We carried out an unannounced inspection of Adam House on 10 October 2018.

Adam House is a ‘care home’ which is registered to provide care and accommodation for up to six adults with mental ill health. People in care homes receive accommodation and nursing care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Nursing care was not provided.

The service is a large terraced house situated a short distance from Burnley town centre. The aim of the Adam House is to provide a ’Step Up’ service as a part of an individual care package and recovery pathway within the Healycare Ltd. At the time of our inspection one person was using the service.

At the time of the inspection the registered manager had taken planned leave of absence from the service. 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. In the absence of the registered manager the provider had made interim arrangements for the management of the service.

At our last inspection the service was rated Good. At this inspection we found some shortfalls in making sure the facilities and equipment is safe. We have therefore made a recommendation about the management of people’s safety and showing that all appropriate checks had been carried out.

The management and leadership arrangements needed some stability to support the day to day running of the service.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on supporting people safely and abuse and protection matters.

Risks to people's individual well-being and promoting independence were being assessed and managed.

Processes were in place to maintain hygiene standards and the areas we saw looked were clean.

Arrangements were in place to gather information on people’s needs, abilities and preferences before they used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

We found people were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were offered opportunities and encouragement with physical exercise.

There were processes in place to support people with managing their medicines. Staff responsible for supporting people with medicines had completed training. They had been assessed to make sure they were competent in this task.

People were actively involved with planning their own menus, shopping and cooking.

There were enough staff available to provide agreed care and support.

People had a detailed care plans, describing their individual needs and choices. This provided clear guidance for staff on how to provide support.

People’s privacy, individuality and dignity was respected. They were supported with their interests, including activities in the local community.

People had opportunities for skill development and confidence building.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns.

People could also express concerns or dissatisfaction during their care reviews and during ‘house meetings.’

There were arrangements in place to train and support staff. Some staff were behind with refresher training, but this was being managed.

We found there was a lack of written information to help people make decisions and promote their rights.

The inspection was carried out on 2 and 3 March 2016. The first day of the inspection was unannounced.

Adam House provides accommodation and support for up to six people with mental ill health. The home is a large terraced house situated a short distance from Burnley town centre. There is a lounge and a dining kitchen. There are single and shared bedrooms. There is an enclosed yard to the rear of the home. The aim of Adam House is to provide a ’Step Up’ (progression to greater independence) service as a part of an individual care package and rehabilitation programme.

At the time of the inspection there were no people accommodated at the service. However the facilities were being accessed during the day by one person accommodated at the provider’s neighbouring registered service Healy House. This was as a part of the person’s individual care package and rehabilitation programme. The programme of rehabilitation at the service included scope for people to work towards living in the accommodation independently with minimal support. There was potential for other people accommodated at Healy House to access Adam House in the future; we therefore took some of their views into consideration.

The service was managed by 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.

At the last inspection on 6 February 2014 we found the service was not meeting all the standards assessed. The provider had not ensured the premises were suitable and safe. Following the inspection we received an action plan from the provider which told us they would be compliant with the requirements by 13 March 2016. We also received documentary evidence to confirm specific safety checks had been carried out by a qualified contractor. We then carried out a review of the information and found the service was meeting all the standards assessed.

The people we spoke with indicated satisfaction with the care and support they experienced at Adam House. One person said, “It’s okay.”

We found arrangements were in place to help keep people safe and secure. Risks to people’s well-being were being assessed and managed. People using the service had no concerns about the way they were supported. They told us they felt safe at the service, one person said, “Things are fine.”

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Appropriate character checks had been completed before new staff started working at the service.

Arrangements were in place to maintain appropriate staffing levels. There were systems in place to ensure all staff received regular training and supervision. We found some training was overdue but action had been taken to address this.

Staff responsible for supporting people with medicines had completed training and further training was being arranged. This had included an assessment to make sure they were competent in this task.

The service was working within the principles of the Mental Capacity Act 2005. We found people were supported to make their own decisions and choices.

People were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were actively involved with planning, preparing and cooking meals. This meant they could make choices on the meals provided and develop their independence skills.

We received positive comments about the care and support people received from staff. We observed some positive and respectful interactions. A social worker/care coordinator said, “The approaches I have observed from staff to service users have been positive. They have always been engaged with them.”

At the time of this inspection Adam House had been a dormant service for over two years. This means that although the location had remained registered it was not in use as service. We had been made aware that services had been restarted; therefore we carried a scheduled routine inspection to check that essential standards of quality and safety were being met.

On this inspection we were unable to speak with people who used the service. Their experiences were captured though observation, discussions with staff and looking at records.

Overall we found people experienced care and support which met their needs. However, we found some matters were in need of attention to ensure people were protected against the risks from unsafe or unsuitable premises.

People were being involved as far as possible in making decisions about matters which affected them. They were supported to make choices and develop independent living skills.

People were supported to access resources and activities within the community.

People were getting support with healthcare needs and they had access to on-going support from health care professionals.

We found the staffing arrangements were sufficient in helping to ensure people received effective care and support.

People did not benefit from a suitable legal statement describing the purpose and aims of the service. However, we were told this matter was being dealt with.

At the time of this inspection visit there were no people being accommodated in Adam House. Therefore we were unable to seek peoples’ views and evaluate their experience of the service.

However, the standards we looked at showed there were some arrangements in place which would provide people with effective care and support.

Including:

• Involving people in their care, support and daily living activities.

• Promoting independence and respecting people as individuals.

• Finding out about peoples’ needs and planning for their care and support.

• Ensuring people are safe and free from abuse.

• Asking people about their experiences and checking the quality of the service.