We inspected The Adelaide Nursing Home on 18 January 2018. We carried out this comprehensive inspection due to information of concern we had received. The Adelaide Nursing Home 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 Adelaide Nursing Home is registered to accommodate up to 35 people, some of whom were living with dementia and other chronic conditions. The Adelaide Nursing Home is comprised over two floors, with a communal lounge/dining area and garden. There were 32 people living at the service during our inspection.

A registered manager was 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 and associated Regulations about how the service is run.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, quizzes and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ mana

We carried out this unannounced inspection of The Adelaide Nursing Home on 11 April 2017. We previously carried out a comprehensive inspection at The Adelaide Nursing Home on 31 March 2015. We found areas of practice that needed improvement. This was because we identified issues in respect to the provision of meaningful activities. The service received an overall rating of ‘good’ from the comprehensive inspection on 31 March 2015.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found improvements had been made. The overall rating for The Adelaide Nursing Home remains as ‘good’.

The Adelaide Nursing Home provides personal care, accommodation and nursing care for up to 35 people. On the day of our inspection there were 33 older people at the service, some of whom were living with dementia and chronic health conditions. The service is spread over two floors with a passenger lift, communal lounge/dining room and a garden.

People enjoyed taking part in meaningful activities both in the service and the community. One person told us, “I like to do knitting, [member of staff] helps me with that. I have my TV and radio in my room. I do go downstairs. I do anything that’s going on. I’ve done the arts and crafts and bingo, I get involved when I can”.

People and relatives told us they felt the service was safe. One person told us, “I call them my adopted family, they look after me so well”. Another person said, “They know what they’re doing. It’s no problem, I feel safe”. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider continued to have arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. One person told us, “Oh yes, some are a little more skilful than others, but they’ll learn in time. Some have obviously been at it a little longer so they are a little defter”.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People and relatives also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs continued to be met and people reported that they had a good choice of food and drink. One person told us, “There’s a very good choice of food. I’m asked what I like and they tell me what there is and I usually have what I ask for. I have my lunch in my room or sometimes in the garden”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. One member of staff told us, “[Registered manager] is constantly putting us on training and improving our education. Supervision helps us to stay reminded of good practice and not get lax. Supervision is important”.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team and this was observed throughout the inspection. One person told us, “My carer is

The inspection took place on 31 March 2015. The Adelaide Nursing Home was last inspected on 6 June 2013 and no concerns were identified.

The Adelaide Nursing Home is located in Hove. It is registered to support a maximum of 35 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. The home is two converted houses set over two floors. On the day of our inspection, there were 31 people living at the home.

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.

The home had some arrangements in place to meet people’s social and recreational needs. However, we could not see that activities were routinely organised in line with people’s personal preferences. Feedback from people clearly indicated this need was not being addressed, in particular for people who remained in their rooms and wished to have one to one interaction. We have identified this as an area of practice that requires improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps taken by the service to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were encouraged and supported to eat and drink well. One person said, “The food is quite good, not like school dinners”. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Staff had received regular supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People felt well looked after and supported and we observed friendly and genuine relationships had developed between people and staff. One person told us, “I feel very well cared for here. No problems at all”. One staff member told us, “It’s our priority to see that the residents are happy. We need to make sure they get what they want”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and completed surveys showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “I do feel listened to yes, and I know the sister would sort anything out for me”.

Care plans gave detailed information on how people wished to be supported and were reviewed and updated regularly.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where management were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service.

We found a breach 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 this report.

During our inspection we spoke with two people who used the service and three visiting relatives. We also spoke with five staff members; these were the area manager, a registered nurse, two care workers and the maintenance worker. We also took information from other sources to help us understand the views of people who used the service.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us “It’s great here, I like everything”. Staff we spoke with had a good understanding of the support needs of the people who used the service. One member of staff we spoke with told us “We allow people to be as independent as they want to be here. We treat them with dignity and respect, and respect their choices”.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service. The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

We saw that the people who used the service were in safe and secure premises that promoted their wellbeing. We also saw that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.

People said there was a pleasant atmosphere in the home, and people were friendly. Staff have the right skills, and managers and staff are approachable. People are being well cared- for. People enjoy the meals and have a choice about what they have to eat.