Waterloo House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment, we rated this key question as requiring improvement. At this assessment, the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment, and support did not always achieve good outcomes or was inconsistent.

The provider was previously in breach of the legal regulation in relation to the premises. Improvements were found at this assessment, and the provider was no longer in breach of this regulation. However, we have identified 2 additional breaches of legal regulations. The provider was in breach of the legal regulations relating to person-centred care and the need for consent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were either unable or chose not to tell us if they had taken part in an assessment of their needs before receiving support at Waterloo House. However, people expressed confidence in the staff who supported them and were aware the staff kept records regarding their care and support needs. Relatives did not provide any feedback on the assessment process.

The provider had systems and processes in place to help ensure people’s needs were fully assessed prior to offering support. The registered manager told us people's needs were assessed before they started using the service. Information from these assessments was used to develop care plans and risk assessments. However, we found people’s support plans were not being regularly reviewed or updated when people’s needs changed. For example, we reviewed 5 care and support plans and found these contained conflicting information, lacked detail and were not accurate. Risk assessments lacked sufficient guidance about how to manage or mitigate risks, which potentially placed people at risk of harm, as detailed within the safe section of this report.

This meant support plans and risk assessments were not always reflective of people’s needs and lacked essential guidance for staff. This contributed to the breach of regulation in relation to person-centred care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Systems were in place to ensure care was delivered in line with best practice guidance. For example, nationally recognised risk assessments were used to assess risks, such as the Malnutrition Universal Screening Tool (MUST) and Water Low Risk Assessment. However, we found these records were not being regularly reviewed or kept up to date as people’s health needs changed and did not contain sufficient information to mitigate risks. For example: pressure area care, diabetes, and self-neglect. Records for one person instructed staff to monitor and record the person’s blood pressure, pulse, and SATS daily. However, staff had not been provided with any information about what a good range looked like or when they should escalate concerns.

Staff had received training to ensure they were informed about and kept up to date with best practice guidance. However, we found training did not always determine practice.

The failure to provide safe care and treatment that met people’s needs and reflected their preferences contributed to a breach of regulation in relation to person-centred care.

People told us they were happy with the support they received at the service. Comments included, “Yeah, it’s fine here, I’ve enjoyed it,” “The staff are always polite and kind,” “This is a nice place, they’ve (staff) got respect for me”. A relative said, “I have no concerns with how they support [Person’s name]; the staff are wonderful.”

Staff knew people’s likes and dislikes and appeared to have a good awareness of people's dietary needs. Care records highlighted where risks with eating and drinking had been identified. Where people needed a specific diet, this was provided in line with their assessed needs, and senior staff were knowledgeable about the extra support some people might need to maintain nutrition and hydration.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice, and control. Staff did not always support people to live healthier lives, or, where possible, reduce their future needs for care and support.

Records confirmed staff supported people to attend a range of appointments with dentists, opticians, GPs, and local mental health support. Staff told us they reported concerns with regard to people’s mental and physical health to the management team and made referrals to healthcare professionals as needed. The registered manager said, regular handovers enabled the sharing of information about people’s health needs. However, whilst staff understood people’s needs, and escalated concerns, support plans and risk assessments did not always provide detailed information about individuals’ changing needs or contain clear guidance for staff on how to manage them. For example, staff told us that one person was receiving end-of-life care. However, we found there was no end-of-life care plan in place. There was limited information within people’s support plans about how they could be supported to develop life skills and increase their independence. There was little evidence to show how people participated in the development of their care and support. This contributed to the breach of regulation in relation to person-centred care.

People who chose to share their views with us did not raise any concerns with how they were empowered to make decisions, supported to lead healthy lives or increase their independence. However, 2 people told us they had not had their medication reviewed since living at the service, and one person said, “Sometimes I feel isolated, there are no activities here”.

Relatives had confidence in the staff and told us their loved ones were supported to manage their care, support and health needs by staff who knew them well. Comments included, “[Staff member name] tries to address any health conditions that pop up and ensures his physical health checks are done properly,” another said, “Staff arranged for [person’s name] nails and hair to be cut and the dentist to visit. When [person’s name] had a medical issue, they arranged for him to be admitted to the local hospital.

The provider had systems and processes in place to effectively monitor people’s health and well-being. However, we found these were not always effective.

The registered manager and staff described how they monitored people’s health and care needs regularly to ensure risks were mitigated and people received care according to their assessed needs. However, we found some care and support plans lacked detail of the support people needed to meet their assessed needs, develop life skills, increase their independence, and there was limited information about how people were being involved in the development of their support. For example, the registered manager told us about a person who was waiting for a medical procedure due to a deterioration in their health. However, a letter from the hospital confirmed the person had made a recovery and no longer needed the procedure. This information had not been used to update the person’s support plan. Records for another person showed inconsistencies in blood glucose levels, which had not been escalated in line with the guidance provided by healthcare professionals.

Staff had a good understanding of how people communicated and used this knowledge to support people to make choices about their everyday needs. However, one person’s support plan stated that staff used communication aids in the form of a diary and a whiteboard to communicate, thus enabling the person to understand and retain information. When we asked, none of the staff or managers were aware of this information and confirmed the whiteboard was not in place.

The governance lead told us people were involved in identifying their support needs and were involved in the care review process. Support plans were not accessible to people, and there was limited information to show how people were involved in developing their care and support. More work was needed to ensure people were truly involved and seen as partners in their care.

The provider’s failure to ensure people's care was appropriate, met their needs and reflected their preferences contributed to the breach of regulation in relation to person-centred care.

People who wished to share their views with us spoke positively about the support they received. Relatives did not raise any concerns about the way their loved ones were cared for, and felt staff kept them up to date with changes in people’s needs.

Staff described how they monitored people’s health and care needs to ensure risks were mitigated and people received care according to their assessed needs. For example, staff described how they monitored people’s skin for red marks, applied prescribed creams, helped people reposition at regular intervals to relieve pressure and escalated concerns to the management team and/or external healthcare professionals as needed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We found people were not always supported to have maximum choice and control of their lives, and staff did not fully understand their roles and responsibilities under the Mental Capacity Act 2005 (MCA), including Deprivation of Liberty Safeguards. For example, where restrictions had been placed on people’s care and support to keep them safe, this was not recognised by staff as restrictive practice, and people’s capacity to consent to these arrangements had not been assessed, nor had staff followed a best interests process.

The registered manager told us they had submitted a DoLS application to the local authority for consideration. However, the service had assessed the person as having capacity, and there were no restrictions placed on this person’s care and support.

Mental capacity assessments were not always clear; there was a lack of information about who took part in the assessment or what their views were.

The provider had a clear policy and process in place to help ensure people were supported to understand their rights. Records showed, and staff confirmed they had received training in safeguarding adults, the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager and staff described the importance of obtaining people's consent and following the principles of the Mental Capacity Act. However, we found that this knowledge and understanding were not applied consistently, nor did it determine practice.

The failure to accurately assess and record people's capacity and best interests’ decisions risked compromising people's rights. This contributed to a breach of regulation in relation to consent to care and treatment.

People who were able to share their views with us told us they felt safe living at Waterloo House; they were able to come and go as they pleased and make their own decisions. One person said, “I struggle to make bigger decisions, I have an advocate that helps me.” Another person told us they were not happy living at the service. They understood their rights and were in the process of challenging the need for the placement with the local authority. Relatives did not raise any specific concerns about how the service supported people to understand their rights. One relative said, “They [meaning staff] are very respectful of his wishes.” Another said, “I do feel they respect my views.