Archived: Gloucestershire Old Peoples Housing Society

Gloucestershire Old Peoples Housing Society is better known as Watermoor House and will be referred to as such throughout this report.

Watermoor House 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. Watermoor House accommodates 39 people in one adapted building. There were 31 people at Watermoor House at the time of the inspection.

There was no registered manager in post at the service as the previous registered manager had left their post two months before the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had started working at the service and was in the process of registering with the Care Quality Commission.

The previous inspection was completed in April 2017 and the service was rated ‘Good’ overall. At this inspection we found a number of concerns and the service was rated ‘Requires Improvement’ overall. Following the inspection, the manager informed us about some of the measures they had implemented immediately following our inspection to drive improvement. This included actions such as weekly audits of people’s care plans and liaising with the local authority for further staff training.

Risk assessments were not always updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, sufficient action had not been taken to ensure the ongoing safety of the person. The admissions process was not robust and did not ensure the staff had all relevant information related to the care of people being admitted to the service.

Staff had received training and supervision appropriate to their role however this had not always been effective in providing staff with the skills they needed to support people effectively. Although staff sought consent and gave choice to people, the service was not always adhering to the principles of the Mental Capacity Act 2005 (MCA). As a result, people were not always supported to have choice and control over their lives.

Improvements were required to ensure people’s care plans and associated documents were person centred and clearly reflected their current level of need. Where complaints had been raised, these had been managed appropriately.

Governance systems had been established in the service but these were not effective in identifying and rectifying shortfalls in the service. There were policies and procedures in place and these had all been updated and reviewed regularly however; these were not always used by the manager or staff.

Staff had received training around safeguarding and were confident to raise any concerns relating to potential abuse or neglect. The administration and management of medicines was safe. There were sufficient numbers of staff working at Watermoor House. There was a robust recruitment process to ensure suitable staff were recruited. People could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People we spoke with told us the staff were caring and kind. People were given information about the service in ways they wanted to and could understand. There were positive comments from people, relatives and staff regarding the manager.

This is the first time the service has been rated Requires Improvement.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations have been concluded.

Gloucestershire Old Peoples Housing Society is better known as Watermoor House and will be referred to as such throughout this report. Watermoor House is a residential care home and is registered to provide support for up to 39 people. Nursing care and support is provided by district nurses and local GP’s as required. Several people at the home were living with the first stages of dementia. There were 33 people at the home at the time of the inspection.

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.

There were six breaches of legal requirements at the last inspection in November 2016. At our comprehensive inspection on 13 and 18 April 2017 the provider had followed their action plan which they told us would be completed on 28 February 2017 with regard to meeting the requirements of the regulations.

The service was mostly well-led. Quality checks had been implemented but did not always track where issues had been addressed or were still outstanding. We recommend that the service follows a recognised governance procedure to monitor quality. The provider had put in place a system to drive improvements in daily records through staff meetings and supervision, but we found this had not been fully effective. We recommend the provider implements a system to ensure care records are improved. The registered manager was well liked and respected. Staff morale was good and reflected the positive support from management. The registered manager had informed CQC of the relevant notifications as required by the law.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment to support people. Staff had a good awareness of safeguarding policies and procedures and felt confident to raise any issues of concerns with the management team. The registered manager had carried out the relevant checks to ensure they employed suitable people at Watermoor House.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular individual meetings called supervisions and appraisals. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). The environment had been adapted to meet the needs of people living at the home. People were supported to personalise their living spaces.

The service was responsive to people’s needs. Care plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity. People had end of life care plans which reflected their needs and preferences.

Gloucestershire Old Peoples Housing Society is better known as Watermoor House and will be referred to as such throughout this report.

Watermoor House is a residential care home and is registered to provide support for up to 39 people. Nursing care and support is provided by district nurses and local GP’s as required. Several people at Watermoor House were living with the first stages of dementia. There were 33 people at Watermoor House at the time of the inspection.

There was a registered manager in post at Watermoor House. 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.’

Our inspection highlighted shortfalls where a number of regulations were not met and improvements were required.

People did not always receive a service that was safe. Although staffing levels appeared to be safe, staff informed us there was an increased use of agency staff who did not always know the needs of people living at Watermoor House. Risk assessments were not adequate and did not contain sufficient levels of information to enable staff to provide safe care and treatment. Staff demonstrated a good understanding of safeguarding and felt confident to report any concerns to management or external agencies. Staff had been trained in the safe administration, recording and storage of medicines. Recruitment practices at Watermoor House were safe and ensured suitable people were employed at the home.

People were not always receiving effective care and support. Staff felt the training being provided was not effective and was not meeting their learning needs. Although care records stated whether people had mental capacity or not, there were no records of people’s level of capacity being assessed under the Mental Capacity Act 2005 (MCA). People’s nutritional needs were not always recorded and care files contained contradictory information around this. People’s personal living areas were personalised. Staff received regular supervision or appraisals.

The service was caring. The majority of people and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained people’s dignity. People had end of life care plans which clearly reflected their wishes and preferences.

The service was not always responsive. People’s care plans were not person centred and did not provide sufficient detail to enable staff to provide safe care and treatment to people. Daily notes were not always sufficiently detailed to provide a clear overview of a person’s day. Complaints had been dealt with but people said they were not always satisfied with the outcome of their complaint. There was an activities co-ordinator and people had a number of different activities available to them.

The service was not always well-led. The majority of the staff we spoke with stated communication between management and the staff was poor and this had resulted in low staff morale across the majority of the staff group. There were no quality assurance checks and audits being completed at Watermoor House. The registered manager had failed to inform the Care Quality Commission of significant incidents such as falls or deaths which had occurred at the home.

We found a number of 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 this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

People confirmed that staff listened to them and acted appropriately to their requests. One person said "The staff are lovely and I feel listened to however, I would like to see the manager more' and 'I haven't been here very long but nothing is too much to ask'.

People living at the home told us "I looked around many homes and decided this was best suited to care for me', 'Lovely home here, I am very well cared for by excellent staff' and 'The staff have helped me to become more independent'.

The communal dining room was clean and tidy. We observed staff preparing breakfast for people using colour coded knifes and food preparation boards to prevent cross contamination with other foods. We saw that staff appropriately washed their hands before and after completing this task.

People living at the home told us "The food is very nice here" and "Food always seems fresh and portion sizes are good" another person said "We are offered a choice and nothing seems too much trouble".

People told us about what it was like to live at the home and how they felt they were cared for by the staff. One person told us "I am cared for very well and this was the best decision I have made, moving here' and 'The care provided here is very good and I feel I'm encouraged to maintain my independence'.

People we spoke with during our visit told us "The staff work very hard and there always seems enough staff on duty" and "The staffing levels are good here".

People were given support by the provider to make a comment or complaint where they needed assistance. People living in the home told us 'I would tell the manager on duty if I was unhappy'.

Staff we spoke with were clear on their roles and responsibilities in relation to supporting people to make decisions about their life. This meant that people received a service in line with their assessed needs.