This inspection took place on 16 and 17 February 2017. The first day of the inspection was unannounced.

Adelaide Lodge is registered to provide accommodation for 48 people who require personal care. Some people using the service are living with dementia and other mental and physical health issues. At the time of the inspection there were 43 living at the service.

The service last inspected on 8 and 9 December 2015 when it was rated as requires improvement overall. At that inspection we found three breaches of the regulations the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to staff recruitment; the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The provider had developed an action plan to ensure improvements were made and sustained and had kept CQC informed of the progress made. We found that improvements had been made at this inspection.

A new registered manager had been appointed since the last inspection. The registered manager is also registered as the manager of another residential service adjacent to Adelaide Lodge. They divided their time between the two services. 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 and associated Regulations about how the service is run.

People using the service, their relatives and professionals said they felt the service was safe. Comments included, “I would rather be here than at home, I feel safer here than in my own home” and “Life here is very good. I would rather be here than anywhere else.”

People were protected from potential abuse and harm. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. The registered manager had responded appropriately to safeguarding concerns and the necessary alerts had been made to the local authority to ensure any concerns were dealt with. Risks relating to people’s care were assessed and records showed that control measures that had been put in place to minimise risks to people. Medicines were managed and stored safely and people received their medicines as prescribed.

There were sufficient numbers of staff on duty to support people with their needs and to ensure they remained safe. Staff recruitment procedures were effective in ensuring appropriate staff were employed. However we have made a recommendation to ensure all the necessary recruitment information is obtained from recruitment agencies before prospective staff start working at the service. Staff received a thorough induction to work in the home. They received training in a wide range of areas and felt they had support for their continued professional development.

People were protected by the practice in place in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been appropriately made when needed.

The accommodation provided was safe and maintained to a good standard, with a variety of well furnished lounges, a dining room and seating areas. Some improvements had been made to provide an environment which was enabling and stimulating for people living with dementia. This work was on-going.

People were provided with a varied and balanced diet. Their health needs were met and they had access to external professionals as required. Visiting professionals expressed their confidence in the service and confirmed their recommendations were acted upon.

People received care and support from a staff team who treated them in a friendly, compassionate and understanding way. People and their relatives spoke highly about the staff’s approach.

There was an activities programme in place and pe

In this report the name of a registered manager appears who was on maternity leave and not currently managing the regulatory activities at this location. At the time of our inspection the acting manager was in the process of applying for registration as manager of the home.

There were 38 people living at the home on the day of our visit. We found the home fresh, clean and well maintained. We spoke with 12 people, 10 staff, the Acting Manager and Director of Care. We met the provider and spoke with three visitors.

The home provided support for a wide range of dependency needs. Many people had a degree of dementia which meant it was difficult to have a full conversation. Those we did speak with told us they were ‘very well looked after’ and were comfortable. Everyone spoke highly of the staff. People said 'they couldn't do anymore', 'staff are magnificent'. We observed friendly, warm interactions between staff and people.

We noted that staff welcomed visitors who popped into the home throughout the day.

We saw that staff offered people choices and where a person could not communicate verbally staff interpreted a person’s wishes through gestures or observation which confirmed their agreement to the care provided. Care and support was assessed, planned and delivered in ways to support people’s individual needs and preferences. Staff were employed to programme activities which maintained and rekindled people's interests.

We found that care plans were person centred and records were up to date.

Staff were supported through supervision and training, although some staff had not yet completed essential mandatory training.

Quality monitoring systems were in place which ensured people were protected and safe at the home.

At this unannounced inspection we spent one day at the home. We spoke with thirteen people living at the service and heard comments from three health professionals with current links to the home. We spoke with six members of the care staff and the manager.

On the day we visited the 41 people were living at the home. People living at the home were older people, and some people had a diagnosis of dementia. We observed the care, support and interactions with staff of some people with dementia who were unable to talk in depth with us. People we spoke with were positive about their experiences. Comments included, ‘’it is nice here, you can do as you please” and “I wouldn’t want to live anywhere else.”

During the inspection we read a range of documents used to plan and evaluate care. We found that care and support was well planned, with people being involved in the process where possible. People told us they felt able to raise concerns within the home in order to improve services for them. People made choices about how they wanted to spend their day, and this was respected. There were systems in place to ensure the home was hygienic and staff handled people’s medication safely. There were sufficient staff on duty day and night to meet people’s assessed needs.

There are a number of people who live at Adelaide Lodge who have a dementia type illness and so some people were not able to comment directly on the care and support provided at Adelaide Lodge. We talked to people living at the home; some people were able to verbally express their views and others could not. People told us they were 'happy to live at Adelaide Lodge' and 'the girls are good to me' and that staff were 'lovely' and 'kind'.

We spent most of the inspection in communal areas observing care and the

interaction between staff and the people living at the home, talking to people in their own rooms, taking lunch with people using the service and talking with the manager and Provider.

We saw that people looked well cared for, comfortable and warm. Generally, people looked relaxed in their surroundings, and were able to move around the communal areas, and appeared as ease with the staff that cared for them. We saw staff listened to people's requests and attended to people respectfully in a timely way. We saw that people were given choice throughout the inspection such as what they would like to drink, where they wanted to sit and what they wanted to do. We found that some people with a dementia type illness were not always engaged with staff or offered opportunities to spend time with staff and that they were not enabled to be stimulated in a meaningful way. We have recommended that there be improvements in this area.

People's medication was administered in a safe and reassuring manner. We saw that staff quickly and appropriately reacted to people's changing behaviour, and recognised when additional support from health and social care professionals was needed. However, at times there was good monitoring of behaviour that could be challenging for staff but there was not timely interventions overall to assess how these behaviours could be triggered and/or minimised.

We found that people’s health and welfare needs were met and although there had been an incident where miscommunication between staff and another health professional had resulted in a delay in changing care delivery, this had been taken on board and addressed by the home.

This inspection took place on 8 and 9 December 2015. The first day of the inspection was unannounced.

Adelaide Lodge is registered to provide accommodation for 48 people who require personal care. Some people using the service are living with dementia and other mental and physical health issues. At the time of the inspection there were thirty eight people living at the service.

We last inspected this service on 19 February 2014 and found that the service was meeting the requirements of the regulations we inspected at that time.

The registered manager had left the service in October 2015. A new manager had been appointed and started working at the service on 7 December 2015. They were in the process of completing a CQC registered manager’s application. Following the inspection an application was to register with the CQC was submitted, which is being processed. 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.’

Not all aspects of the recruitment process were robust. Recruitment checks on prospective staff did not include information about their full employment history to ensure they were suitable to work with people.

People received their oral medicines as prescribed. However, not all aspects of the management of medicines were safe, in particular the use of prescribed creams was poorly documented.

Staff did not comply with the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. This was not being done and may have led to staff making unauthorised decisions on other people’s behalf.

DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The staff were not fully informed about DoLS protection; they had not taken the required steps to gain the legal authority to subject people to continuous supervision and control, including preventing them from leaving.

There were a range of audits and systems in place to enable the provider to monitor the quality of the service provided. However, the quality assurance system was not always effective because issues identified at the inspection had not been recognised during the auditing and monitoring process.

The senior management team had recognised improvements could be made at the service to benefit people living with dementia. People living with dementia would benefit from activities based on current good practice guidance for dementia care.

People said they felt safe living at the service because they knew staff were available when needed. People and their relatives said staff were caring, kind, friendly and respectful. Comments included, “…I want to say how kind people (staff) are…” and “I like it as it is. It’s very good I have got no complaints at all. They are very obliging if you want any help they give you what you want.”

The service ensured people were protected from abuse. Staffing levels were supportive of people’s needs. The provider used a ‘dependency’ tool to calculate staffing levels to ensure people’s needs were met. Risks to people’s health and safety had been identified and actions had been taken to reduce the risk of harm. Accident and incidents had been reported appropriately and regular analysis of accidents and incidents was used to identify any trends or changes that could be made to prevent recurrence.

People were supported to eat and drink enough and maintain a balanced diet. Staff, including the cook were knowledgeable about people’s individual nutritional needs. People had access to healthcare professionals to meet their health needs. Feedback from professionals showed the service worked in partnership with them for the benefit of people using the service.

Systems were in place to ensure the service was clean and that people were protected from

acquired infections. The service was clean, fresh and entirely odour-free throughout. The premises were well maintained and in good decorative order. However, the environment was not enabling for people living with dementia as physical features such as signage and colour schemes did not support their independence or help them with ‘way-finding’.

Staff had opportunities for regular training to enhance their skills and knowledge of working with people at the service. Staff said they were well supported by the management team.

Needs assessments and care plans were comprehensive in most respects, and regularly reviewed to ensure staff had the information needed to deliver safe care. People said the home took care to understand and respond to their needs and personal preferences. One person described responsive, observant, inclusive and flexible practice in how and when they received person care. A relative expressed confidence in the service and talked about its individual approach to meeting people’s needs.

People knew who to speak with should they have any concerns. The senior management team confirmed no complaints had been received by the service in the past 12 months.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.