This inspection took place on 25 April 2018 and was unannounced.

At our last inspection on 30 November 2016 we rated Adel Grange as requires improvement. We found the provider had breached one regulation associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to protecting people’s dignity and respect. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of responsive and well led to at least good.

When we completed our previous inspection, we found concerns regarding care planning for people who exhibit distressed behaviour, which placed themselves and other people at potential risk. At this time this topic area was included under the key question of responsive. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of safe. Therefore, for this inspection, we have inspected this key question and the previous key question of responsive to make sure all areas are inspected to validate the ratings.

At this inspection, we found that people’s needs were assessed and appropriate steps had been taken to reduce the impact of people’s behaviour on others. Improvements made following the November 2016 inspection had been embedded and sustained.

This service is now rated as Good.

Adel Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 30 people living with dementia in one adapted building. At this inspection there were 27 people living in the home.

There was a manager in post. The manager had submitted their application to the Care Quality Commission to be the 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.

There was a clear emphasis on leadership, teamwork and good communication between staff at all levels. The manager had developed a positive culture which promoted high quality, person-centred care. Safe recruitment procedures were followed and staff were provided with constructive training, coaching and supervision to implement identified changes.

The manager had developed new quality assurance procedures and they acted as an effective role model and mentor to ensure these were implemented appropriately. The manager was aware of the areas which still required improvement and spoke confidently about further plans for staff development. Individual staff or ‘champions’ had specific responsibility for systems relating to safeguarding recruitment, medicines, care planning, infection control and health and safety. This promoted a sense of ownership among the staff team. This proactive approach was also seen when a minor incident occurred during our inspection visit as the manager analysed the situation to put changes in place to prevent a reoccurrence.

Staff treated people with dignity and respect. They displayed a caring and compassionate attitude towards people throughout our inspection. Staff knew about people’s preferences, likes and

dislikes and they used this knowledge to deliver personalised care.

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

Comprehensive support plans were in place for people who tended to become anxious or upset. These ensured that staff knew the b

We inspected Adel Grange Home on 30 November 2016. The visit was unannounced. Our last inspection took place in March 2016 where we identified six breaches of legal requirements including person centred care, dignity and respect, need for consent, safe care and treatment, good governance and staffing. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations and a clear time frame in which they would complete this. On this visit we checked and found improvements had been made in all but one of the required areas, dignity and respect.

Adel Grange is a residential home for thirty people, situated in North Leeds. On the day of our inspection there were 26 people using the service. The building is listed and retains many original features. Some alterations have been made to make the home more accessible.

At the time of our inspection 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 who used the service and their relatives told us the service was safe. The home was well maintained, clean and tidy, and checks were carried out to make sure the premises and equipment was safe.

There was sufficient staff with the appropriate skills and experience; several staff members told us the staffing arrangements had improved. Appropriate checks were carried out before staff were employed.

People who used the service and their relatives told us they were happy with the staff that provided care and support. Staff we spoke with said they felt well supported and understood their role as they received training that made sure they knew how to do their job well. Staff we spoke with understood their responsibilities around how they should support people with decision making. Medicines were managed safely.

People enjoyed the food, and had plenty to eat and drink. People told us they were well cared for and visiting relatives told us the service was caring. We observed staff supported people in a calm, compassionate and caring way. Staff were cheerful and friendly. When staff assisted people to move and transfer they explained what was happening and reassured them throughout. Systems were in place that ensured people accessed healthcare services when needed.

Staff responded to people’s individual needs and delivered personalised care. People’s care plans and other records showed their needs had been initially assessed and care was usually planned, although there was inconsistency with the level of detail within the care plans for those persons who challenged the service. Care plans contained appropriate records to show people’s capacity to make different decisions had been assessed. There was a range of activities available to people within the home.

People told us they would talk to staff and management if they had any concerns and complaints had been responded to in a timely manner and in a way which resolved the issue where possible to the person’s satisfaction. Several written compliments had also been received.

We received positive feedback from people about the registered manager. Resident and relative meetings and staff meetings were held. We saw from minutes of meetings that people had opportunities to discuss the service.

We reviewed a wide range of audits which had been completed at the service and were used to monitor the quality and safety of service delivery.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Our inspection took place on 21 March 2016 and was unannounced. At our focused inspection on 24 June 2015 we found the provider had followed their action plan to address shortfalls in relation to breaches of Regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Adel Grange is a residential home for thirty people, situated in North Leeds. On the day of our inspection there were 27 people using the service. The building is listed and retains many original features. Some alterations have been made to make the home more accessible.

Communal accommodation consists of two lounges and a spacious dining room. Most bedrooms have en-suite facilities and are accessed by a passenger lift. There are some rooms available on the ground floor.

There was a registered manager in post. 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.

We found the provider had an inconsistent approach to assessment and recording of the risks to people. Some care plans contained detailed risk assessments, however we saw some care plans where risks had not been identified, meaning staff would not be aware of how to ensure the risks to people were adequately mitigated.

Safeguarding was understood by staff, although the provider had not ensured training in this area was kept up to date. We saw records which evidenced some concerns were escalated to external bodies when needed. Accident and incident recording was mainly good, however we found two falls had not been recorded or reported.

Appropriate background checks were carried out before new staff began working in the service. We saw there was no system in place to ensure staffing levels were matched to the current care and support needs in the service. People who used the service, their relatives and staff all expressed concerns that staffing levels were not adequate.

We found the provider was managing people’s medicines safely and kept training in this area up to date, however there was a lack of ongoing checks of staff competency in the administration of medicines and other areas of training.

There was an inconsistent approach to the obtaining of consents from people who used the service. Not all care plans evidenced the provider was undertaking assessments related to the Mental Capacity Act 2008. Where people’s relatives had given consent there was a lack of evidence best interests decisions had been made.

Staff were supported in their roles with regular supervision, however appraisals had not been kept up to date. We saw there was a plan in place to address this. Staff training was not kept up to date in all areas, and the registered manager told us the provider did not provide support to ensure the training programme was adhered to.

We saw people were supported to have access to a wide range of health professionals.

We observed the lunchtime service and saw it was relaxed, with people assisted to make choices in a patient and caring way. One person was supported to eat their meal and we saw the staff member did not provide this support in a caring way.

There was good feedback about staff from people and their relatives, however we were told that agency workers were not always effective in their roles. Our observations of staff practice evidenced some staff worked in a kind and person-centred way, however this was not consistent. We saw several incidences of staff not being mindful of appropriate behaviours or the feelings of the person they were supporting.

We found people’s care plans lacked person centred information relating to their preferred lifestyles, likes and dislikes. Care plans were not always updated to reflect people’s changing needs. Synopsis car

We carried out an unannounced comprehensive inspection of this service on 20 October 2014 at which three breaches of the legal requirements were found. This was in relation to, management of medicines, recruitment procedures and monitoring the quality of service provided.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 24 June 2015 to check they had followed their plan and to confirm they now met legal requirements.

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 “Adel Grange” on our website at www.cqc.org.uk

Adel Grange Residential Home provides care in a building that is listed and retains many original features in North Leeds. Some alterations have been made to make the home more accessible. The home provides care and support for up to 30 older people, some of whom are living with dementia or related mental health problems.

Communal accommodation consists of two lounges and a spacious dining room. Most bedrooms have en-suite facilities and are accessed by a passenger lift. There are some rooms available on the ground floor.

The home had a manager who has worked in this role since May 2015. This person is not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

At our focused inspection on 24 June 2015, we found the provider had followed their plan which they had told us they would and legal requirements had been met.

People who used the service told us they were happy living at the home and they felt safe. We looked at the arrangements in place for the storage, administration, ordering and disposal of medicines and found these to be safe. Medicines were administered to people by a trained person.

We found people were cared for, or supported by suitably qualified, skilled and experienced staff. Recruitment and selection were taking place and appropriate checks had been undertaken before staff began work.

The manager told us they monitored the quality of the service by monthly quality audits, daily walk rounds, residents and relatives meetings meeting and talking with people. However we found when we looked around the home more work is required around monitoring equipment and cleaning.

When we looked in people’s bedrooms, communal bathrooms and toilets we found some of these areas were not clean. For example, in two people’s bedroom's we found faecal matter on their furniture, wall and radiator. We looked at the equipment in place at the home for people to use when they received personal care and we found some of the items were also not clean. You can see what action was taken later in the report.

We inspected Adel Grange Residential Home on 22 October 2014 and the visit was unannounced. Our last inspection took place in December 2013 and at that time we found the home was meeting the regulations we looked at.

Adel Grange Residential Home provides care in a building that is listed and retains many original features in North Leeds. Alterations have been made to make the home more accessible. The home provides care and support for up to 30 older people, some of whom are living with dementia or related mental health problems. There were 28 people living at the home on the day of inspection.

Communal accommodation consists of two lounges and a spacious dining room. Most bedrooms have en-suite facilities and are accessed by a passenger lift. There are some rooms available on the ground floor.

There was a manager in post, however this person was not registered. 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. The home had employed a manager and we were told they will soon be going through the Care Quality Commission registration process.

The experience of people who lived at the home was positive. People told us they felt safe living at the home, staff were kind and caring and they received good care. They told us they were aware of the complaints system. They also said they would be happy to raise any concerns they had with the staff and would be confident these would be listened to and acted upon.

However we found processes to keep people safe were inadequate. For example, staff who had recently been employed at the home did not always have references from their last employer and people who had left employment and returned did not always go through the recruitment process. The lack of robust recruitment procedures risked people being cared for by unsuitable staff.

This is a breach of Regulation 21, (Requirements relating to workers); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Medicines were not managed safely; where people had ‘as required’ medication prescribed there was no guidance in place for staff to ensure they received them when they most needed them. This meant people were at risk of not receiving their medicines when they needed them and at the time when they would be most effective.

This is a breach of Regulation 13, (Management of medicine); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We looked at the audit system and found some of the audits and t had not been done. For example care plan audits, temperature checks of water and the audit of medication.

This is a breach of Regulation 10, (Assessing and Monitoring the service); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

On our visit we saw people looked well cared for. We saw staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

The service was meeting the requirement of the Deprivation of Liberty Safeguards (DoLs) to ensure people’s rights were protected.

The home met people’s nutritional needs and people reported they had a good choice of food.

People reported that care was effective and they received appropriate healthcare support. We saw people were referred to relevant healthcare professionals in a timely manner.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The home has been sending the CareQuality Commission monthly action /progress plan of works been completed.

Staff spoken with told us the provider has made a lot of changes to the home which they feel has benefited the people who used the service.

At the time of our visit the home was very warm, radiators were working and hot water was available in bedrooms.

The manager told us work will start on upgrading the communal bathrooms and toilets in January/February 2014. The action plan sent to us by the provider confirmed this.

The provider had taken steps to provide care in an environment that is adequately maintained.

We spoke with three people who used the service they told us they were very pleased with the improvements the home is making.

People who used the service and visitors told us they were satisfied with the service they received and they were respected. People we spoke with who used the service said if they had any concerns they were happy to raise them with the staff or management and were confident they would be dealt with appropriately.

People told us they were happy with the food served at the home. We observed some people needing assistance to eat their meal and staff were respectful of their dignity during this time.

We spoke with some visitors. They told us they were happy with the care that was provided. One person said, "I find the staff very helpful and I think people are getting good care.” Another person said, “You’re always welcomed.”

During our last inspection we found the registered care provider had not fully complied with Regulation 15 Safety and suitability of premises. At this inspection while there had been some improvements the home remained non-compliant. As a result we have issued a warning notice.

We spoke with three people who used the service, three relatives of people who used the service and two visiting health professionals. People who used the service said they were happy living at the home and they were well looked after. Relatives said they had no concerns about the care provided and the way their family members were treated. One said, “Nothing is too much trouble for them.” Another said, “(name of person) is always very well turned out.” Both the health professionals we spoke with said they had no concerns that people’s health needs were not appropriately met. They said the service worked well with them and followed their advice.

We saw that people were happy and comfortable with staff in their interaction with them. We saw that people looked well cared for, clean and tidy and had clean clothes. Staff responded well to any requests for assistance.

The people we spoke with told us there were enough staff and they were attended to promptly. Relatives spoke highly of the staff and how their family member was attended to.

A number of shortfalls were identified with the premises and their upkeep. People who used the service, staff and visitors were not fully protected against the risks of unsafe or unsuitable premises.

The care provider did not have adequate systems and procedures in place for monitoring the quality and safety of the service they provide.

The Local Authority Commissioners told us they had no concerns about the service.

People using the service and visitors told us they are satisfied with the service they receive and they are respected. People said the environment is always clean and pleasant. People we spoke to said if they have any concerns they are happy to raise them with the staff or management and are confident they will be dealt with appropriately.

Staff told us that people receive a good service and they can make decisions about their care. Staff said they are confident that the management of the home would deal with safeguarding issues or concerns appropriately and systems are in place to make sure people are safe.