Waterloo House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s needs were met through good organisation and delivery.

This service scored 68 (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 make sure people were at the centre of their care and treatment choices or decide in partnership with people, how to respond to any relevant changes in people’s needs.

There was some information in people’s care plans about what was important to them including their own personal preferences and physical health. However, some elements of people’s care plans would benefit from further details. For example, more personalised information around how to safely support 1 person with their personal care to minimise their distress and anxiety. Staff were aware how to reduce the person’s anxiety, so they did not come to harm. People and relatives were not always aware of their care plan information. One person said, “I’ve not seen a care plan, I don’t think I’ve ever had a review.” Another person told us, “I can’t recall anything about a care plan.” The registered manager told us people were involved but we suggested work was done to ensure people were given more opportunity. What was clear from people’s comments was that staff were responsive to their requests if they wanted or needed anything.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Relatives felt supported and encouraged to continue playing an important role in caring for their family member. People and relatives were comfortable with staff saying, “They are quite kind I don’t have a problem with any of them. They treat me very well” and “They are all very kind and they talk to me nicely.” The management and staff team had built effective partnership working with external healthcare professionals and commissioners of services so people could be confident of receiving the care they needed at the right time. Health professional feedback was positive and showed care for people was considered and planned so it could be as responsive as possible.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Individual care plans included whether people had any sensory needs and the support they needed. For example, whether they required hearing aids or spectacles. Staff knew which people required sensory aids and reminded people to wear spectacles and to use their hearing aids.

Care plans included guidance about people’s ability to understand and communicate and how they needed information to be shared with them. Information was available in accessible formats. For example, there was signage to help guide people around the home and literature could be produced in large print or picture format. The registered manager used notice boards in communal areas to tell people and relatives about important events, activity sessions and how improvements had been made around the home.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

We found most people and relatives told us they were not aware of or involved in the care plan or ongoing reviews. However, people and relatives felt any decisions or changes to their care were communicated with them. We recommended the registered manager consider how they involved people and relatives in care plans reviews.

People felt comfortable to raise any concerns or share feedback but no one we spoke with had needed to. People and relatives said they were not always aware of any meetings but there were other opportunities to raise anything they wanted to. This included directly approaching the registered manager and deputy manager who were always visible in the home.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Assessments before people moved into the home helped the provider know, if they could meet people’s needs from the start. Assessments formed care plans and information from family members helped shape people’s care and support needs. External health professionals told us any referrals made to them were timely and any advice they gave was followed. One health professional told us, “Staff consistently take proactive and preventative actions to support people to remain well and avoid deterioration. They are alert to early signs of changes in a person’s condition and understand when and whom to escalate concerns to.”

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The staff team received training across various subjects to help them promote people’s rights and provide the support people needed. This included recognising people’s strengths and where some people and relatives needed more support. Staff recognised the importance of promoting equality and diversity to improve outcomes for people. One senior staff member explained how they knew which people had sight or hearing difficulties, so they tailored their approach accordingly.

Staff recognised the importance of promoting equality and diversity to improve outcomes for people. One senior staff member explained how they knew which people had sight or hearing difficulties, so they tailored their approach accordingly. Some people and relatives spoke positively about staff, around their understanding, compassion and how well they treated them. External health professional feedback gave us a sense that where people needed access to health and treatment, they received it or were referred to those who could help.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

During our visit, no one was receiving end of life care. Care plans had some basic information about whether people wanted to be resuscitated in the event of a cardiac emergency. End of life care was looked at monthly when people’s care needs were evaluated. The registered manager said GP and frailty nurse input was always sought. The registered manager said, “We do have end of life preference forms, we usually do plans when the time arrives and have that conversation, but some are more detailed.”

One health professional told us how staff had recently supported a family as their relative’s health had deteriorated. They told us, “The person’s family and appointed deputy were struggling with the emotional impact of the person’s gradual decline, and there were increasing concerns about potential hospital admission due to unmanaged symptoms and escalating distress.” They went on to say, “This difficult discussion ensured that everyone had a shared understanding of the person’s needs and wishes.”