Watermoor House

Watermoor House is a residential care home providing accommodation and personal care for up to 39 older people and people living with dementia in one adapted building which has a range of communal areas, an external courtyard and outdoor areas people can use. At the time of the inspection, 25 people were living in the home.

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

We found some improvements were still needed to ensure safe recruitment practices were followed and to the provider’s quality monitoring systems and processes . Not all staff understood people's risks and how to keep them safe. People's care records were not always reflective and up to date with this information.

The provider's audits were not always effective in identifying and addressing quality and safety concerns in staff recruitment and care records.

We did not find that these shortfalls had impacted people's care. The new manager had recently started, and prior to our inspection, identified the action required to ensure improvements were made.

People told us they felt content living at Watermoor House. People's relatives were complimentary about the care their loved ones received. Staff spoke positively about the leadership of the home and the new home manager.

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 supported to receive their prescribed medicines safely.

People were supported by staff trained to meet their needs.

The service had infection control processes and systems to reduce the risk of people contracting COVID-19.

Managers promoted a culture that enabled people, their representatives and staff to feel comfortable giving feedback, raising a concern or, where needed, making a complaint.

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 01 November 2022), and there were breaches of regulation. 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 that not enough improvements had been made, and the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to verify if the provider made enough improvement in relation to previous breaches of regulations.

The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident was subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the risk of falls. This inspection examined those risks.

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 used the ratings awarded at the last inspection for those key questions not inspected to calculate the overall rating. This is based on the findings of this inspection.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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 Watermoor House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 from 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 of regulations in relation to people’s risk management, safe recruitment, and good governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Watermoor House is a residential care home providing accommodation and personal care for up to 39 older people and people living with dementia in one adapted building which has a range of communal areas, an external courtyard and outdoor areas people can use. At the time of the inspection there were 24 people living in the home.

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

People told us they feel happy living at Watermoor House. People’s relatives were complimentary about the care their loved ones received. Staff spoke positively about the leadership of the home.

We found some improvements were needed to ensure safe recruitment practices were followed. Staff understood people’s risks and how to keep them safe but people’s care records were not always up to date with this information. The provider’s audits were not always fully effective in identifying and addressing quality and safety concerns in the area of staff recruitment and care records.

We did not find that these shortfalls had impacted on people's care and the deputy manager had started taking action during our inspection to ensure improvements were being made.

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 supported to receive their medicines safely and as prescribed.

People were supported by staff who had been trained and supported to meet their needs.

The service had infection control processes and systems in place to reduce the risk of people contracting COVID-19.

Managers promoted a culture which enabled people, their representatives and staff to feel comfortable in giving feedback, raising a concern or where needed, to make a complaint.

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 13 October 2020)

Why we inspected

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

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. This is based on the findings at this inspection.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see safe 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 Watermoor House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 of regulations in relation to safe recruitment and good governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Watermoor House is a residential care home providing accommodation and personal care to 29 older people and people living with dementia at the time of the inspection. Watermoor House can accommodate up to 38 people in one adapted building which has a range of communal areas, an external courtyard and outdoor areas people can use.

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

People and their relatives told us Watermoor House was a safe home, which met people’s needs.

People’s risks were assessed and managed. Where possible, people were involved in decisions regarding their care and potential risks, enabling them to take ‘positive’ risks. People were supported by staff with their physical, mental and spiritual needs.

Staff understood their responsibilities to protect people from avoidable harm. The registered manager and provider acted in accordance with the duty of candour. People’s relatives told us they were kept informed of any changes and spoke positively of the communication they had received from the service during the Covid-19 pandemic.

People’s medicines were safely managed and administered. The registered manager, medicines officer and provider ensured robust systems were in place for the management of people’s medicines. These systems enabled them to identify any errors, promoting people’s wellbeing and staff learning.

Staff had received the training and support they required to meet people’s needs. Staff spoke positively about the support they had received from the registered manager during the pandemic. The registered manager and provider focused on staff wellbeing and promoting a whole home ‘caring’ culture.

The registered manager and provider had implemented robust governance systems to monitor the quality of care people received. The Board of Trustees (which oversees) the home, received reports from the registered manager, including specific reports in relation to the management of the home and people’s needs during the pandemic.

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 (report published 25 October 2019) and we identified three breaches of the regulations. This included a breach of regulation 19 (Fit and proper persons employed), regulation 12 (Safe care and treatment) and regulation 17 (Good Governance). We imposed a condition on the provider’s registration. This included providing CQC with regular service improvement updates.

We found significant improvements had been implemented and sustained at this inspection and the provider and registered manager were now meeting all of the relevant regulations.

Why we inspected

We undertook this focused inspection to identify if the service had improved and to confirm they now met the legal requirements. We also 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 coronavirus and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Enforcement

We imposed conditions on the provider’s registration following our previous inspection (published on 25 October 2019). This required the provider to send us a monthly update of progress made to improve the service. We will discuss with the provider if they wish to apply to remove these conditions.

Follow up

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

People’s experience of using this service:

People’s medicines were not always managed safely. There was not a robust system in place to support people with their topical creams and lotions. The protocols in place to support the use of ‘as required’ medicines were not clear. Safe systems were not in place to return unused medicines to the pharmacy.

People were not being supported by staff who had been recruited safely. We found gaps in employment history that had not been checked and the provider did not ask staff to complete a health check. The provider was not carrying out the required ‘right to work’ checks prior to staff starting their employment.

The management team did not routinely review accidents and incidents. This meant that risks had not always been reviewed so that safety measures could be put in place.

People told us they felt safe living at the service. Staff told us they understood safeguarding and knew how to report their concerns. We found one incident of potential safeguarding which had not been reported to the local authority or us.

Quality monitoring was not effective in identifying or driving improvement at the service. There was not an open and transparent culture at the service. There was a lack of management response to some concerns raised by staff. We received concerns about management approach prior to our inspection and following our inspection. The registered manager told us they had been dealing with staffing issues for a long time and was finding day to day management difficult.

Rating at last inspection: At the last inspection in November 2018 (report published December 2018) this service was rated as Good.

Why we inspected: This inspection was prompted by two whistle-blowers and other concerns received since the last inspection. This was a focused inspection to review the key questions ‘Safe’ and ‘Well-led’.

Enforcement: We have found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspection is added to reports after any representations and appeals have been concluded. We will meet with the provider to discuss our findings in this report. Full details can be found at the end of the report.

Follow up: We will continue to monitor this service and plan to inspection in line with our inspection schedule.

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

We carried out this inspection following concerns raised regarding the service in October 2018, these concerns were focused on the safety of people. As a result, we undertook a comprehensive inspection to look into those concerns.

This is the first inspection of the service since it re-registered with the Care Quality Commission in May 2018. We previously inspected the home under its old registration. You can read the report from our last comprehensive inspection, by selecting the 'old profile' link for Watermoor House on our website at www.cqc.org.uk. At this inspection we found the service was meeting all the requirements and it was rated ‘Good’ overall.

There was a registered manager in place 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.

People told us they were kept safe. Risks were identified, managed and reduced. Where staff had identified risks to people’s health and wellbeing, the risk assessments and guidance around these were detailed and contained sufficient information for staff to support people to minimise risk. Staff were recruited safely and they were trained and supported to meet people’s needs effectively. People’s medicines were managed safely and they received these as prescribed. The environment was kept clean and well maintained.

People were supported by skilled staff who had received training appropriate to their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the home supported this practice. People’s nutritional wellbeing had been maintained and they continued to have access to health care professionals when needed.

People’s needs were assessed, care plans were developed and care was delivered in a way which met their needs and preferences. People were treated equally and their individual preferences and wishes were respected. Relatives were provided with opportunities to speak on behalf of their relative and were welcome to visit when they chose to.

Staff were kind, caring and compassionate. There were arrangements in place to help people feel included and to take part in social activities. Staff had the skills and knowledge to support people’s end of life needs.

The home was well managed and the registered manager ensured people’s needs and wishes were the primary focus. People, relatives and staff spoke positively about the leadership offered by the registered manager. Effective and appropriate systems, processes and practices ensured the home ran smoothly and that necessary regulations were met. Complaints could be raised and these were investigated and addressed. All feedback was welcomed and used to improve the service further.