Waterside Care Centre

Waterside Care Centre is registered to provide nursing and personal care for up to 47 people. This is a purpose-built home where care and support are provided to people aged 65 and over, including people living with dementia. At the time of the inspection 37 people were living at the home.

People’s experience of using this service and what we found

People were safeguarded and protected from the risk of avoidable harm. Staff demonstrated good infection prevention and control practice. There were sufficient staff to provide responsive and unhurried care. Medicines were managed safely, however, management and storage of topical creams required improvement. We have made a recommendation about management of topical creams.

People received an assessment when they joined the service to support the development of a care plan. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff helped people maintain a balanced diet and manage health conditions with support from other professionals as needed.

Staff were caring, compassionate and kind. Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity.

There was a positive and open culture, and the management team were approachable. There were systems in place to ensure people received good quality care. Staff were able to share their views about the service and people and their relatives were also able to five give feedback.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 July 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we had told the provider to take at the last inspection. We had carried out an unannounced comprehensive inspection of this service on 11 May 2023. Breaches of legal requirements had been found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, to meet people's nutritional and hydration needs, to ensure fit and proper persons employed and to improve good governance.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection re-ports and timeline’ link for Waterside Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Waterside Care Centre is registered to provide nursing and personal care for up to 47 people. This is a purpose-built home where care and support are provided for people aged 65 and over, this includes people living with dementia. At the time of the inspection 42 people were living at the home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Right Care:

People were supported to access health care appointments. Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. The provider had not always taken the necessary steps to ensure people were safe.

Right Culture:

Staff did not always have the training or understanding necessary to carry out their roles effectively. The environment and culture did not promote empowerment for the people that lived in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the care and lack of opportunity for people at Waterside. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waterside Care Centre Name of location on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care, personalised care, staff training and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Waterside Care Centre is registered to provide nursing and personal care for up to 47 people. This is a purpose-built home where care and support are provided for people aged 65 and over, this includes people living with dementia. At the time of the inspection 47 people were living at the home.

People’s experience of using this service and what we found

People living at the home and their relatives were happy with the standard of care they received. They felt people's needs were met and staff were skilful in supporting them to provide kind and compassionate care. Staffing arrangements were monitored and reviewed to promote people’s needs and safety.

Since the last inspection there was more consistency around staff knowledge about people’s identified risks and plans supported staff in their caring roles to keep people safe. Risks around eating safely and maintaining a healthy weight were identified and where necessary people were referred to healthcare professionals for advice. Medicines were managed by staff who had received the training to do so safely. Staff had received training in infection control and knew how to work to minimise the risk of infection.

People’s needs were assessed before they moved into the home. Care plans noted people’s care needs together with their preferences and dislikes so personalised care was promoted. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff involved people who lived at the home and their relatives in planning their care and were confident to raise any issues they had with the registered manager. Where people’s needs had changed staff practices continued to promote consistent care and support. People were supported by staff who knew their communication needs well and used varying methods to support people’s understanding.

People were supported emotionally and physically with activities which included sensory sessions and visits from external sources to bring enjoyment and interest into people’s lives. Staff supported people to be pain free at the end of their lives and for their wishes to be followed at this important time in their lives. Relatives were welcomed into the home and included in their family member’s care.

The provider had arrangements in place to monitor the quality and safety of the service. The registered manager took corrective action to resolve any concerns identified. Incidents and complaints were analysed, and learning was shared with staff. People living at the home and their relatives were encouraged to raise issues around quality and safety.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last overall rating for this service was Good (published 24 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waterside Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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 previously inspected Waterside Care Centre in August 2015. At the time of that inspection we rated the location as good overall. We found the safe question section to be requires improvement due to shortfalls in people receiving their medicines as prescribed in a consistent way to meet their health needs. The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection.

At this inspection there were some shortfalls in how risks to people’s welfare had been recorded and followed through in practice. Staff practices and recording of risks to people’s welfare did not consistently match the actions required to provide assurances the identified risks to people were always managed in a safe way. Although we found no evidence of people being harmed by these shortfalls the registered manager acknowledged improvements were required.

People's medicines were managed safely but there were some gaps in medicine records where staff had omitted to sign when people had received their medicines. Staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Staff knew how to recognise and report any concerns to keep people safe from harm.

The registered manager assessed staffing levels dependent on people's level of needs. People were supported by staff who had the necessary skills and knowledge to understand and meet people's needs. Staff felt supported and had access to training relevant to their roles. Staff put into practice the knowledge they had gained which included seeking people's consent before supporting them and respected their decisions. Staff provided information to people in a way they understood to support them to make their own decisions.

Staff supported people in a kind and caring way. Staff knew and respected people as individuals and kept people at the heart of all the care they received. People were provided with food and drink which met their individual needs and preferences. Staff enjoyed their work and created opportunities for people to have fun and interesting things to do which met and stimulated their different senses.

People were supported to remain as independent as possible due to staff knowing people’s individual likes and dislikes. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

People received individualised care which reflected their needs and wishes. People benefitted from flexible care and support which was responsive to changes in their needs and requirements. Relatives were given opportunities to comment on the quality of the service and felt comfortable to raise any concerns they had.

There was a positive working culture where staff and the registered manager worked together to provide good quality care. Relatives had mixed views about the management of the home but believed the care their family members received was safe and of a good quality. Quality checks were developed and implemented on an on-going basis to continually drive improvements in the service people were provided.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We saw that people who used the service felt safe at Waterside We saw that staff were kind and friendly towards them and usually provided the care and support they needed.

People were usually involved in day to day decisions and could make choices about what support they needed.

People's care records had been completed and these generally matched their individual care needs. We found that risk assessments were usually in place and that these made sure that people were not placed at risk of inappropriate care and support.

Systems were in place to manage people's medicines. These were not always sufficiently safe to ensure that people had received medicines and treatments in line with instructions. We were assured that improvements would take place.

We found that equipment had been checked and serviced at regular intervals to ensure it was safe to use

Systems were in place to make sure that managers and staff learnt from accidents and incidents. We saw that suitable action had been taken to reduce accidents and the risks to people. Systems were also in place to ensure that equipment was clean and safe to be used by staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoL's). We found that staff had knowledge of DoL's. This meant that people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed and care and treatment was planned and delivered in line with their individual needs. We found that relatives had been involved but this was limited.

We found from our observations and from speaking with staff that they had a good understanding of people's care and support needs. We found that people's mobility and mental health care needs had been taken into account in relation to the environment.

Is the service caring?

We saw that staff treated people kindly. We saw staff interactions were often supportive and respectful. Staff assisted people sensitively, whilst at the same time promoting their independence as much as possible. We saw that staff supported people and provided comfort and reassurance and usually gave people time to respond.

We saw that staff respected people's choices and they helped people to promote their own independence. We found that people were able to make choices about their food and drink and where they spent the day.

Is the service responsive?

We saw that people's views had been sought through satisfaction surveys.

We found that people were confident that any issues they had would be responded to in a timely way.

People received help and support from health care professionals when required such as doctors, dentist and chiropodists.

Is the service well led?

The registered manager had worked with other health care professionals and other services to ensure that people received the appropriate level of care they needed.

The quality of the service provided had been regularly assessed and monitored by the registered manager and the provider. The systems used had included obtaining the views of people who used the service and their relatives.

We saw that records identified any shortfalls and the actions taken to address these and make improvements.

Staff told us they received supervision. Staff felt supported by the registered manager.

During this inspection we spoke with the registered manager, members of staff, people that lived at the home and some of their relatives.

People were very complimentary about the care that was provided. They told us they were involved in planning their care. A relative said: 'We are very happy about X's placement here'. 'I am really satisfied with the care my wife receives'.

People's dignity had been respected. Relatives had been involved in supporting people with planning their care and their choices had been respected. Care was planned and records had been maintained. Reviews of care had been conducted regularly and changes made when necessary.

People were safeguarded from the risk of harm because staff had a clear understanding of their roles and responsibilities in this area. People had access to medical professionals.

Staff had been supported to do their work and told us that they had received appropriate training. Staff received regular training that enabled them to deliver care to an appropriate standard.

There were systems of audits in place to monitor the quality of the service provided. People were asked for their views about the home and these were listened to.