- Care home
Trafford Waters Care Home Also known as Tanglewood Shared Services Limited
Assessment report published 23 June 2026
Contents
Ratings
Our view of the service
Date of assessment: 26, 27 and 31 March, 25 April 2026.
Trafford Waters Care Home provides personal care to older adults, including people living with dementia. The service is registered to accommodate up to 85 people. At the time of the inspection there were 41 people living at the home.
The assessment was triggered by intelligence from the local authority about poor standards of care. The local authority had been working with the provider and had agreed to a temporary suspension of new referrals and an action plan was put in place.
This was the home’s first assessment since becoming registered. It has been rated requires improvement. We identified 5 breaches of the legal regulations. The service was in breach for person centred care, safe care and treatment, meeting nutritional and hydration needs, staffing, and good governance.
Staffing levels and the support provided to staff were a key theme throughout the assessment. Staffing levels had been increased following a local authority visit in February 2026, and additional support was introduced to improve staff deployment and organisation. Further training was also being provided. However, our observations and feedback from people, staff, relatives and the local authority indicated these improvements were not yet sufficient. The service had not ensured there were enough suitably qualified, competent, skilled and experienced staff to meet people’s needs effectively. This had been further compounded by poor staff retention, high sickness rates, low morale and reports of poor leadership.
We observed many interactions during the assessment that were not person centred. Staff were often too busy or lacked the experience and training to engage effectively with people who had conditions such as dementia.
People did not always receive appropriate support to eat and drink in line with their care plans. When people lacked capacity for example, they did not always receive the prompts and encouragement required to support them at mealtimes.
Records did not always demonstrate medicines had been administered as prescribed. Where errors had been identified, lessons learned had not been effectively embedded in practice, as similar issues continued to reoccur. This meant it was not always clear how robust these processes were.
There had been a comprehensive response from the provider to the concerns raised by the local authority in February 2026. A new manager had also been recruited and the provider continued to work in partnership with the local authority to make the required improvements.
In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.
We have also asked the provider for an action plan in response to the concerns found at this assessment.
People's experience of this service
We received positive feedback about the kindness of staff, and no concerns were raised about their conduct. However, there was a clear theme reported to us was about staffing levels and the impact this had on the quality of care.
People told us, “They are a bit short of staff, they are a bit thin on the ground at weekends, and I have to wait a bit longer.” Families told us, “It’s hard, the staff are lovely, but they aren’t experienced and haven’t many life skills. When [relative] needs toileting, we have been helping with the toileting as there is no one about and they are so short staffed” and “However, sometimes they need someone in the rooms and others are left in the lounge and there is no one to help them, they are definitely understaffed.”
Residents and families did not report any concerns related to discrimination and inequality during the assessment.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Most of the interactions observed were poor and were mostly task focused. We did observe some positive interactions, and staff were doing their best, but they were often too busy to do this consistently.
A survey completed by relatives was completed in January 2026, saw a small number of responses received. Just under half of those who responded shared negative views about the quality of care. All respondents rated the friendliness and compassion of staff highly. Relatives’ meetings were also held in February and March 2026 to gather further feedback.
People living at the service attended regular monthly meetings, where they were supported to share their views, make suggestions and provide feedback about their experiences. In addition, several formal complaints had been received during 2026.