Waterfield House

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 69 (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 did not always have a proactive and positive culture of safety based on effective investigation and recording of incidents.

The service had systems in place for reporting, reviewing and analysing incidents, accidents and events. However, the recording of lessons learnt was generic. Recording did not always provide a clear picture of what the situation had been, what happened, and action taken to prevent recurrence.

Staff meeting minutes demonstrated that areas identified for learning such as infection control and safeguarding were discussed at team meetings with a view to driving improvements in the service.

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.

People told us they felt welcomed when they moved into the service. A person told us they, “Came a week ago, it’s very pleasant, people are helpful.”

The registered manager told us that people’s care needs were assessed before they moved into the service. When people moved into the service, they received a welcome pack with information about g staff uniforms and mealtimes. The welcome pack also asked for information from people such as the activities they enjoyed. This supported people to settle into the service and staff to get to know them.

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 told us they felt safe at the service. A person said, “I feel safe, it is the attitude of the helpful staff, they are always around.”

Staff understood their responsibilities to protect people from abuse and harm. Staff had received training and knew how to recognise the signs of abuse and how to report. Staff were confident their managers would take any concern seriously. A staff member said, “If I suspected abuse, I would speak to my management team and if I felt nothing was being taken seriously, I would take this higher and also to CQC.” Information about reporting abuse was available to people and visitors including visible signage in the service. Staff were able to describe people’s rights to make unwise decisions for example, smoking.

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 Act 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 make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks associated with people’s individual care and treatment needs had been assessed and were regularly reviewed. Care plans had comprehensive risk assessments and corresponding care plans, so staff knew what action to take to reduce any risk of harm. The service used nationally recognised assessment tools and evidence-based guidance such as Malnutrition Universal Screening Tool (MUST) and Waterlow score to assess pressure ulcer risk.

Behavioural tools were in place to help staff minimise behaviour that communicates a need, emotion or distress, and how to respond safely and consistently. However, staff recording on these did not always support their effective use. The registered manager gave assurances they were addressing this through staff meetings and further training.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People told us the physical environment met their needs. A relative said, “Seen the dining room and [family member’s] room, very neat, very clean, no smells, not fussy and private shower room.”

The environment was designed to meet the needs of people living with dementia this included appropriate signage. The registered manager told us how leaving the doors open between units had resulted in people showing less distressed behavior as they were able to move around more freely.

Health and safety audits and checks were completed regularly on the environment, premises and equipment. The management team also completed daily walk arounds to check the environment was safe. Fire risks were assessed, and staff had completed fire safety training and participated in regular fire drills. Personal emergency evacuation plans had been completed and these informed staff and emergency services of how to support people to safely evacuate the building. Systems and processes were in place to regularly test the water supply from the risk of legionella a water bacteria that can cause serious ill health.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We received mixed views from people and relatives as to whether there were sufficient staff. One person said, “They need more staff, often hard to find someone,” but another said, “Staff are very kind and do what they can for you, the buzzer hangs there and when I use it they come very quickly, if you press they don’t take long to come day or night – if I need help I know that they will come.”

The provider used a dependency tool to assess people’s individual care and treatment needs and to determine safe staffing levels. The registered manager told us staffing levels were reviewed regularly to ensure safe staffing levels were maintained at all times. Staffing had recently been increased following the admission of 2 new people.

We observed staff supported people in the least restrictive way, allowing them space while also being available as soon as any support was required.

Staff were recruited in a safe way. Staff files did not always demonstrate that appropriate pre-employment checks had not been completed. The provider had identified this shortly before our inspection and was taking action to rectify deficiencies.

Induction training was provided to new staff and this included ‘shadowing’ experienced staff. Staff then went on to complete the care certificate which is a nationally recognised induction training to ensure they were aware of expected standards within the sector.

Staff completed mandatory training and additional training the provider had identified as required. All staff completed a range of staff competencies, including additional clinical care tasks by nurses and healthcare staff. Staff training data confirmed good compliance. Staff confirmed they received the training and support they required, and this included ‘supervision’ with their line managers so performance and any training or development needs could be discussed and planned. A staff member said, “I have regular training manual handling, safeguarding, dementia.”

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.

Surfaces and equipment were clean, equipment not in use was stored safely. Staff had received training in infection prevention and control, and they had access to personal protective equipment (PPE). There were audits and checks in place to ensure staff followed correct procedures. During our visit we observed staff using PPE appropriately. Staff told us they had access to good supplies of PPE. Housekeeping staff were polite and considerate when cleaning people’s rooms and returning their laundry.

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

People told us they received their medicines as prescribed. A person said, “Have tablets twice a day and they stay with me when taking them.”

We observed that staff supported people to take their medicines in a safe and caring manner. Medicines audits were completed regularly to check that systems were safe. Staff had received training in medicines management and had their competency assessed regularly.They worked with external healthcare professionals and raised concerns promptly when needed. However, there was no robust process in place to provide a clear audit trail when medicines were administered by external staff. This meant that staff may not know if a medicine has been administered or not.

Records showed that people were receiving their regular medicines safely. Some records relating to medicines management needed improvement. For example, staff did not always record where patches were applied, which is important to prevent skin irritation from repeated use on the same area.Guidance for 'when required' (PRN) medicines, such as pain relief, was available however, this was not always person-centred. Where variable doses were prescribed, there was often no clear instruction on what dose to administer or when. Where multiple PRN medicines were prescribed for the same condition, there was no guidance on which order they should be administered in.