Adisham House

Adisham House is a ‘care home’. People in care homes receive accommodation and personal 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. Adisham House is registered to provide accommodation and personal care for up to 10 people. The home specialises in providing care to people with learning disabilities and the registered provider was working within the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our inspection there were nine people living in the service. Accommodation is arranged over three floors.

At our last inspection we rated the service as Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

There was a registered manager at the service. The provider was also 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.

People felt safe living at Adisham House with the support from the staff. Accidents and incidents, including safeguarding matters were recorded, investigated and reported in a timely manner to the local authority or CQC as necessary.

People experienced a service that was safe. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and people were supported to take positive risks. The premises were maintained and checked to help to keep people safe.

The service was extremely person-centred and staff were proactive in making sure that people were supported to live fulfilled and meaningful lives. Person centred means that care was tailored to meet the needs and aspirations of each person, as an individual. The vision of the service was shared by the staff.

The provider had an excellent oversight of the service and knew the staff well. Staff told us the registered manager and head of care were approachable and they were confident to raise any concerns they had with them. Staff were supported to fulfil their role in meeting people’s needs. The complaints policy was accessible to people using the service.

There were enough staff employed to meet people's needs. Staff were recruited safely and recruitment processes were robust. Staff training was up to date, and the team had a mix of skills, knowledge and experience. Staff had opportunities to enhance their skills and knowledge and all were qualified in health and social care.

The registered manager supported staff through supervision and appraisals which were held regularly and recorded. Competency checks were carried out to ensure staff remained competent in their role.

People were given their medicines safely and when they needed them. Policies and procedures were in place so that people took their medicines when needed. People were supported to remain as healthy as possible and they had been given access to specialist healthcare professionals who could support people with a learning disability.

People had access to the food and drink that they enjoyed. People were supported to choose what they wanted to eat. Peoples nutrition and hydration needs had been assessed and recorded.

Staff knew people well and we observed they treated people with respect and ensured their privacy and dignity were maintained. People and a relative told us staff were kind and caring.

People were central to the support they received. Care and support was planned with people and their relatives and reviewed to make sure people continued to have the support that they needed. People were encouraged to be as independent as possible.

People took part in activities of their choice within the service and in the local community. People could choose what they wanted to do each day. There were enough staff to support people to participate in the activities they chose.

Processes were in place to monitor the quality and they regularly asked people for feedback about the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall and this was displayed on their website.

Further information is in the detailed findings below.

Adisham House is registered to provide accommodation and personal care for up to ten people. People living at the service had a range of learning disabilities. Some people had physical disabilities and occasionally required support with behaviours which challenged.

Downstairs there was a lounge, conservatory, kitchen and dining room. There was also three bedrooms and a wet room which was utilised by people whose mobility had recently declined. There were six further bedrooms on two additional floors and two bathrooms (one on each floor.) At the time of the inspection there were nine people living at the service.

The service had a registered manager in post. A registered manager is a person who is 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 service had been run by the same family for over thirty years. People and their relatives repeatedly told us that they thought the service was “fantastic” and “there is no where else I’d want my family member to be.” Most people living at the service had lived there a long time. There was a small stable staff team who knew people well. Staff were kind and caring and people consistently fed back that they were extremely happy living at the service. People were treated with respect and dignity at all times.

People were encouraged to be as independent as possible. Staff had researched innovative and creative ways of helping people access the activities they wanted to. People were involved in writing their support plans and associated risk assessments. Several people’s mobility was declining due to their healthcare needs and they had been supported to remain as independent as possible. When people moved to the service there had been obvious improvements to their quality of life, such as a reduction in medication and the ability to do new things. People were actively involved in writing their support plans and risk assessments. They identified goals to work towards and these were consistently met.

There had been no complaints about the service in the past year. There were regular residents meetings where people could share their views on the service. One person was supported to write up the minutes of the meetings so they were easy to understand. Relatives were regularly surveyed to ask for their feedback. One relative told us, “I get their surveys and I have never put anything but excellent.”

People said they felt safe. Potential risks had been identified and recorded and there was clear guidance in place to help manage them. Staff carried out regular health and safety checks to the premises and equipment to ensure they were safe and working properly. Regular fire drills occurred to ensure people and staff knew what to do in an emergency.

There was a safeguarding policy in place which outlined different types of abuse and what to do if staff had any concerns. This policy did not currently contain the three new categories of abuse listed in the Care Act 2014. The registered manager said they would update this immediately. Staff knew how to recognise and respond to different types of abuse.

There was enough staff to support people at all times. Staffing levels were flexible depending on people’s needs and what they were doing each day. All of the appropriate recruitment and safety checks had been completed before staff were able to start work. Medicines were stored appropriately. People received their medicines when they needed it and were encouraged to be as independent as possible when taking it.

Staff had received training to ensure they could support people effectively. People’s healthcare needs varied greatly and they were supported to retain their independence by doing exercises and using aids and adaptions as necessary. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. People were supported to eat healthily. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and supported people to make their own choices. People signed their care plans, giving consent to their care. People were able to come and go as they pleased.

The registered manager ensured that the quality of care was high and carried out regular audits. Staff told us that the service was well led and that the management team were very supportive. People and their relatives both said they felt the service was “home” and had a “family” feel. People were fully involved in the running of the service and all participated in cooking cleaning and gardening.

People were taking part in activities in the community and at home. People were encouraged to be fully involved in the running of the service including taking part in the gardening, cooking and cleaning. One person said that they had support to do their laundry and to keep their bedroom clean and tidy.

People told us about their recent holidays and one person said that they were already planning their next holiday. People's hobbies and interests were supported and people had support to achieve the personal goals and aspirations.

People maintained good health because the service worked very closely with health and social care professionals. The home was safe and well maintained and suited people's needs.

Staff were supported and supervised and given the training they needed to provide a good quality service. There was enough skilled and experienced staff to meet peoples' needs and staff engaged with people in a calm, respectful and reassuring manner. Robust recruitment checks meant that people were supported by suitably vetted staff.

People told us or indicated that they felt safe and well looked after.

People indicated that they could express any problems to the staff who would listen and act. People indicated that they thought the staff were kind and caring. Staffing was planned around individual needs and activities.

People looked happy and relaxed in the company of each other and staff. We saw that people took part in a range of community based activities that they enjoyed. People went to and returned from various clubs and activities on the day of our visit.

People expressed that the home was clean and that their bedrooms were kept clean. People had support to take part in the cooking and cleaning and had the opportunity to go food shopping and prepare their own meals. People were fully included in the running of the home.

People's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.