Waters Edge Care Home

Waters Edge Care Home is a residential care home providing personal care for up to 63 people aged 65 and over across 2 floors. At the time of our inspection there were 58 people living at the home, some of whom were living with dementia.

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

People were supported by trained staff who safeguarded them from harm. People were supported in a timely way by staff who knew them well. People received their medicines safely. People were supported by staff who were following infection control guidance.

Where things had gone wrong the registered manager reviewed concerns and took action to ensure improvements were made. People had care plans and risk assessments in place which explored their needs and risks and gave staff clear guidance to meet these.

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. People and those important to them were involved in the care planning and review process.

People were supported to eat and drink in line with their needs. People received care in line with their needs and preferences. People had timely access to health and social care professionals.

The quality of people's care and support was regularly reviewed to ensure where any improvements were required these were made. People, relatives and staff were encouraged to feedback about the care and support and action was taken to address any feedback where required.

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 requires improvement (published 15 May 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service and information shared by the Local Authority about potential improvements at the home.

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.

We undertook this focused inspection to check whether the provider had made improvements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

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 requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

We found the following examples of good practice.

• The provider had implemented a visiting policy during the pandemic. Visitors to the home were required to wear a fluid resistant mask and complete a Covid-19 health questionnaire prior to entry. Visitors were also required to undertake a temperature check.

• People could see their relatives, when restrictions allowed, in a visiting room with a glass partition which ensured social distancing. Visitors and residents could access the room via separate entrances and communicated with each other using a microphone and speaker system.

• People’s emotional wellbeing was observed and where concerns were identified, measures were implemented to promote positive wellbeing. For example, one person was supported to move to a different room so they could safely access the garden without having to mobilise through a corridor where people had tested positive for Covid-19.

• PPE was worn by staff in line with current guidance. Donning and doffing rooms and staff changing facilities had been created to enable staff to change Personal Protective Equipment (PPE).

• Staff were well supported by the management and the Human Resources department provided welfare calls to promote their wellbeing.

• Staff risk assessments were undertaken and where staff members were assessed as high risk due to underlying health conditions, measures were put in place to mitigate risk to staff.

Waters Edge is a care home that accommodates 63 people in a purpose built residential home for the elderly. Support is provided on two floors. There are various communal areas, including lounges and dining rooms that people can access. The home also has an adapted garden.

People’s experience of using this service:

At the last inspection in June 2018, the service was rated as Good overall.

The care people received was not always safe. Measures put in place to keep people safe were not always effectively implemented in the home. Records were not always up to date to reflect people’s current needs. Individual risks to people were considered and reviewed when incidents had occurred. Staff raised concerns about staffing levels and these had not been reviewed to reflect changes made in the home. Safeguarding procedures were in place and these were followed. Medicines were managed in a safe way. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The provider had introduced a more robust system as a safeguarding concern had not previously been shared across the home. The action the provider had told us they had taken to keep people safe had not always been fully completed. There were audits in place which were effective in continually developing the quality of the care that was provided to them. Feedback was sought from people and relatives who used the service and this was used to make changes. Staff felt supported and listened to.

More information is in the full report.

Rating at last inspection:

Good (Last report published 14 June 2018)

Why we inspected:

We carried out this focused inspection as we received information of concern about the management of unwitnessed falls within the home.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Waters Edge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Waters Edge is registered to provide accommodation for up to 63 people. There are two floors which both have various communal areas for people to access including, communal lounges and dining areas. There is also a large garden area for people to access. At the time of our inspection 50 people were using the service.

There was a registered manager in place. 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.

As some capacity assessment were not in place, people were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Relatives consented on behalf of people when they did not have the legal power to do so.

There were enough staff to support people. People felt safe and were supported by staff who knew them well. The provider had suitable recruitment processes in place to ensure staffs suitability to work within the home. Staff understood how to recognise and report potential abuse. They felt listened to and were assured action would be taken if concerns were raised. Individual risks had been identified for people and staff had the information needed to keep people safe. Medicines were administered, stored and recorded to ensure people were protected from the risks associated to them

People were supported in a caring way by staff they liked. They were encouraged to remain independent and make everyday choices. People’s privacy and dignity was maintained. When people needed support to access health professionals this was available for them. Visitors were welcomed in the home. People enjoyed the food that was available to them and were offered a choice. People were also offered the opportunity to participate in activities they enjoyed.

Staff received an induction and training that helped them offer support to people. Staff knew people well including their likes and dislikes. And care plans were written and reviewed in line with current legislation. There were infection control procedures within the home that were effectively implemented. People knew how to complain and there were procedures in place in relation to this.

Staff felt listened to and had the opportunity to raise concerns. The registered manager understood their responsibilities around registration with us and notified us of significant events that occurred within the home. There were systems in place to drive improvements within the service. People and relatives had the opportunity to raise concerns and suggest improvements and we saw these were considered. When needed lessons had been considered and learnt so that improvements could be made.

Our last inspection took place in March 2016 and we found when people lacked capacity to make certain decisions capacity assessments had not been completed and best interest decisions were not in place. We also found the provider did not have systems and reviews in place that were effective in identifying areas of improvement. We found that not all the information which was recorded was accurate.

The service was registered to provide accommodation for up to 63 people. At the time of our inspection 55 people were using the service.

There was a registered manager in post. 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.

When people were not able to consent, mental capacity assessments and best interest decisions were not completed. The systems in place did not always identify areas of improvements and the provider was not displaying their rating in the home in line with our requirements.

People were happy with the staff that supported them and they felt safe living in the home. Staff understood safeguarding and how to report concerns if needed. The provider had procedures in place for reporting safeguarding concerns. Risks to people were managed in a safe way and equipment used within the home was maintained to ensure it was safe to use. There were enough staff available to offer support to people and they did not have to wait. Medicines were managed in a safe way to ensure people were protected from the risks associated with them.

People’s privacy and dignity was promoted and they were treated in a kind and caring way. People were encouraged to be independent and make choices about their day. Families told us they were free to visit throughout the day. People enjoyed the food and were offered a choice. We found people had the opportunity to participate in activities they enjoyed. When needed people had access to health care professionals.

Staff received training and induction that helped them support people. The provider ensured staffs suitability to work within the home. Staff felt listened to and were able to raise concerns. The provider used feedback from people and relatives to bring about changes.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service was registered to provide accommodation for up to 63 people. At the time of our inspection 54 people were using the service.

There was a registered manager in post. 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.

When people were not able to consent mental capacity assessments and best interest decisions were not completed. The provider had not considered that some people were being restricted and that deprivations of liberty safeguards were needed.

The systems in place to review and monitor care were not always effective. We found that not all the information which was recorded was accurate.

People told us they felt safe and staff knew how to recognise and report potential abuse. Risks to people were managed in a way to keep people safe. We found there were enough staff to support people and they had received an induction and training that helped then to do this. Medicines were managed in a way to keep people safe from the risks associated to them.

People told us the food was sufficient and we saw choices were available for people. People and relatives told us they were involved with reviewing their care and were happy with the care they received. We found people had access to health professionals when needed.

We found people’s privacy and dignity was promoted and they were treated in a kind and caring way. People were encouraged to be independent and make choices about their day. There were activities available that people enjoyed that they could participate in. Families told us they were free to visit and people were encouraged to maintain relationships that were important to them.

Staff felt listened to and were confident concerns they had would be dealt with. The provider used feedback from people and relatives to bring about improvements to the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we spoke with the registered manager, the deputy manager, two team leaders, two care staff and two domestics. We met and spoke with nine people that used the service and two relatives. We looked at five people's care plans. We saw how people gave consent to receive care and support. We looked at how care was planned, delivered and documented in the care plans. The care records we looked at were up to date and personalised.

We reviewed the medication administration procedures in the home and found them to be in good order. We looked at how staff were recruited and saw that the provider followed a good standard of recruitment procedures to ensure suitable staff were employed in the home. During the inspection we looked at the home's complaints procedures and complaint records. People we spoke with told us they knew how to make a complaint if necessary.

People who used the service told us they liked it at Watersedge and the staff were good to them. We saw that people were offered choices throughout the day.

Relatives of people who used the service told us that they were happy with the care that their relative received.

On the day of the inspection the service was busy with activities being offered to people in the communal lounge area and visitors coming and going visiting their relatives. Everyone appeared happy and relaxed.

We saw social care and health professionals within the home. This included a GP and a social worker, who were visiting people who used the service.

The service had made several improvements to the facilities since our last inspection, including a cafe area and a bar, the cafe was in use during the day as a place for relatives and visitors to meet with people who used the service.

Systems were in place to monitor the quality of the service and the manager told us they worked alongside the staff to ensure high standards were met.