We carried out a review of the data available to us about Waterloo House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Waterloo House, you can give feedback on this service.
Waterloo House is a residential care home providing personal care and accommodation to 31 people aged 65 and over at the time of the inspection. The service can support up to 35 people in one adapted building.
People’s experience of using this service and what we found
The provider was not registered to support people with mental health needs but one person living at Waterloo House needed this type of support. Staff were not trained in this area of care and an important incident involving this person had not been reported to us. Since joining Waterloo House, the registered manager developed a service improvement plan and understood the importance of continuous learning to drive improvements. There was a culture of openness and honesty and new systems for quality assurance and been introduced. Staff enjoyed working at Waterloo House and caring for the people who lived there.
People were supported by staff who understood how to keep them safe from avoidable harm and abuse. There were enough staff to meet people’s needs. Risks to people were assessed with clear guidance for staff to help manage them, and staff spoken with could identify when people may be at increased risk due to their health conditions or mobility. Effective infection control measures meant Waterloo House was kept clean, fresh and hygienic. Accidents and incidents were recorded and monitored to identify what actions could be taken to reduce the risk of them happening again. Medicines were managed safely and only staff who received training in medicine competency were allowed to administer medication.
People’s needs were assessed and used to develop care plans for specific health conditions and risks. Staff received training, induction and a period of shadowing to equip them with the knowledge and skills needed to support people safely. Staff could explain how they used their training to help look after people living with dementia including visual choices and techniques in safe hand holding during personal care. People accessed external healthcare promptly because staff monitored their health for signs of change and made relevant referrals when needed. Improvements were being made to the internal design and decoration of the premises and the garden.
People were supported by kind and caring staff who knew them well. Staff had time to understand people’s needs to support them safely and enjoyed spending meaningful time with people learning about their past and their families. The provider valued people’s views and their participation in care planning. New ways of encouraging opinion was being promoted and results of questionnaires were displayed throughout the home.
People received care that was personalised because their preferences were identified as part of care planning. Further improvements were planned in this area of practice. A new lifestyle and wellbeing coordinator was employed to maximise the availability of time available for people to spend engaged in meaningful activity. There was a variety of activities to suit individual needs including baking, smoothie making and crafts, as well as singers who regularly visited the home and annual garden parties. Information packs for people, relatives and visitors was displayed throughout the home providing information on the complaints process, quality assurance, and the role of CQC in response to feedback from relatives.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
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 9 September 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
Waterloo House is a residential home which provides care over two floors to older people including people who are living with dementia or a cognitive impairment.
Waterloo House is registered to provide care for 35 people. At the time of our inspection visit there were 33 people living at the home.
At the last inspection in May 2015 the service was rated ‘Good’ overall. At this inspection we found the service remained ‘Good’ overall.
There was a registered manager at the home however they were not present during this inspection. A temporary manager was managing the home and because of recent managerial changes, it was planned they would become the new registered manager once they had completed their application to become registered with us. A registered manager is a person who has registered with the Care Quality Commission 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 and relatives were pleased and satisfied with the quality of care provided. People were encouraged to make their own decisions about how they lived their lives, such as receiving their care and support in line with their expressed wishes.
People were supported to remain as independent as possible so they could live their lives as they wanted. People made choices about what they wanted to do for themselves, such as what to do, where to sit and what to wear. People were encouraged to maintain important relationships with family, and relatives felt involved in the support their family members received.
Care plans contained supportive information but needed to be more detailed and personalised for staff to help them to provide the individual care people required. For people assessed as being at risk, care records included information for staff so risks to people were minimised, although these were not always specific enough. However, we found staff knew how to support people to minimise identified risks and they knew how to keep people and others safe.
Staff knew how to keep people safe from the risk of abuse. Staff and the manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.
Staff understood people’s individual needs and abilities which meant they provided care in a way that helped keep people safe. Staff received essential and regular training to meet people’s needs, and effectively used their skills, knowledge and experience to support people.
People’s care and support was provided by a caring and consistent staff team. People told us they felt safe living at Waterloo House. Relatives were complimentary about the staff team, their caring approach and told us nothing was too much trouble.
The manager and care staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge ensured people received consistent support when they were involved in making some decisions. Care records did not clearly identify what decisions or support people needed if they lacked capacity. However, staff told us and we saw, staff sought people’s consent before they provided care and support.
People were supported and encouraged to pursue hobbies and leisure activities although some people said there was little to keep them stimulated. The manager was working to improve the variety and range of activities to make them more personalised.
People received meals and drinks that met their individual dietary requirements. Anyone identified at risk of malnutrition or dehydration, were monitored and if concerns were identified, advice was sought and followed.
People said the visibility and access of staff and management made them feel they could share concerns or complaints. The manager had an ‘open door’ for people, relatives, staff and visitors to the home. People said the visibility of the manager meant they could raise any minor concerns so they did not escalate into formal complaints.
A recent management change has had a positive impact on the staff team and the manager had a system of audits and checks to improve the delivery of service. The manager has prioritised those areas that need improvement such as care plans, risk assessments and seeking people’s feedback. The provider was confident in the manager’s ability to ensure improvements were made. The provider continued to have oversight of the service which gave them confidence that a good quality service was being delivered. The provider had submitted a Provider Information return (PIR) and they understood their legal responsibility to notify of us of important and serious incidents.
Further information is in the detailed findings below.
This inspection took place on 30 June and 1 July 2015 and was unannounced.
Waterloo House is a two storey residential home which provides care to older people including people who are living with dementia. Waterloo House is registered to provide care for 33 people. At the time of our inspection there were 33 people living at Waterloo House.
A registered manager was not in post. A new manager had been appointed and their application for registration was being assessed at the time of our visit. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.
All the people we spoke with told us they felt well cared for and safe living at Waterloo House. People told us staff were respectful and kind towards them and staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care and asked people for their consent before any care was given. Staff protected people’s confidential information from others.
Care plans contained accurate and relevant information for staff to help them provide the individual care and treatment people required. We saw examples of care records that reflected people’s wishes and how they wanted their care delivered. People received support from staff who had the knowledge to care for people.
People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent, which meant people received their medicines from suitably trained and experienced staff.
The provider had thorough recruitment procedures that helped protect people as necessary checks had been completed on potential staff before a decision was made to employ them at the home.
Staff understood the need to respect people’s choices and decisions. Assessments had been made and reviewed to determine people’s individual capacity to make certain decisions. Where people did not have capacity, decisions had been taken in ‘their best interests’ with the involvement of family members and appropriate health care professionals.
The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). The registered manager had contacted the local authority to make sure people’s freedoms and liberties were not restricted unnecessarily. At the time of this inspection, no applications had been authorised under DoLS.
There was an audit system that identified and improved the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received. If anyone had concerns, these were listened to and supported by the provider, manager and staff who responded in a timely way.
Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. We were able to speak with four people and a relative of a person who lived at the home. The people we spoke with were able to tell us about their personal experiences of what it was like living at Waterloo House.
Is the service safe?
People told us they felt safe living at the home. People told us the staff were kind and friendly towards them and provided the care and support they needed. People told us they felt safe because they were able to lock their own doors if they wanted to. People also told us they were involved in their day to day care decisions and could make their own choices about what support they needed.
Staffing levels were set by the registered manager and based on an assessment of the dependency levels of people who lived in the home. There were sufficient numbers of care and support staff on duty to meet the needs of people.
People's records had been completed at the required intervals and people's care records matched their individual care needs. We found people had appropriate risk assessments in place that made sure they were not placed at additional risk. We found people received care and support that met their needs and people received care in a safe and secure environment.
We found equipment was checked and serviced at the required intervals. We found the service completed regular housekeeping audits to make sure the quality of service people received met their needs.
We found the provider had made sure that all of the facilities were fit and safe for use. We found the provider had carried out regular maintenance and testing of equipment. We found the home was well maintained.
Is the service effective?
People's health and care needs were assessed and people had been involved in planning the care they received. We found care plans had been reviewed regularly and matched the care people required. We found care plans supported staff to deliver care and support to meet people's needs.
People were involved in how their care was delivered. Staff asked people for their consent before any care or treatment was provided. We found relatives had been involved in the planning and delivery of care people received where appropriate. This was important, especially for those people who lived at the home who were unable to make their own care decisions.
People's mobility and other needs were taken into account in relation to their environment. This enabled people to move around freely and safely and with the level of support that met their needs. The home had a lift which made it easier and safer for people to access other parts of the home.
Visitors we spoke with confirmed they were able to see people in private and that they could visit their friends and relatives whenever they wanted.
We found staff received the required training to support people effectively. We found staff had completed the necessary training which meant people were protected from receiving unsafe care or treatment.
Is the service caring?
Staff were attentive to people's needs throughout our inspection. We saw staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Waterloo House. We saw staff supported people and provided comfort and reassurance to people if they were upset.
People told us that staff respected their choices and staff helped them to promote their own independence as much as possible. We found people were free to make their own choices about food, drinks, bedtimes, personal care, clothes they wanted to wear and where they wanted to spend their time in the home. People told us they did not have to wait long when they needed help or support. People told us the staff were very supportive and friendly. We heard people ask staff if they could go outside in the garden and we saw staff supported people to do this.
Is the service responsive?
People received help and support from other health professionals when required, such as doctors, dentists and opticians. People were supported to participate in activities inside and outside of the home.
People told us that they were able to raise any concerns they had, although all the people we spoke with were satisfied with the service they received.
Is the service well led?
The service worked with other health professionals and services to make sure people received the appropriate levels of care they needed. We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service that people received.