was generally good. Staff spoke about the manager positively, and felt they were treated fairly and had the freedom to speak up. Appropriate healthcare professional were being involved when needed.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff spoke about the visions and values of the service. One staff member said, “I think they try to support people to live more independently.” However some of the issues we identified did not highlight a positive culture.

A staff meeting from April 2024 identified potential issues with staff culture and their conduct whilst at work as this may be affecting their ability to safely care for people. Records we found relating to incidents suggested there may be an issue with staff culture and the way staff interacted with people, which at points caused undue distress to people living at the service. An incident reported by a family member suggested there was an issue with staff culture.

Staff told us they felt supported in their role and the management were approachable and fair to all staff.

Although we found the management approachable and compassionate throughout our inspection, many of the concerns identified during the inspection raised concerns about the capability of management to understand their regulatory requirements. The lack of paperwork in relation to the recruitment of the manager did not allow us to see a fair recruitment process, and as the manager’s supervisions were being conducted by a family member, this did not show how appropriate accountability was always considered.

Staff knew how to whistleblow and they felt confident to speak up should they need to. One staff member said, “If you have problems, you can go to the manager or any senior and I feel comfortable to do that.”

Appropriate policies and procedures were in place to ensure staff had the freedom to speak up. The provider had a whistleblowing policy available to staff. Staff were able to raise any concerns in team meetings. Staff surveys were conducted to gain staff feedback, an analysis and action plan was put in place to ensure any concerns were addressed.

Staff told us they were treated equally and fairly in a compassionate way. One staff member said, “I have worked in many companies, they do not discriminate here.”

An equality and diversity policy was in place which set out how equality and diversity is tackled and how this covers everyone from staff, to people and their relatives.

Staff told us they felt the management carried out regular checks on safety and standards of care. However, staff practice demonstrated they had not understood their responsibilities as they were not following the provider’s policies and procedures. Concerns identified with governance and oversight demonstrated that the management did not fully understand their responsibility to provide robust oversight.

Governance systems were not effective in ensuring a high-quality service was always being provided. There was no daily or weekly walk arounds or audits for the environment to check for any safety concerns. During our inspection the registered manager told us they had implemented the necessary weekly checks. Documents required to complete the inspection were not always readily available despite having announced the inspection and providing a list of documents required. This was an issue we also encountered at our last inspection. The service were not acting in line with some of their policies. Multiple audits did not identify the issues we found during our inspection. For example, a monthly self-harm audit did not record an incident which occurred involving a ligature, a care plan audit did also not identify this incident. The kitchen audit did not identify the issues with the safer food better business records, the checklist for safety audit did not identify the issues we found regarding fire safety. Medication audits did not identify missed doses and wrong pill counts. There was no CQC rating displayed at Adam house, this was an issue we also identified at our last inspection. We were advised that the provider had oversight over the service, but no records could be provided, we were told this is because the provider was away from the business. We found examples of incidents that may have needed to be notified to CQC, but this had not happened. This will be reviewed and followed up outside of this inspection process.

Most relatives felt they were kept up to date and relevant healthcare professional were involved when needed, one relative felt they could be kept more up to date.

Staff spoke about how they involved external professionals such as advocates and social workers when needed.

Partners felt Adam House worked in partnership with them and collaborated. One professional told us, “Yes, they have been very forthcoming with information sharing both in person and on my request and all staff spoken to have had excellent understanding of [person] and her complex needs.”

The service worked in partnership with various organisations including social workers, the learning disability team, GPs and advocates.

Staff spoke about how they have helped people to lose weight which had had a positive impact on their health. Another staff member spoke about how they try to support innovative practices, they said, “On Wednesday we do a social group and I have started doing something called life skills, I have taught about financial management and different relationships.”

As there were no records relating to lessons learned, audits did not identify issues we found and feedback surveys, where a less than good score had been obtained, had not been fully actioned following analysis, we were not always able to see how the service implemented learning, improvement and innovation.