Waterloo House

Updated 29 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

Our inspection was conducted by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Waterloo House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Waterloo House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager. However, a new manager (‘the manager’) was in post and had submitted an application to CQC to become the registered manager.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 29 September 2022 and ended on 5 October 2022. We visited the service on both dates.

What we did before the inspection

In planning our inspection, we reviewed information we had received about the service. This included updates provided to us by the local authority and CQC notifications (events which happened in the service that the provider is required to tell us about).

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

As part of our inspection we spoke with the manager; 1 of the directors of the company which owns the home; 4 members of the care staff team and a cook. We also spoke with 11 residents and relatives.

We reviewed a range of written records including 5 people's care plan; staff recruitment and training records and information relating to the auditing and monitoring of service provision.

Updated 29 November 2022

About the service

Waterloo House is a care home registered to provide accommodation and support for up to 35 people, in 1 adapted building. There were 18 people living in the home on the first day of our inspection.

People’s experience of using this service and what we found

Since our last inspection a new manager had been appointed. Although they had only been in post a few months, the new manager had already won the trust and respect of their team and had started to establish a positive organisational culture.

With support from an external consultant, head office personnel and senior staff in the service the new manager had worked hard to address the various concerns identified at our last inspection. Under their leadership, improvements had been made to moving and handling practice; provision of special diets; recruitment checks; safety of premises and equipment and staff training.

However, there was a need for further improvement in a number of areas.

There were continuing shortfalls in the provider’s approach to auditing and monitoring the quality and safety of service provision. Some people’s care plans and associated documents contained out-of-date or contradictory information.

People’s rights under the Mental Capacity Act (2005) were not consistently upheld and systems to prevent the spread of infection were not consistently effective.

The provider had failed to notify us of some significant events. We are currently considering our regulatory response to this issue.

More positively, medicines management remained safe. There were sufficient staff deployed to meet people’s needs. Staff knew how to recognise and report any concerns to keep people safe from harm. Staff communicated effectively with a range of external organisations. People received food and drink of their choice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was Inadequate (published 16 June 2022) and there were 4 breaches of regulations relating to care safety, staff training, safeguarding people from abuse and organisational governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also imposed additional conditions on the provider’s registration.

At this inspection we found improvements had been made. The provider had addressed 3 of the 4 breaches of regulations. However, there were continuing shortfalls in organisational governance resulting in 1 continued breach.

This service has been in Special Measures since June 2022. During this inspection, despite the continued breach of regulations, the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

We undertook this focused inspection to check whether the provider had followed their action plan, complied with the additional conditions of registration and now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-Led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waterloo House on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to the provider’s ongoing failure to ensure effective auditing and monitoring of service provision.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.