CQC report explained · a residential care home
What the CQC found at Waterfall House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People felt safe, risks were assessed and medicines were generally given safely and on time. Inspectors were concerned that one night staff member could not safely support people who needed two staff in an emergency or evacuation.
- Effective?
- Good
- People's needs were assessed, care plans were detailed, staff were trained and people received support with food, drinks and healthcare. Some mental capacity decisions were not clearly recorded, and the provider's training had not been refreshed.
- Caring?
- Good
- Inspectors saw kind and respectful interactions. People were involved in decisions, their privacy and dignity were respected, and they were encouraged to remain independent.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and communication requirements. People were supported to maintain relationships, use local facilities and take part in activities.
- Well-led?
- Good
- The home had systems to monitor care, medicines, health and safety and food hygiene. The manager and provider listened to feedback and agreed to address the concerns about night staffing and training.
What inspectors found, December 2019
Rated Good; inspectors found kind, personalised care, but raised concerns about night staffing and some care records.
This was an unannounced inspection on 13 November 2019. Inspectors spoke with people, relatives, staff, the provider and manager. They observed care and checked care records, medicines, staff files, training, risk assessments and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and were happy living there. Inspectors saw respectful care, detailed care plans, support with medicines, food, health appointments and independence.
The inspection was brought forward after concerns about night staffing, the level of care and food and drink. Inspectors found no evidence that people were harmed because of these concerns. However, they found only one staff member was rostered at night, which could be unsafe if two people were needed to evacuate during an emergency.
Inspectors also found gaps in some records and training. Mental capacity and best-interest decisions were not always clearly recorded. Guidance for medicines given when needed was incomplete, and the provider's training had not been refreshed. The last rating was also Good, published on 9 May 2018.
People felt safe and settled
People and relatives said they felt safe. Many people had lived at the home for several years and considered it their home.
“People told us that they were happy living at Waterfall House and felt safe.” from the report
Kind and respectful care
Inspectors saw positive relationships between staff and people. Staff respected privacy, dignity and people's choices.
“During the inspection, we observed staff interacting with people with a kind, caring and respectful approach.” from the report
Personalised care plans
Care plans included people's backgrounds, preferences, communication needs and support requirements. They were reviewed regularly.
“Care plans were person centred and detailed and focused on people's needs and wishes.” from the report
Support for independence
People were encouraged to make choices, use the community and take part in everyday tasks such as cooking and cleaning.
“People were supported to maintain their independence as far as practicably possible.” from the report
Medicines generally managed safely
Records showed medicines were given on time and as prescribed, with no gaps or omissions noted.
“Medicine Administration Records showed that people received their medicines safely, on time and as prescribed.” from the report
Only one staff member at night
seriousThe home had one waking night staff member. Inspectors said this would not safely support people who needed two staff during an emergency or evacuation.
“At night, the provider only rostered one staff member to complete a waking night shift so there was only one staff member available to support people at night.” from the report
Mental capacity records
needs fixingSome capacity assessments and best-interest decisions were not clearly recorded in people's care plans. The manager sent examples of completed records after the inspection.
“However, where people lacked capacity and best interest decisions had been made on behalf of people, these had not always been clearly documented and incorporated into the care planning process.” from the report
Incomplete guidance for some medicines
needs fixingInstructions for medicines given when needed had not been completed. Completed protocols were sent to inspectors after the inspection.
“However, 'as and when required' protocols had not been completed so that staff had clear guidance and instruction on how to administer these medicines safely.” from the report
Provider training not refreshed
needs fixingThe provider sometimes joined the emergency care rota, but their training had not been refreshed. The provider agreed to address this.
“However, we did find that the training records for the provider themselves, showed that they had not refreshed any of their training.” from the report
Oral hygiene needed more attention
minorToothbrushes and toothpaste were visible for some people but not everyone. The manager said more attention would be given to people willing to engage.
“We saw some people had access to toothbrushes and toothpaste, but this was not visible for everyone in their bedrooms.” from the report
- 01How many staff now work during the night, and how would you evacuate someone whose plan says they need two staff?
- 02Have all mental capacity assessments and best-interest decisions been added clearly to people's care plans?
- 03Are protocols now complete for every medicine that may be given 'as and when required'?
- 04Has the provider's care training been refreshed and formally recorded?
- 05How do you support people who need help or encouragement with oral hygiene?
This was an unannounced comprehensive inspection covering all five CQC questions, after concerns were received about staffing, care and food and drink. This explanation was written from the published report of 10 December 2019 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, May 2018
Rated Good; inspectors found safe, caring and person-centred support, with some records and end-of-life arrangements needing attention.
This was an unannounced comprehensive inspection on 4 April 2018. Inspectors reviewed information held about the home, spoke with six people and four relatives, and observed how staff supported people.
They also spoke with staff and the manager, and checked care records, staff and training records, medicines records, audits, policies and procedures. The home supported 11 people with mental health needs and could accommodate up to 18.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. This was unchanged from the previous inspection in February 2016. The home had improved its quality checks by recording the checks and actions taken.
People felt safe
People and relatives said they felt safe. Staff understood how to recognise and report suspected abuse, and risk assessments covered individual health and social care risks.
“People told us that they felt safe living at Waterfall House.” from the report
Safe medicines
Inspectors found complete medicines records, appropriate management of controlled drugs and regular medicines checks.
“Records seen were complete with no gaps or omissions in recording.” from the report
Respect and independence
Staff sought consent, respected privacy and supported people to do things for themselves. People could move around the home and leave when they wished.
“We observed care staff knocking on people's bedroom doors before entering and asking people's permission before carrying out any particular task.” from the report
Person-centred care
Care plans included people's choices, preferences and life histories. Activities and rehabilitation were based on people's abilities and interests.
“People's care plans were detailed and person centred.” from the report
Improved quality checks
The home had acted on the previous inspection's finding about unrecorded checks. It now recorded checks and actions across areas including medicines, care plans and infection control.
“During this inspection we found that the registered manager had taken note of our feedback and had recorded all checks that were completed with details of actions taken where issues were found.” from the report
Medicines competency records
needs fixingStaff competency observations were completed during induction and later, but the home had not recorded them. The manager said this would be recorded in future.
“Observations of care staff were also completed as part of their induction process and periodically thereafter in order to assess their competency, however, these were not recorded.” from the report
End-of-life care
needs fixingThe home said it was not equipped or specifically experienced to provide end-of-life care. If someone needed this support, the manager would normally refer them elsewhere, although their wishes were recorded.
“The service did not always specifically support people who had been assessed as requiring end of life care as they did not feel they were equipped or specifically experienced in this area.” from the report
- 01How are staff competency checks for medicines now recorded and reviewed?
- 02What would happen if my relative needed end-of-life care while living here?
- 03How would you support a move to another service if end-of-life care became necessary?
- 04How often would my relative's care plan and risk assessments be reviewed?
- 05How would my relative be supported to keep their independence and take part in activities they choose?
This was an unannounced comprehensive inspection covering all five CQC areas, with all ratings assessed as Good. This explanation was written from the published report of 11 May 2018 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 Waterfall House
3 rated inspections over 4 years: the service has held its Good rating throughout.
- December 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 8 December 2010.
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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