Watford House Residential Home

Watford House is a residential care home providing personal care to up to 43 people in one adapted building. The service provides support to older people and younger adults, some of whom may have a physical disability or a diagnosis of dementia. At the time of our inspection there were 40 people using the service.

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

People were protected from the risk of harm and abuse by a staff team who knew how to recognise and respond to safeguarding concerns. There were enough staff to meet people’s needs and these staff had been trained to assess and safely manage people’s risks. Since the last inspection, systems to monitor the safe management of medicines had improved and people received their medicines safely. Staff members had been trained to follow effective infection prevention and control procedures.

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.

The quality monitoring systems in place were also much improved and supported the registered manager in driving improvement and providing good quality care. People, their relatives and staff were consulted about the care they received and spoke positively of the registered manager.

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 requires improvement (published 24 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service

We carried out an unannounced comprehensive inspection of this service on 1 March 2022. Breaches of legal regulations 12 (safe care and treatment) and 17 (good governance) were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe 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 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 Watford House 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.

Watford House Residential Home is a care home providing support with personal care needs and accommodation for up to 43 people, aged 49 and over, in one adapted building. At the time of this inspection, 39 people were living there, some of whom were living with dementia.

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

People were not always safe as the physical environment was not safely maintained. Substances hazardous to health were left in communal areas and some staff practice did not adhere to best infection prevention and control guidance.

The provider could not evidence people received their medicines as prescribed.

The provider did not have effective quality monitoring procedures in place to drive good care.

Staff understood how to safeguard people from the risk of abuse and knew what to do if they suspected something was wrong.

People had assessments of risk associated with their care and support.

The provider had kept us informed about key events and had good working relationships with others involved in peoples care. People and staff told us they found the management team to be approachable.

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 12 July 2021).

Why we inspected

We received concerns in relation to people’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Following our inspection site visit the provider took action to mitigate the immediate risks to people including fire safety improvements and removal of items likely to cause harm.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe and the providers monitoring of the provision of care at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Watford House is a residential care home providing personal and nursing care to 37 people aged 49 and over at the time of the inspection in one adapted building. The service can support up to 43 people.

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

Governance arrangements were not consistently effective in identifying gaps in training, accident monitoring and care plan details these issues and driving improvements. People had their needs assessed and plans were put in place to meet them. However, assessments and care plans did not fully consider peoples protected characteristics.

Staff had an induction, training and the support they needed to carry out their roles, however training for administering specific medicine was out of date. This was put in place straight away after the inspection and we found medicines were administered to people safely.

People were protected from abuse and kept safe by staff that understood how to recognise the signs and report any concerns. Risks to people were assessed and plans put in place to mitigate these.

When accidents or incidents occurred, action was taken to reduce the risk of similar incidents happening again. People were supported by enough staff to meet their needs and keep them safe.

People were supported by consistent staff who knew them and their needs well. The home was adapted to meet individual needs.

Staff worked effectively with one another and staff sought support from health professionals as required to meet people health needs.

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 were communicated with effectively and were involved in making decisions about their care. Staff enabled people to make choices for themselves and were respectful in how they supported people.

People were supported in a person-centred way and were provided with a variety of opportunities to take part in activities. There was a complaint process in place which people understood how to use.

The registered manager knew people and staff well. The registered manager responded to feedback and learning to make improvements to the service and worked in partnership with other agencies.

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.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 01 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the quality of care people were receiving. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective and well led sections of this full report.

Follow up

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

People’s experience of using this service:

• Changes had been made to the quality assurance process, however, further improvements were required to ensure people received effective care.

• Some people's care plans had not been updated following changes to their care needs.

• There were gaps in staff training and staff had limited understanding of some important issues, such as ensuring people’s legal rights were upheld in accordance with the Mental Capacity Act 2005.

• People's preferences were not always considered when they were supported to engage in activities and there were limited activities to stimulate people.

• People felt safe using the service.

• Staff recognised the risks to people’s health, safety and well-being and understood how to identify and report abuse.

• People had access to support from staff when needed.

• Staff recruitment processes included a check of their background to review their suitability to work at the service.

• People received support with the medicines. Regular checks were undertaken to ensure people received the correct medicines by staff who were competent to support them.

• Staff understood and practised infection control techniques and had access to protective equipment to promote this.

• People were supported to have enough to eat and drink to maintain their well-being.

• People were supported to obtain advice from healthcare professionals, which was incorporated into people’s care.

• Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

• People and those important to them, were involved in planning their care with support.

• People and their families understood how to complain if they wanted to.

• There had been staffing changes since our last inspection, including new senior management. Staff were positive about the changes and improvements to the service.

• The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

More information is in the full report.

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 9 June 2017).

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

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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.

Our last inspection visit took place on 7 July 2016. At this time, we found there were breaches in regulations and we issued two requirement notices and told the provider to make improvements. These related to risks to individuals not being consistently managed, and actions not taken to minimise these risks. The provider had not notified us about certain incidents relating to people or the running of the home. The provider sent us a report on 30 August 2016 explaining the actions they would take to improve. We also asked the provider to make improvements to ensure people were supported in a dignified way. In addition, the registered manager did not have effective systems in place to monitor and improve the quality of care for people. At this inspection, we found that some improvements had been made, but further improvements were required.

People’s capacity to make decisions had been considered, however this had not been assessed in line with current guidance. They were supported to access healthcare services, but sometimes referrals were not made in a timely manner. People’s preferences were not always considered, and some people were not able to engage in activities that would stimulate and occupy them. People knew how to raise concerns and complaints, but these were not always dealt with as people wished. There were systems were in place to monitor the quality of the service, but these were not always effective.

Risks to people were assessed, monitored and reviewed. Actions were taken to reduce future risks. Staff knew how to recognise and report abuse, and people were safe receiving support. There were enough staff to meet people’s needs and the provider ensured their suitability to work with people. Medicines were administered and stored to protect people from the risks associated with them.

Staff supported people to make choices and gained people’s consent. Staff received an induction and training that helped them to support people. People enjoyed the food and were supported to maintain a balanced diet.

People’s dignity was promoted and their privacy respected. Staff encouraged people to be independent and were caring in their approach. Visitors were made to feel welcome and there were no restrictions as to when they could call. People were involved in the planning of their care and support.

The registered manager understood their responsibilities of their registration with us. People were positive about the management and leadership, and staff felt supported in their roles.

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.

Our last inspection took place on 4 November 2015. At this time, breaches of legal requirements were found in safe care and treatment, and in good governance. We issued two warning notices and told the provider to take action to meet the regulations. We also asked the provider to make improvements in other areas. The provider sent us a report on 12 January 2016 explaining the actions they would take to improve. At this inspection, we found that a number of improvements had been made, but there were further improvements required.

Risks to people who used the service were not consistently managed, and measures had not always been put into place to reduce the potential risks of people falling. Some records had not been reviewed and updated when needed to give staff clear guidance as to how they should support people safely.

People were not always treated in a dignified and respectful manner. Staff were caring in their approach, but the main interaction with people was focussed on offering support or completing a care task.

Effective systems were not always in place to assess, monitor and improve the quality of care and the provider had not always notified us of reportable incidents that had occurred.

Since our last inspection, we saw that improvements had been made to ensure some risks were managed more effectively to keep people safe. Medicines were managed safely and the environment had improved to reduce the risks of infection for people and staff. People told us they felt safe and staff were aware of how to protect people from abuse and harm. There were enough staff to keep people safe and meet their needs and the provider had safe recruitment processes in place.

We also found there were improvements with the training and support that staff received to meet people’s needs effectively and carry out their roles. People received food and drink that met their nutritional needs and were referred to other healthcare professionals to maintain their health and wellbeing.

People were supported to make decisions. When people were not able to make decisions for themselves, care and support was provided in their best interests. When people were restricted, the necessary authorisations were in place.

People were encouraged to be as independent as they could be and there was increased involvement for people and their families to be involved with the planning of their care. Staff knew people well and were aware of their preferences, and they encouraged people to participate in activities.

Feedback about the service was being encouraged and people felt confident they could raise any concerns with the registered manager.

People spoke positively about the management and leadership, and the provider was developing the management structure within the service to provide more managerial support. The registered manager and provider were keen to make further improvements within the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with were happy with the care they received. One person told us: 'I am very happy with the care. I haven't been well and staff made sure they called the doctor. I am having some treatment'. People were well supported when having their care needs met.

We saw changes had been made at mealtimes to ensure that people were supported and encouraged to eat a nutritious diet.

A decision had been made to remove the birds from the home. This decision was made because there was no one available to ensure the birds and their cages were kept clean at all times to prevent the risk of cross infection at the home.

Staffing levels had improved since our last inspection and staff made aware of the availability of bank staff when needed. We found that the manager had added additional tasks to be undertaken by staff at night, which could impact on people not having their care needs met in a timely manner. The manager planned to monitor this.

We saw that improvements had been made to people's care records to ensure that they reflected people's current care needs and the care provided.

Our visit at Watford House was unannounced. At the time of our visit there were 30 people living at the home. During our visit we spoke with five people and six visiting relatives. We spoke with nine members of staff, which included care staff, cleaning staff and the cook. We spoke with a health professional who visited the home to provide care and treatment for two people.

We looked at anonymous concerns we had received about the service. These related to the care of people in the home and staffing levels. One person told us, 'I feel that the level of care has decreased'. We found that there were some omissions in meeting people's care needs. We observed at our visit that there were identified times when there were insufficient staff to meet people's needs.

We observed positive interactions between staff and the people who lived there.

We saw that mealtimes needed to be managed better so that people were suitably supported to maintain their nutritional needs.

We saw that improvements were needed to ensure that people were protected from the risk of cross infection.

During our visit we spoke briefly with most of the 39 people living at the home. We had longer conversations with six people living at the home. The owner was at the home at the time of our visit. We spoke with the owner and four members of staff.

Due to the varied needs of some of the people that lived at the home we were not always able to obtain their personal opinions about the home. To help us understand people's view of their day to day lives we used a number of methods such as reading records and conversations with relatives.

One of the people we spoke with told us, 'I am very happy living here. It has helped me to stop worrying'. Another person told us, 'The staff are very helpful and kind to me'.

A relative we met told us that they were very happy with the care their family member received. They spoke highly of the staff and described them as kind and caring.

We saw that there were safeguarding procedures in place. Two care staff we spoke with had a very good knowledge of the procedures. Both staff told us that they had received training in this subject.

We found that the service had systems in place to monitor the quality of the services provided to people living at the home. We saw that improvements could be made to care plan documentation to ensure that they reflected the care people received.