Watford House Care Home

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to premises and equipment and the ways people’s medicines were managed.
 

This service scored 53 (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. They had actively engaged with an action plan developed in partnership with a local stakeholder and had made clear progress in implementing improvements to enhance the safety and quality of care provided.

The provider had effective systems in place to identify, review and learn from incidents, accidents and complaints. The provider maintained records of these events, with the registered manager undertaking timely reviews and follow-up actions. Incidents and accidents were analysed monthly to identify patterns and trends, enabling lessons learned to be shared with the staff team.
 

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. Although the provider had temporarily paused new admissions, they had taken steps to strengthen their admission and transition processes to ensure people received care that met their needs from the outset. The registered manager completed comprehensive pre-admission assessments to understand people's care and support needs and determine whether the service could meet those needs safely and effectively. A moving-in checklist was used to identify and assess any risks, with appropriate risk assessments and care plans developed and shared with staff through handovers to promote continuity of care.

The provider recognised the importance of involving people and those close to them in transition planning. The registered manager told us they worked closely with people's relatives and representatives throughout the admission process and completed a review after 7 days to ensure people had settled well and that their needs continued to be met.

Relatives spoke positively about the support provided during transitions. One relative told us, “It was organised well; [family member] got the room my [other family member] had previously and they recognised it. That was very nice for 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 and their relatives mostly told us they felt the service was safe and knew who they would contact if they had concerns about their own safety or the safety of others. Staff also told us the home was a safe place to live and work and did not raise any concerns regarding people's wellbeing or protection.

The provider had safeguarding systems and processes in place to identify, record and respond to concerns. This included safeguarding reporting procedures, regular monitoring and analysis of safeguarding events, and an up-to-date safeguarding policy to guide practice. Staff received safeguarding training and demonstrated an understanding of how to recognise potential signs of abuse and the action they should take to keep people safe.

The provider responded appropriately when safeguarding concerns arose. At the time of our assessment, a safeguarding incident had been reported to the local authority and an investigation had commenced. Leaders took immediate action to address identified inconsistencies within one person's care plan while the matter was being reviewed.

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 where people were subject to a deprivation of liberty, the provider had implemented appropriate safeguards and processes.
 

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 care and support needs had been identified, assessed and documented within care plans and risk assessments. These provided staff with guidance on the actions required to minimise risks while supporting people to achieve the best possible outcomes.

The provider demonstrated a person-centred approach to risk management and recognised the importance of positive risk-taking. The registered manager told us they worked with people to ensure risks were managed appropriately without unnecessarily restricting their independence. For example, a person with limited mobility was supported to take a few steps independently if they chose to do so, while mobility aids and additional support were readily available to reduce the risk of harm should they be needed. This enabled people to remain as independent as possible while maintaining their safety.

Where people had specific health risks, suitable measures were in place to reduce the likelihood of harm. For example, where people were at risk of developing pressure damage, appropriate assessments had been completed and interventions implemented, including regular repositioning and the use of pressure-relieving equipment.

Relatives spoke positively about the way risks were managed within the service and told us people had access to appropriate equipment and support to keep them safe. This included measures to reduce the risk of falls, such as sensor mats and other assistive equipment.

However, a relative made us aware that their family member was not always receiving appropriate support with their dietary requirements and this presented a risk to their health and well-being. The provider had been made aware of this and were taking appropriate action to prevent reoccurrence.
 

The provider did not detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The provider had failed to ensure the premises were adequately maintained, clean, and suitable for the people living there. Throughout the assessment, we observed significant concerns within the environment, including areas of damp, damaged décor, broken radiator covers, worn furniture, missing ceiling tiles, and cracked walls.

The condition of the building had the potential to negatively impact people's safety, comfort and wellbeing. Walls, doors and bannisters throughout the home were heavily scuffed and chipped, and we observed staff experiencing difficulty when manoeuvring people in wheelchairs through some doors and walkways.

Environmental hazards had not always been addressed in a timely manner. In one downstairs lounge, a previous leak had resulted in visible signs of damp and possible mould growth. The affected ceiling remained stained and had not been repaired or replaced. In addition, some radiators had no covers or had damaged covers, creating a risk of injury to people using the service.

The registered manager and the staff team had identified a number of environmental concerns and had reported these issues to the provider. However, timely action had not been taken prior to this assessment to address the maintenance and cleanliness concerns identified. Following the assessment, the provider has taken steps to prioritise key areas requiring improvement, and work had commenced to address these issues and improve the safety, quality and overall condition of the environment.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

During our assessment, we observed occasions where people experienced delays in receiving support. For example, a person waited more than 15 minutes for assistance to use the toilet. Staff appeared busy and stretched at times, which impacted on the quality of care people received. We observed an occasion where one member of staff was supporting three people to eat their meals simultaneously. This approach did not always promote a dignified dining experience or enable people to receive individualised support. We also found communal lounge areas were not consistently supervised, which meant there was a risk that changes in people's needs, wellbeing or safety may not be identified promptly.

Feedback regarding staffing levels was mixed. Some people and relatives felt there were enough staff available to meet people's needs, while others told us people sometimes had to wait for assistance. Staff did not raise immediate concerns about people's safety; however, they consistently described the service as busy and told us additional staff, particularly during peak periods, would improve their ability to provide effective care and support.

Although staff worked hard to meet people's needs and there was no evidence of people experiencing immediate harm as a result of staffing levels, our observations showed staffing arrangements were not always effective in ensuring people received timely, person-centred care and support. This meant people's experience of care was not consistently positive.
 

The provider did not assess or manage the risk of infection. They did not detect and control the risk of it spreading or share concerns with appropriate agencies promptly. During our assessment, we identified widespread concerns regarding cleanliness, hygiene standards and the maintenance of equipment and facilities throughout the home.

Communal seating and equipment were not maintained in a clean and hygienic condition. We sampled five pressure cushions across the home and found all were visibly unclean, stained and emitted a strong odour of urine when unzipped. Chairs beneath the cushions were also visibly dirty and contained sticky residue. Pressure-relieving equipment is used by people who can be at increased risk of skin damage and infection. The poor cleanliness of this equipment placed people at risk of exposure to harmful bacteria, compromised their comfort and dignity, and did not promote safe care.

Doors, door frames, windowsills and skirting boards throughout the home had a noticeable build-up of dust and dirt, indicating these areas had not been cleaned for some time. This meant people were living in an environment that did not consistently promote good hygiene and infection prevention practices.

Standards of food hygiene and storage were not consistently maintained. The kitchen environment was visibly unclean, with food residue present on walls, floors, sinks and within the refrigerator. We found multiple food items that had been opened but were not labelled with opening or use-by dates, several uncovered food items stored in the fridge and cupboards, and one food item that had exceeded its expiry date by several months. These findings demonstrated poor food hygiene practices and increased the risk of food contamination, which could result in people becoming unwell.

Bathroom and toilet facilities were also found to be in a poor hygienic condition. Multiple bathrooms and toilets throughout the home were visibly unclean and had strong unpleasant odours. We observed toilets and raised toilet seats with faecal staining, as well as unclean bathing equipment, including bath and shower chairs. Window sills, radiator covers and flooring contained visible dirt, dust and staining. In addition, parts of the flooring had become damaged and lifted, creating areas where dirt could accumulate and making effective cleaning more difficult. Grouting and silicone seals were also in poor condition, further impacting the cleanliness and maintenance of these areas.

Further concerns were identified regarding people's personal hygiene and the general cleanliness of the environment. Some people had long and unkempt fingernails, and a strong odour of urine was evident in parts of the home.

The provider had failed to ensure robust infection prevention and control arrangements were in place. As a result, people were exposed to unnecessary risks of infection and were living in an environment that did not consistently support their safety, comfort, dignity or wellbeing.
 

People were not always protected from the risks associated with the unsafe management of medicines. The provider had not ensured robust systems were in place to support the safe storage, administration and oversight of medicines. During our assessment, we identified concerns relating to medicine records, stock management and the storage of medicines, which increased the risk of medicines not being managed safely.

Medicine Administration Records (MARs) contained gaps in recording, with missed staff signatures identified. This meant it was not always possible to determine whether people had received their medicines as prescribed. We also found discrepancies in medicine stock counts. The quantities of some medicines held did not correspond with the recorded stock levels, indicating medicines were not always being effectively monitored.

Medicines were not always stored safely and in accordance with best practice. For example, we found food supplement drinks left unattended on the top of the medicines trolley in the dining area. Unsafe storage arrangements increased the risk of medicines becoming inaccessible when required, deteriorating in quality, or being accessed by unauthorised individuals. This placed people at potential risk of harm and did not provide assurance that medicines were being managed appropriately.

Following the assessment, the provider took immediate action to address the concerns we identified. A full medicines audit was completed to identify and rectify any discrepancies in recording, storage and stock control. Staff received additional training to reinforce safe medicines practices, and further assurance measures were implemented to strengthen oversight and monitoring of medicines management.