Waters Park House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and events within the service were recorded, reviewed and then acted on. The service effectively monitored for themes and trends. We found the management team were open and transparent and were taking action to drive improvement at the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had a close working relationship with the local acute and community NHS Trusts and also worked closely with other NHS Trusts across the South West. This was primarily for discharges into their care from acute hospital but also occasionally for admission to hospital.

The service had prepared information to go with people should they need to be admitted to hospital. This system of ‘passports’ ensured that important information on people’s specialist needs was taken to hospital with them should they need urgent medical care.

The service worked closely with their local and connected GP surgeries. These surgeries worked with the service on weekly ward round meetings to ensure that everyone in the service had immediate support for their often complex health needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were being treated with respect and their dignity maintained. For example, staff were knocking before entering peoples’ rooms, all support and care was given in private, and people were given privacy when they wished.

Due to the complex needs of many of the people using the service the provider was involved with local safeguarding processes. The service worked appropriately with the health and social care system to ensure people were safeguarded as necessary. Staff had adequate knowledge of safeguarding, and staff and managers were aware of safeguarding processes to use when necessary.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

Due to cognitive impairment some people had been assessed for their capacity to consent to leaving the home without support. We found all those who used the service without capacity to make informed choices, had a Deprivation of Liberty Safeguards (DoLS) application, or approved DoLS order put in place where required.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments relating to the health, safety and welfare of people using the service were completed. These assessments were detailed, clearly demonstrating what the risks were and how they were mitigated.

Relatives were present and involved in the regular Multi-Disciplinary Team (MDT) meetings. At these MDT meetings people and their relatives were involved in the discussion of how to manage and mitigate people’s risks while enabling people to have active fulfilling lives.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service was clean, tidy, generally in good repair and felt homely. However, there were areas, particularly in corridors, which needed refurbishment, largely due to damage from wheelchairs. There was an area of flooring in one corridor that was unsafe as it was a trip hazard. This area of hallway had been identified in the business plan, and a date set for the necessary work to take place. The floor in this area of corridor was to be lifted, relevelled and the flooring replaced, but this work had to take place during the night to enable normal activity in the home during the day.

The business plan also included the full renovation and refitting of 2 flats. These renovations involved substantial work as each flat contained kitchenette areas and shower rooms as well as bedrooms.

The fire protection system was safe. However no routine fire system safety audits of the equipment were taking place between the annual servicing visits. These visual checks were introduced by the end of our assessment.

The service had just finished a full refurbishment of the outside area of the building to provide a more comfortable and useable area for people to use. This included providing full wheelchair access and more covered areas so that people were protected from the sun when outside.

The service had additional facilities to support rehabilitation. There was a separate gym, although most clinical sessions for physical rehabilitation took place in people’s own living spaces. There was also a supervised kitchenette, and a food and drink preparation area, separate from the home’s central kitchen. This provided an area for rehabilitation support to take place with people.

The provider did not always make sure staff received effective supervision and development and training.

A low number of care staff had completed the mandatory training as required by the provider. This was largely because the service attempted to deliver almost all their training in person with a trainer. This inevitably made completing training more complex and harder to achieve. The registered manager said they had struggled with training completion lastyear and they had not recovered from this situation. The service managers said they would consider changing some of their training to on line training packages, to ensure that staff had their essential training routinely available. In the short term the registered manager said the clinical staff would provide guidance to the staff. A senior staff member said, “Although some people are out of date (with safeguarding training) we talk to the staff about safeguarding with lessons learnt in staff meetings, if we have something like an incident. So, it is something that is spoken about regularly.”

Specialist training, such as medication administration competency checks and PEG (Percutaneous Endoscopic Gastrostomy) feeding tube system training, were fully up to date for the nursing staff.

The provider always made sure there were enough qualified, skilled and experienced staff.

The service had a high level of staffing in place. This was partly due to several people needing to have individual staff to support them with certain activities. However, even taking this factor into account, and without the inclusion of the clinical staff who also took part in personal care, there was a high ratio of care staff to people that used the service. On our first visit to the service there were 20 people using the service and there were 14 care staff working during the day.

The service was providing individual supervision to all care staff, delivered by the senior staff to different roles. Central records were not being kept of supervision sessions taking place, but we were able to identify this information from other sources. The care staff had received supervision regularly and within each 4 month period as required by the provider’s policy.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Throughout our assessment visits we found the service was clean. People’s relatives commented positively about how well cleanliness was maintained by the service. There were several domestic staff who took care to maintain cleanliness in all areas of the home.

Personal Protective Equipment (PPE) was fully available to staff, and they were using it consistently during their work. Staff used different levels of PPE depending on the person’s individual needs. Clinical waste was being appropriately disposed of using specific waste bins. The system for the management of waste reduced the potential for cross infection.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medication administration was well managed and medication stock levels carefully monitored to ensure the home was not holding more medicines than necessary. People’s medicines were stored in separate sections within cupboards in the medication room, and these were kept clean and tidy.

The service continued to operate a paper based system for the administration of medication. We checked these paper records and found they were well maintained. The service will be transferring to electronic system of administration in the near future. When an electronic care planning and recording system is introduced, the administration of medication will also be managed electronically.

There was a good working relationship with a local pharmacy, which included the effective reordering of medicines. This pharmacy will continue to support the service after the transition to electronic medication administration and so this effective relationship will be maintained.