Waterloo House

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 Some people’s care plans and associated documents contained out-of-date or contradictory information.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.

Waterloo House is a residential care home providing personal and nursing care to up to 35 people. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 27 people using the service.

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

People were at risk of injury as their mobility needs were not safely assessed. Areas of the service needed repairs and could not be effectively cleaned; this increased the risk of injury and infection. Environmental risks were not mitigated, and people had access to areas where they could be harmed. Medicines were not securely stored. People were not always protected from the risk of abuse as the provider did not always inform the local authority and CQC of safeguarding concerns.

There were risks people’s dietary needs may not be met increasing the risk of choking and complications associated with poor management of diabetes. The provider did not always make referrals to relevant professionals for people to have expert advice on managing their health-related conditions.

Quality assurance systems were not effective and needed improvement. There was a lack of management oversight in reviewing incidents and accidents. However, we found that the staff treated people with dignity and respect.

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 6 December 2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident. The information CQC received about the incident indicated concerns about the management of people’s mobility needs . As a result, this inspection did not examine the circumstances of the incident.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end 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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, safeguarding, good governance, leadership and management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

On the day of our inspection 28 people were living at the service.

At our last inspection on 12 January 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service and were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed, and care plans set out how to minimise any risk identified and were monitored for any changes needed.

People continued to receive an effective service. Staff received all the training and support they required to meet people’s individual needs, including their nutritional needs. Staff worked well with external health care professionals and people were supported to access health services when required. People were supported to make their own choices and staff cared for people in the least restrictive way possible. The registered persons had processes in place which helped make sure that when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

CQC is required by law to monitor the operation of the MCA and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Through our discussions with the registered manager and staff we were assured they understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing day to day support and care to people. DoLS were in place where needed to protect people when they did not have capacity to make decisions and where it was considered necessary to restrict their freedom in some way, usually to protect them from risks. At the time of our inspection, 16 people were subject to an active DoLS authorisation and the registered manager informed us they were awaiting the outcome of one further application which had been submitted to the local authority for approval.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People were involved with assessing and planning for their care needs and regularly reviewing the arrangements in place. They were supported to pursue their individual interests and hobbies, and group social activities were offered. There was a complaints procedure in place and people and their relatives knew how to raise any concerns or formal complaints if they needed to. Staff knew how to escalate any concerns they may have and told us they felt well supported by the registered manager and provider.

The service continued to be well led. People, their relatives and staff were encouraged to give their views on how the service was run. There was an open and transparent and person-centred culture within the service. The registered manager and provider worked well together using the audit systems they had established to ensure they regularly checked on and reviewed the services they provided so they could take any action needed to keep on improving them.

People we spoke with said they were happy with the care they received. They made comments such as, "I am on first name terms with all the staff and they seem to understand all our conditions" and "There is nothing I can fault. They (staff) go beyond the call of duty."

People experienced individual care and support from staff who respected their privacy and dignity. Staff promoted people's independence by helping them to make choices and decisions about their lifestyles wherever they could do so.

People were supported to have a varied and nutritious diet which took into account personal preferences and choices.

We found the home was clean, tidy and well maintained and provided people with a comfortable and homely environment. Where any safety risks were identified we were told how these were being addressed. Bedrooms were individually furnished and decorated according to people's individual preferences.

We also found there was an effective system in place for the provider to monitor and assess the quality of services within the home.

People told us they were happy living in the home, one said, "In my opinion, this is one of the best homes around." One resident's relative told us, "I have no concerns at all, absolutely none."