Waterloo 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 72 (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.

The registered manager told us they used opportunities through their monthly checks and meetings with senior staff to look for ways to improve people’s outcomes. Accidents and incidents were analysed to identify any themes and people’s care plans were updated. Where additional measures were needed to manage incidents through falls, this was taken. For example, the registered manager told us of 1 person who had their hearing reviewed after a series of falls. The introduction of hearing aid had reduced the person’s falls. The registered manager also reviewed monthly, people’s weights, any infections and people’s use of equipment to ensure people continued to receive the right care. Staff were kept updated of any changes to people which helped them provide the right levels of care.

During our onsite inspection, we shared some of the improvement actions we identified around fire safety checks and medicines management. Before we concluded our second visit, the registered manager had started to consider ways to address those issues.

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.

Relatives felt timely actions were taken if their family member needed to see any health professionals to manage any health or changing medical conditions. A relative told us they were keep updated if there were any changes and if longer term solutions were needed, what those were.

Senior staff communicated essential handover information about people’s care needs at shift changes. This meant staff had up to date information about people’s needs and whether extra observations or referrals to health professionals were required.

The registered manager told us their electronic systems could produce important information about the person if needed. This ensured any risks around the person’s care, for example in relation to their mobility, cognition or nutrition, were shared with other healthcare professionals. A GP told us they liaised with the deputy manager to review people who were acutely unwell, new admissions and post hospital discharge reviews.

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.

People told us they felt safe living at Waterloo House. A typical comment was, “I’m safe yes, I’m never frightened. The staff are good, they look after me.” Another person said, “I’m safe, oh yes, it’s because everyone is nice to everyone else.” A relative shared how they felt when they left their family member in the company of staff and commented, “[Person] is safe, I am absolutely confident. They (staff) didn’t know I was coming today and he looked fantastic. I can’t fault this place as a dementia care home.” People said if they asked for staff help, they were attended to promptly so they did not ever feel neglected.

Staff knew what constituted poor practice and staff shared with us, what they would do to protect people. A typical response was, “I would remove the staff member, make sure the person was safe and report it to the manager. We have telephone numbers for other departments such as safeguarding (local authority).” Staff knew they had to report any incidents, and they were confident any incidents of poor practice would be dealt with by the registered manager.

The registered manager knew how to report any concerns to us and how to escalate concerns to local authority safeguarding teams. From reviewing records, we could see 1 example where the registered manager had reminded staff around the importance of responding to people who used their emergency call bell. This showed us the registered manager was alert to ensuring people continued to receive safe treatment.

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. Where people had restrictions in their care plans which staff felt they did not have the capacity to consent to, the provider ensured DoLS applications had been submitted to the relevant supervisory body.

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.

People told us they felt safe when staff supported them and relatives felt staff managed risks safely. One relative said, “Staff have to hoist [person] and there’s always two of them. [Person] has a pressure area at the moment, so they get them up and put them to bed periodically.” Another relative said their family member could fall from bed so there was a mat at the side of the bed to alert staff to go to the person if they began mobilising.

Assessments were carried out to identify any potential risks to people’s overall health. Individual care plans guided staff of the actions they needed to follow to manage and reduce identified risks to keep people safe. Where people needed equipment to maintain their safety, this was identified and risk assessed. During our visit, we saw 2 staff use a hoist to transfer a person from their chair to a wheelchair. Staff made sure, footplates were in the right position before they moved the person. Where people needed pressure relieving mattresses to maintain skin integrity, these were set correctly to provide the right support.

However, 1 person had behaviours that could cause them and others distress and there was limited information to tell staff how to manage those risks. When staff supported this person with personal care, there was some aspects of the person’s care plan that needed updating to ensure staff provided consistent support. The registered manager assured us they would review this and other people’s records to ensure they remained accurate.

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

A dedicated maintenance person was responsible for ensuring the health and safety and environment was safe for people. The maintenance person said they had been at the home for a long time and understood how to keep the premises safe. We saw regular checks were completed on health and safety, fire safety and water quality. We found some fire doors did not always close shut into the door jambs. The maintenance person agreed to undertake further checks to make any adjustments required so people remained protected in the event of an emergency situation.People raised no concerns with us about their home environment. People could access the communal areas and where necessary, people had aids to help them navigate the home. Garden space was available to people which they enjoyed during better weather.

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.

No one raised any concerns about staff’s suitability or experience to care for them. Yet, we were given mixed views from people about the number of staff available to support them at certain times. Some people felt at busy times staff were not always on hand to support them, while others said staff were always available and if they needed assistance, it was provided.

Our observations showed there were enough staff to meet people’s immediate needs for assistance, as well as providing a staff presence in communal areas. However, we did see opportunities for staff to engage more with people in communal areas. The training and recruitment manager recognised at times, staff were task focussed and this was an area for improvement.

Staff did not raise any concerns about staffing levels but said there were times they could be busy, or if staff called in sick at short notice. The deputy manager and registered manager told us they would support staff to ensure people were safe. A relative confirmed the registered manager was visible in the home.The registered manager was confident current staffing levels matched people’s needs but said if needed, staffing levels would be increased. Staffing levels were based on people’s individual dependency so if needs increased or decreased, the registered manager evaluated their staffing to reflect people’s needs.

Systems to check the suitability of staff before they commenced employment were effective. The provider made sure all safe recruitment checks were made and recorded. Recruitment checks included references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions. Staff accessed relevant training to develop their skills and effective inductions of new staff made sure they were suitable to look after people. The recruitment and training manager said they completed observations of staff practice and spot checks to make sure they continued to provide safe care.

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.

Waterloo House was clean and there were no unpleasant odours. Housekeeping staff kept the home clean and minimised the risks of infection. Housekeeping staff used colour coded mops for certain areas to minimise cross infection risks. Colour coded bags helped separate people’s laundry items for effective laundering. Personal protective equipment [PPE] was accessible to staff, together with guidance about maintaining good hand hygiene and maintain good practice through refresher training.Staff were seen to wear PPE at the right times, when providing personal care to people. Before people received their lunch, a staff member offered people a hand wipe and asked if they wanted to wipe their hands before they ate. This helped minimise any cross-infection risks.The registered manager told us they recently requested infection prevention control officers from the local authority to come to the home to give them the assurance their practices kept people protected from cross infection.

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

People told us they received their medicines safely and staff supported them to take them as prescribed. One person said, “I do take medication, they give it to me, they do wait” and another said, “The girls (staff) provide me with my medication, they always wait while I take it. I have had no problems.”

We found some improvements were required to better record when people received their medicines. For example, some people were prescribed medicines to be given at set times before food or drink. We could not be confident this was done because there were insufficient records to support this. One person had their medicines administered covertly (disguised in food or drink) and although the pharmacist had approved this, there was no information on how to give this safely, for example in certain drinks or foods. Following our visit, the registered manager confirmed they had got clear directions from the pharmacist.

Some medicine administration checks were completed but these were not adequate and, in some cases, recorded. The registered manager assured us; any future checks would be recorded. We found medicines were stored within safe temperature ranges and for medicines administered ‘as and when’, there were protocols in place to advise staff how to give them safely. The training and recruitment manager told us they completed observed practice to ensure staff administered medicines safely. They confirmed staff who administered medicines were trained and their competency checks completed throughout the year.