CQC report explained · a nursing home
What the CQC found at Water Mill House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Care plans, risk assessments and daily records were not always accurate or complete. Medicines were not always managed safely, although infection prevention and control had improved.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used to calculate the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used to calculate the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used to calculate the overall rating.
- Well-led?
- Requires improvement
- The home had quality monitoring systems, but these did not consistently identify problems or make sure improvements lasted. Inspectors also found a positive atmosphere and a management team that responded to feedback.
What inspectors found, September 2023
Water Mill House Care Home is rated Requires Improvement; inspectors found kind care, but care records, medicines safety and quality checks were not reliable.
This was an unannounced focused inspection. Inspectors visited on 04 and 12 July 2023, spoke with people, relatives and staff, and checked care records, medicines records, staffing information and quality checks.
The home was clean and well maintained. People and relatives said they felt safe and that staff cared for them. There were enough staff during the inspection, and staff had time to talk with people. However, care plans and risk assessments were sometimes inaccurate or inconsistent. Daily records had gaps and did not always show that planned care had been provided.
Inspectors also found unsafe medicines arrangements. Allergy information was missing from some medicines records, and some medical devices had not been maintained properly. The manager corrected the allergy records during the inspection. The home was in breach of Regulation 12 and Regulation 17.
The overall rating remained Requires Improvement, as did Safe and Well-led. This was the second consecutive inspection with this rating. Infection control had improved since the previous inspection, but new concerns were found. The other key question ratings were carried forward because they were not inspected this time.
Kind and respectful care
People, relatives and staff generally described positive relationships. Inspectors saw a warm and friendly atmosphere.
“There was a warm, friendly atmosphere in the home.” from the report
Clean surroundings
The home was clean and well maintained. Inspectors found improvements in infection prevention and control since the previous inspection.
“The service was clean and well maintained throughout.” from the report
Staffing and continuity
Inspectors found enough staff during the visit. The home had not needed agency staff for 12 months, so people were supported by a consistent team.
“The provider had worked hard to recruit to vacancies at the service and had not required the use of agency staff for 12 months.” from the report
Action on night care concerns
The manager had increased night monitoring, supervision and mentoring, and had worked night shifts to understand the problems and support improvements.
“The registered manager had also recently completed a week of night shifts to identify issues at night and how to support improvements.” from the report
Inaccurate care information
seriousCare plans and risk assessments sometimes gave conflicting information about people's needs. This could lead to unsafe or unsuitable care.
“Information in care plans and risk assessments was not always consistent to support staff to know how to care for people safely.” from the report
Weight loss not acted on
seriousOne person had significant weight loss, but the records did not show action or referrals to reduce the risk to their health.
“There was no evidence on the record to indicate that any action had been taken or referrals made.” from the report
Medicines and equipment safety
seriousSome medicines records did not include allergy information. A syringe driver had not been calibrated and blood glucose monitors had not been quality checked.
“The provider did not ensure medical devices were appropriately maintained.” from the report
Weak quality checks
needs fixingAudits missed important problems or did not lead to effective action. Progress on improving records was slow.
“Systems to monitor quality were not used effectively to make improvements to the service.” from the report
- 01How are you checking that care plans and risk assessments contain accurate, person-specific information?
- 02How do you now make sure daily records are completed when care is provided, especially for fluids, snacks and repositioning?
- 03What action has been taken for people at risk from weight loss, and how is their progress being monitored?
- 04How are allergy information, syringe drivers and blood glucose monitors checked and kept up to date?
- 05What evidence can you show that the new quality audits are finding problems and leading to lasting improvements?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried forward from the previous inspection. This explanation was written from the published report of 20 September 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2021
Rated Requires Improvement; inspectors found infection-control failures, incomplete medicines records and staffing pressures, although people generally felt safe and listened to.
This was an unannounced focused inspection on 3 August 2021. Inspectors spoke with people, relatives, staff and professionals. They reviewed care records, medicines records, staff files and the home's management records.
The home was not always safe. Staff did not always use PPE correctly, follow isolation risk assessments or ensure visitors used PPE. Staff also did not always follow people's risk assessments. Medicines were given when needed, but some records were incomplete.
The home was also not always well-led. Management audits had not identified the infection-control problems, and staffing shortages meant people sometimes felt staff were too busy to talk. There were also positive findings, including people feeling safe, appropriate recruitment checks and an open approach to complaints and concerns.
The overall rating changed from Good to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three key-question ratings were not inspected and carried over from the previous comprehensive inspection.
People generally felt safe
People and relatives said they felt safe with the care. Staff knew how to report safeguarding concerns.
“Overall people and relatives spoke about how they felt safe whilst being supported by staff.” from the report
Recruitment checks
The home completed the required pre-employment checks for staff, including references and criminal record checks.
“People were supported by staff who had been through a recruitment selection process.” from the report
Open communication
People, relatives and staff could share their views through meetings, discussions and surveys. The report says managers listened and responded to suggestions.
“People were able to share their views and thoughts to improve the service by having drop in discussions with the management team, resident meetings and surveys.” from the report
Kind and person-centred care
Professionals described staff as kind and caring. They said people appeared to have choice and that individual needs were considered.
“Feedback from professionals stated they witnessed staff being kind and caring towards people and people appear to have full choice of their care.” from the report
Infection-control failures
seriousStaff did not always wear PPE correctly or follow isolation arrangements. Visitors were also seen without PPE, and this was not addressed. This led to a breach of Regulation 12.
“We observed staff not putting on or taking off their PPE when entering a room where someone was isolating.” from the report
Risk instructions were not always followed
seriousStaff did not always follow people's risk assessments. One person was not given equipment needed to eat and did not eat their meal.
“For example, someone needed specific equipment to help them eat. On the day of the inspection this was not given to the person, which resulted in them not eating their meal.” from the report
Staffing pressure
needs fixingStaff shortages sometimes left shifts short. People said staff were busy and task-focused, with limited time to talk.
“Staff have not got time to spend with me, they work really hard.” from the report
Audits missed problems
seriousThe home's quality checks did not identify the infection-control problems found during the inspection. This meant there was increased risk of infection spreading.
“However, these audits they did not identify the issues found at inspection relating to infection prevention control.” from the report
- 01What changes have been made to ensure staff wear and remove PPE correctly, and how are these checks recorded?
- 02How do you make sure residents who are isolating follow their isolation arrangements and that visitors use the required PPE?
- 03How do you check that staff follow each person's risk assessment, including equipment needed for eating or communication?
- 04What are the current staffing levels, and how do you prevent shortages reducing residents' time with staff?
- 05How are medicines counts and records now checked for accuracy?
This was an unannounced focused inspection of Safe and Well-led only; the Effective, Caring and Responsive ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 16 September 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Water Mill House Care Home
5 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- September 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2021Inspected but not ratedSafe: Inspected but not rated
- June 2019Goodstayed GoodSafe: GoodWell-led: Good
- July 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- September 2014
Registered with the Care Quality Commission on 11 September 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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