Waterfield House

Waterfield House is a residential care home providing personal care to 42 older people at the time of the inspection, some people were living with dementia. The service can support up to 76 people in one adapted building.

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

Since our last inspection a new manager was in post. People, staff and relatives were complimentary about the manager. Improvements had been made since our last inspection, including in staffing, staff morale and governance systems. The manager told us about their plans to further drive improvement in the service.

Systems were in place to provide people with a safe service. Risks were being assessed and guidance was provided to staff in how to reduce risks to people using the service. Staff were trained in safeguarding and the systems in place were designed to reduce the risks of abuse.

The service was clean and hygienic. There were infection control processes in place, including risk assessments and procedures relating to COVID-19. Relatives told us how they could visit their family members. Systems were in place to limit risks to people and visitors by, for example, personal protective equipment (PPE) and testing.

Medicines were managed safely, and people received their medicines when required.

The management team were regularly reviewing the staffing levels and call bell response times to reduce the risks of people not being provided with the support they need in a timely way.

There were systems to monitor the service provided and where shortfalls were identified they were addressed, and lessons learned to drive improvement. Improvements had been made in how people’s care was recorded and monitored.

Improvements had been made in how people were asked for their views of the service and these were being listened to and acted on.

Staff told us how the manager was supportive, and the staff team were strong and committed to providing a good service. We were told how the team had pulled together during the pandemic which had strengthened relationships with the staff and people using the service.

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 25 November 2020). There were two breaches of regulation relating to governance and staffing levels. 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

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.

We carried out an announced inspection of this service on 5 October 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Waterfield House 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.

We found the following examples of good practice.

COVID-19 related risk assessments were on display for staff to read and be aware of throughout the service.

The registered manager has created a designated area for new admissions into the service to self-isolate in. Once their isolation period is completed, the person will be moved to another room within the main service.

Further information is in the detailed findings below.

Waterfield House is a residential care home providing personal care to 54 older people, some living with dementia, at the time of the inspection. The service can support up to 76 people in one adapted building.

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

There had been changes in the management of the service since our last inspection. We found a breach of regulation regarding governance. The key question Well-led was rated requires improvement at our last inspection. At this inspection, Well-led had not improved to good and Safe had deteriorated from good to requires improvement.

People were asked for their views about the service in meetings and surveys. However, where people had raised issues in the last five meetings about staffing levels and food, prompt action had not been taken to address their comments regarding staffing.

We found shortfalls in the staffing levels in the service. People were not always provided with the support they needed in a timely way. We found a breach of regulation regarding staffing. The provider updated us on the action they had taken and were taking to address this.

Improvements were needed in records, to show people received the care and support they needed, including if they had enough to drink each day and ensure staff received the guidance they needed to meet people’s needs.

The current infection control systems in place reduced the risks to people. There had been no outbreak of COVID-19 in the service. Prior to our inspection, there had been a contagious outbreak, which was not COVID-19. During our inspection, we found improvements had been made to reduce future risks.

Staff were trained and understood their responsibilities in keeping people safe from harm and abuse. Risks to people were assessed and measures in place to reduce the risks.

The service had systems in place to learn from incidents and use them to drive improvement. A programme of audits were undertaken.

People received their medicines when they needed them. Medicines management was monitored and audited to ensure any shortfalls could be quickly identified and addressed.

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 16 November 2018).

Why we inspected

We received concerns in relation to staffing, care provided, record keeping, leadership and a contagious outbreak raising concerns about infection control processes. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We have identified breached of regulation in relation to staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection of 26 April 2016 the service was rated good. At this inspection the service remained good overall and good in the key questions of Safe, Effective, Caring and Responsive. However, we rated the service as requires improvement in Well-led.

Systems in place to record the administration of topical creams and the amounts fluids that people consumed were not always effectively recorded. People were being given sufficient amounts to drink of their choice.

There were clear plans in place to protect people from risks to their safety. Staffing levels of were appropriate to support people meet their assessed needs. There was a robust recruitment process for employing staff appropriately to care for the people living at Waterfield House. Other than the issue of recording the administration of topical creams people was receiving their prescribed medicines.

People were cared for by staff who received supervision and on-going training to develop their skills to support people with their assessed needs. The service had an established induction program in place to support new staff into the service.

People were provided with sufficient amounts and a variety of meals. The staff ensured that people were referred to professionals when they were unwell.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Care was delivered in an understanding and empathic way to meet people’s needs. People were supported by staff to make day to day decisions about their care. The staff respected people’s dignity and privacy.

Each person had a care plan which was based on an individual needs assessment and took into account people’s preferences. The care plans were reviewed regularly to remain up to date.

People were encouraged to engage with a variety of activities which had been developed from listening to the views of the people. People were aware of how to make a complaint and spoke positively about the staff and registered manager’s practice of acting quickly to deal with any concerns raised. The service had consulted with people and their relatives as appropriate to discuss plans of they wished to receive care should they become unwell.

People and relatives reported the service was run by knowledgeable and responsive staff with an open culture to listen to their views. The service consulted with people living at the service and their relatives regularly regarding their thoughts of the service.

Further information is in the detailed findings below.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, 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.

People were protected from the risk of abuse as staff had attended training to ensure they had good understanding of their roles and responsibilities if they suspected abuse was happening. The manager had shared information with the local authority when needed.

People were supported by a sufficient number of suitably experienced staff. The provider had ensured appropriate recruitment checks were carried out on staff before they started work. The staff had been recruited safely and had the skills and knowledge to provide care and support in to people of their choice.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Positive and caring relationships had been developed between people and staff. Staff responded to people’s needs in a compassionate and caring manner. People were supported to make day to day decisions and were treated with dignity and respect at all times. People were given choices in their daily routines and their privacy and dignity was respected. People were supported and enabled to be as independent as possible in all aspects of their lives.

The staff of the service knew people well and were competent in meeting people’s needs. Staff were supported and supervised in their roles. People, where able, were involved in the planning and reviewing of their care and support.

People’s health needs were managed appropriately with input from relevant health care professionals. People were treated with kindness and respect by staff who knew them well. People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health. Staff ensured that people’s health needs were effectively monitored.

People were supported to maintain relationships with friends and family so that they were not socially isolated. There was an open culture and staff were supported to provide care that was centred on the individual. The manager was open and approachable and enabled people who used the service to express their views.

People knew how to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions about the service. The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

We gathered evidence of people’s experiences of the service by observing how they were treated during our visit. We saw that people’s privacy, dignity and independence was being respected. Staff were observed to be polite and professional as well as demonstrating genuine care, affection and concern for people using the service.

We looked at care records and found that people had appropriate assessments and were cared for according to their needs. We found that staff were recruited appropriately, were well trained and had the skills required to provide safe care.

We saw that there were appropriate arrangements in place to ensure cleanliness and reduce the risk of cross infection at the service. We also found that there were effective systems in place to obtain peoples views about the quality of the service.

Our visit on 07 June 2012 and 04 October 2012 found that the provider had taken action to address the failings in relation to respecting and involving people, care and welfare, meeting nutritional needs, and staffing. We found that people’s privacy, dignity and independence was respected. People’s nutritional needs and weight were being monitored and where required dietetic referrals had been made. Where people’s needs had changed we saw that records had been reviewed to ensure that risks to their health and well being were being effectively managed. We reviewed the staff rotas and found that there were enough, qualified and skilled staff to meet people’s needs.

Our reports publised July 2012 and October 2012 reported our findings under assessing and monitoring the quality of service and safeguarding people who use services. This meant that the judgments previously made for respecting and involving people who use services, care and welfare, meeting nutritional needs and staffing were still showing as not meeting the standards. This review took place to confirm that these outcomes were reviewed on the above dates, where we found the provider was meeting the these standards of quality and safety.

People spoken with told us that the division of the home, into two units had made living in the home a lot better. One person commented, “It is more relaxing and I don’t get so scared of talking with other people using the service”. One person told us that “Things have improved over the last few months, we had lost the happiness, but now we are having happier days”.

Staff told us that the division of units meant there was less strain on staff. They told us that the atmosphere in the home was calmer, with less incidents of aggression between people using the service. One member of staff commented, “It is a happier place to work”.

Two relatives spoken with praised the service and the staff. They told us that the facilities, food and activities provided were to a very high standard and that, “The staff were very nice and helpful”. One relative commented, “It was an absolute god send that we found Waterfield House”.