Waterloo House

Updated 20 August 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors

Waterloo House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

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 not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

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.

We used all of this information to plan our inspection.

During the inspection

We spoke with seven people who used the service about the care they received. We also spoke with six care staff, domestic and catering staff, deputy manager and manager. We reviewed a range of records. Including three people's care records, medication records, staffing information, the services training matrix and the services policies and procedures. We spoke via telephone with two care staff and a health and social care professional. We also received an email from staff about their experience of working at the service. We received three emails from health and social care professionals about their experience of working with the service. We also reviewed the various documents we had requested during the site visit.

Updated 20 August 2022

About the service

Waterloo House is a residential care home providing personal care and accommodation for up to 19 people with mental health needs. At the time of this inspection there were 17 people living in the service. Accommodation is spread over three floors. Waterloo House is an older style property in Stoke, a suburb of the city of Plymouth in Devon.

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

The inspection was prompted following concerns raised to the Care Quality Commission about staffing, leadership and management not listening to concerns raised. At the time of the inspection, the manager was not registered with the Care Quality Commission (CQC) and had been in post for four months.

The premises were in need of repair, redecoration and refurbishment. People, relatives, staff and health and social care professionals all commented on the poor environment. We identified an immediate high risk for people accessing the garden and the manager acted immediately and installed a temporary ramp, grab rails and undertook risk assessments to minimise the risk for people.

The service had a fire inspection and had been served with an enforcement notice of non-compliance which meant that the service was not meeting fire safety regulations and was not safe. The provider had responded to the fire enforcement notices, and contractors were working at the property to make sure the physical environment complied with fire safety requirements. It is of concern that the provider had not been proactive in addressing the risks to the premises until they were highlighted by other agencies.

Care plans would benefit from expansion to provide staff with more detailed information. For example, information on events that were likely to cause people anxiety and guidance for staff on how to provide support at these times. This could lead to people receiving inconsistent care.

People’s risk in areas such as falls had not always been assessed. This meant that staff did not have a risk assessment that could inform, direct or guide them on how to minimise these risks.

The manager was new to the service. They had received some feedback, guidance and support in carrying out their role from the provider. People, staff and the management team told us that the provider was not visible in the service.

The review of records and care documentation evidenced there was poor oversight of the service, which was affecting aspects of the operation of the service. There were no formal auditing systems in place. We were not assured management were reviewing all incidents and identifying themes or learning to mitigate the risk of them happening again.

The manager was keen to learn from the inspection process and act on issues identified. Feedback from people, a relative, staff and health and social care professionals were positive about the current management team. They felt changes to the service were now occurring. For example, changes to the premises, improved care records and communication and felt that, “morale has lifted”. All stated that they felt able to approach the manager with any concerns about the service, or care and that they would be listened to.

People told us they felt safe and cared for. People were encouraged to report any concerns they may have about their welfare to the manager or senior staff.

People were encouraged to be involved in the interests and activities that they enjoyed and to maintain relationships which were important to them.

People and relatives were complimentary about the staff support and their skills. Comments from people included, “The staff are good people”. A relative commented “All the staff are absolutely brilliant, the service they provide is wonderful, it's friendly, very helpful and pleasant, the way they interact with my mum is great as they have got to know her and they know how to manage her good days and her bad days now very well.”

Staff told us they felt very supported by the new management team and had access to a range of training to support them in their roles.

Staff knew how to report and escalate any safeguarding concerns. People received their medicines safely.

People and relatives told us they felt that there were always sufficient staff on duty. The services recruitment practices were robust.

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’s health conditions were well managed, and staff engaged with external healthcare professionals. Staff were proactive in making timely referrals to health professionals when they had concerns around people’s health and well-being.

Concerns, raised by people, had been investigated thoroughly and a response provided to the complainant. From this the manager had reflected what learning could be taken from the concern raised and shared the findings with staff.

There was good communication within the staff team and staff shared information appropriately.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Last rating and update

The last rating for this service was good (published 16 December 2020).

Why we inspected

We received concerns in relation to staffing, leadership and management not listening to concerns raised. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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 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 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

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.

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 found three breaches in relation to the premises, care records and the oversight and leadership of the service at this inspection.

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.