Housing 21 - The Watermill

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 63 (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.

The registered manager had systems in place to ensure learning was taken from incidents and events. Supported by the provider’s quality assurance team, they reviewed any events to ensure any required changes or improvements could be made. This review also included steps taken to mitigate future risk, and any changes to people’s care were shared with the staff team. One staff member told us, “If there are any mistakes made throughout the home, we do get a newsletter with lessons learned. If I had made an error, I’d have a 1 to 1 meeting with a senior and they would ask why, how, and what could be changed?”

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 staff team worked closely with external health and social care professionals to ensure people’s needs were met. Where people’s needs changed, the staff team sought advice from relevant healthcare professionals, such as occupational therapists, to enable them to receive support for their mobility or physical health.

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 and relatives told us they, or their family members, were safe at The Watermill. One person told us, “I feel very safe here, I get on great with the staff, they are all very nice. I feel cared for.”

There were systems in place to ensure any concerns for people’s safety were escalated and referred to the local authority when necessary. The registered manager completed a closed culture assessment annually, to support good practice in safeguarding and safeguarding champions within the home contributed to monthly lessons learned forums. Staff knew how to identify concerns for people’s safety and wellbeing and how to raise any concerns. One staff member told us, “A change in client’s behavior, not their usual self are they isolating more? Are they not eating as they usually would? Marks or bruises. I would inform whoever was on duty at the time and document it on their significant sheet, body map if needed. I would follow It up afterwards. I am confident something would be done about it.”

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. We found that DoLS were applied for when necessary to ensure people who lacked mental capacity were lawfully supported.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Information about people’s risks was not always recorded consistently in people’s care plans. For example, where people had been involved in incidents, information had not always been updated in their care plans to reflect this. However, staff we spoke with were aware an incident had taken place. Where people were at risk of developing sore skin, we found gaps in records relating to repositioning. The registered manager was aware of these concerns and measures had been put in place to drive improvements in this area.

For other people, risks had been assessed and guidance was available for staff to follow about how to safely support them. This included people’s nutritional and hydration needs as well as support when people became anxious or distressed.

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.

We found chemicals that could be harmful to people were not always stored securely within the home, as secure doors were not always locked. We also observed items stored in communal bathrooms which could pose a risk to people. We shared these concerns with the registered manager who took immediate action to ensure people’s safety.

However, signage was available throughout the home and outside people’s bedrooms to aid orientation and regular checks and audits were undertaken in relation to health and safety to ensure the home environment was safe for people.

The provider did not always make sure there were enough qualified, skilled and experienced staff. However, staff received effective support, supervision and development.

We received mixed views from people and relatives about whether there were enough staff to meet people’s needs in a timely way. While no-one suggested people were at risk, examples were shared with us about possible delays in care needs being met. For example, 1 relative told us there were sometimes delays in staff serving meals, as staff had to support people with personal care. Staff shared similar examples with us of how they sometimes struggled to balance people’s needs across each area of the home. One staff member said, “We could do with another staff member [at] certain times of the day. With double-up calls it’s hard as someone who is at high risk of falls is left on their own in the lounge, we could sometimes do with a third staff member. The float [staff] works well but we haven't always got 1.”

However, others expressed more positive views, with 1 relative commenting, “There is always staff around, there’s enough of them. They have the time to talk to her and us.”

We observed staffing throughout various areas of the home throughout the day and saw people’s needs were met in a timely way. We discussed people’s concerns with the registered manager who shared with us the tool they used to calculate staffing levels; this was reflective of people’s needs. They told us the staff team gave mixed feedback during team meetings and so information had been shared with them to explain decision making. They told us they would keep staffing levels under review as people’s needs changed.

Staff had mostly received training relevant to their role and this gave people and relatives confidence in their support. Training included the care certificate, assisted moving, eating and drinking and medication administration.One relative said, “The staff are brilliant. They use the hoist very safely. I can tell they have been trained.” We identified not all staff had received training in catheter care and the registered manager told us this would be arranged without delay.

There were effective recruitment systems in place to ensure staff were safe to work with people.

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.

People spoke positively about the cleanliness of the home. One person said, “My room is nice and clean.” There were cleaning schedules in place to ensure both personal and communal spaces were regularly cleaned to minimise the risk of infection.

Staff had received training in infection prevention and control (IPC) and understood their responsibility to reduce the risk of cross infection. One staff member told us, “IPC keeps everyone safe and healthy. Personal Protective Equipment and washing hands regularly, offering clients to wash their hands also.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

At the time of the inspection the provider was introducing a new digital recording system for the administration of medicines. This was being trialled in 1 area of the home. We identified an error in administration for 1 person, where stocks of medicines did not match the administration records. A member of the management team later confirmed this was due to an error in administration.

However, in other areas of the home, systems used for the management of medicines were safe and people received their medicines as prescribed. People and relatives expressed satisfaction with the support they received around their medicines. One relative told us, “[Person] is definitely safe here. Once they had to give her meds 15 minutes late and they called us to tell us. They weren’t time specific medicines, but they cared so much to let us know.”

Controlled drugs, which are subject to specific storage and recording guidelines were managed in line with good practice guidance. Where people were prescribed ‘as required’ medicines there were clear protocols in place to ensure these were given safely.