This inspection took place on 7 and 8 April 2016 and was announced. The provider was given 48 hours notice. This is in line with our current guidance for inspecting domiciliary care services. This was the first inspection of the service since it was newly registered in July 2013.Adlington House is registered to provide personal care to people who may require some help to maintain their independence. The purpose built three storey building, set in its own grounds, offers 52 self-contained retirement apartments. At the time of our inspection two apartments were shared by married couples and the rest were single occupancy.
The service provides care and support over a twenty four hour period. Staff can be called upon at any time to offer assistance to anyone living at Adlington House. People were able to purchase care packages to support them with their personal care. The service currently provided personal care support to seventeen people. All people who lived at Adlington House have access to an on-call system should they require assistance during the day or night. This service extended to those people living on site who had not purchased a care package with the service. If people’s needs changed they could call on staff who knew them and purchase additional care as needed. This meant that they could access support very quickly, and tailor that support to meet their needs.
In addition care staff would check on the welfare of all people living at Adlington House on a daily basis. The service also provides companionship, domestic support, a chaplain, handyman services and escorts for people, for example when attending hospital appointments.
Access to the building was secure, with key code entry and a buzzer with a screen linking visitors directly to the apartment they wished to visit. The main office was situated on the ground floor by the reception area, and there were also a hairdressing salon, a well-equipped spa room where people could be bathed by staff; activities room, and quiet lounges for people who use the service to meet or spend some peaceful time alone. An outside catering company ran a restaurant situated on the ground floor which was popular and well used by the people who used the service. There was also a ‘guest room’ where visitors could stay overnight or for longer periods if necessary.
The service had a registered manager. 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.
People told us they felt safe and secure and that support was provided by caring staff whom they trusted. There were good and efficient monitoring systems in place to check the welfare of all the people who lived at Adlington House, and we were told by one person that staff will “notice if anything is out of the ordinary”.
We saw that there were enough well trained and competent staff to provide the level of support people required on a day-to-day basis. People we spoke with were complimentary about the staff. One person who used the service told us “The staff are all excellent. They know us, and they know what they’re doing. The perfect combination!” We saw records that showed that the staff were regularly supervised and had an annual appraisal, and were encouraged to seek learning opportunities with access to ongoing training.
There was a consistent staff team with low staff turnover. This meant that care was delivered to people who required support by knowledgeable care staff who knew them well, and knew how they liked their care to be delivered.
Staff demonstrated a good understanding of how to safeguard adults at risk of harm, and the service had a safeguarding policy which was up to date, in line with recent legislation and complemented the local authority safeguarding procedures.
Adlington House had robust and effective systems to investigate incidents, complaints, staff conduct and safeguarding concerns, and used the information as an opportunity for learning.
Appropriate risk assessments were in place to reduce the risk of harm, and records were kept up to date, regularly reviewed and stored securely.
There was enough information in people’s care records to guide staff on the care and support needs required. People and their relatives were involved and consulted about the development of their care records. This helped to make sure that the wishes of people who used the service were considered and planned. The care records showed that risks to people’s health and well-being had been identified and clear instruction provided to help minimise risk.
Communal areas were well lit, clean and warm, and we saw that infection control procedures were in place to prevent the spread of infection. The building was well maintained with copies of maintenance records and servicing, for example, servicing of the lift, was carried out and recorded, with any necessary action taken to remedy faults.
The service was working to the principles of the Mental Capacity Act, 2005 and care staff supported people to make their own choices about their care and daily activities. People told us they were supported to make their own decisions, and we saw evidence that people’s wishes were taken into consideration in planning their care. Their care records made clear what people required support with and what they could do independently.
We saw that staff understood the importance of a good diet and ensured people had enough to eat and drink, People could make their own meals or choose to eat their main meals in the restaurant, where catering staff were aware of their specific needs, and would check if people were missing at meal times. People told us they enjoyed the food provided, and lunchtime particularly was seen as an enjoyable social occasion.
Care was reviewed on a regular basis and individuals were involved in reviewing how and when their care was delivered. When needs changed the service would quickly respond and could arrange packages of care which could change from day to day.
The organisation recognises the risks of social isolation and has set up support mechanisms to combat this risk, and a variety of interest groups was available both within and outside the service. These included a theatre club, travel club, film night and Chinese art class.
People were aware of how to complain. A copy of the complaints policy was prominently displayed near the building entrance. We saw that complaints were thoroughly investigated and the organisation kept a log of complaints which was reviewed and monitored for any trends.
People believed the home was well led. Staff told us the registered manager was supportive, encouraging and nurturing and people who used the service told us that the manager “makes the place work”, and has “created a real family atmosphere which is a pleasure to belong to”.
Quality of care was seen as integral to service delivery, and the service consistently strived to provide a high quality of care.
We saw that systems were in place to monitor the quality of the service provided, including opportunities for people who used the service to comment and assist with driving forward improvements.
The staff at Adlington House were vigilant to individual’s needs and treated people in a caring and compassionate manner, taking time to get to know people’s personal tastes and preferences. When we spoke to people who used the service they talked of genuine care being delivered in a person centred way. They told us that the staff were friendly and available. One person told us that the care staff were “keen to get everything just so. They have a mentality of making everything perfect”.