CQC report explained · a residential care home
What the CQC found at Waterloo House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2020
Rated Good overall; inspectors found kind, safe care, but the home was rated Requires Improvement for well-led management.
Inspectors visited on 4 and 5 March 2020. The first visit was unannounced. They spoke with people, relatives and staff, and checked care records, medicines records, risk assessments, audits and training information.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found enough staff, safe medicines practice overall, kind staff, prompt healthcare referrals and activities suited to people's interests.
Well-led was rated Requires Improvement. One person needed mental health support that the provider was not registered to provide. Staff lacked specialist training and a serious incident had not been reported to the CQC at the time. The manager took immediate steps and introduced new quality checks.
The overall rating stayed Good, the same as at the previous inspection published in September 2017. The CQC said it would continue to monitor the home and may inspect sooner if it received concerning information.
Kind staff
People were supported by staff who knew them well and had time to understand their needs. Relatives also gave positive feedback about the care.
“People were supported by kind and caring staff who knew them well.” from the report
Staffing and safety
Inspectors found enough staff with the right knowledge, experience and skills to meet people's needs safely and promptly.
“There were enough staff with the right knowledge, experience and skills to meet people's needs safely and in a timely way.” from the report
Healthcare support
Staff noticed changes in people's health and made referrals quickly. People had regular access to a GP through visits to the home.
“People accessed external healthcare promptly because staff monitored their health for signs of change and made relevant referrals when needed.” from the report
Activities
A new lifestyle and activity coordinator was using people's interests, care plans and conversations with relatives to plan activities.
“Activities available for people included smoothie making, baking and painting.” from the report
Mental health support
seriousOne person needed mental health support, but the provider was not registered for this type of support. Staff had not received specialist training and the environment was not appropriate for the person.
“One person who lived at Waterloo House had mental health support needs but the provider was not registered to provide this type of support.” from the report
Serious incident reporting
seriousA serious incident involving this person had not been reported to the CQC when it happened. A retrospective notification was made after inspectors raised it.
“A serious incident which involved this person was not reported to us.” from the report
End of life planning
needs fixingThe assessment process did not yet record people's wishes for care at the end of their lives. The provider had identified this as an improvement area.
“End of life care preferences were not currently included as part of the assessment process.” from the report
Mental capacity records
needs fixingSome records did not show all the steps taken to help people understand decisions, and one capacity assessment was completed incorrectly.
“However, we identified some gaps in records of steps taken to optimise people's understanding and one capacity assessment was completed incorrectly.” from the report
Medicine records
minorAudits did not identify that the opening date was missing from some topical cream records. Staff were asked to learn from this.
“Systems for auditing medication did not identify the date of opening on some topical creams had not been recorded.” from the report
- 01What specialist mental health training do staff now have, and how do you support anyone with mental health needs?
- 02What happened after the serious incident, and how do you make sure serious incidents are reported promptly?
- 03Have all care assessments been updated to record people's end of life wishes?
- 04How are you checking that mental capacity assessments and records show all required steps?
- 05How do you now record opening dates for topical creams and audit medicines records?
This was a planned, unannounced inspection that looked at the care provided and the premises; all five key questions were assessed, with Well-led falling from Good to Requires Improvement. This explanation was written from the published report of 21 April 2020 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 2017
Rated Good overall; inspectors found kind, safe care, but care records and some end-of-life instructions needed improvement.
Inspectors carried out a comprehensive inspection. The first visit was unannounced on 21 August 2017, followed by an announced return on 22 August. They spoke with people living at the home, a relative, staff and the provider. They also looked at care records, medicines, training, accidents and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People and relatives were pleased with the care. Staff were described as caring, consistent and knowledgeable, and people were supported to make choices and remain as independent as possible.
Inspectors found some areas needing improvement. Care plans and risk assessments were not always detailed or personalised enough. Some people felt activities were limited. There were also unclear or conflicting instructions about resuscitation for some people. The manager had identified these issues and was working to improve them.
Kind and respectful care
Inspectors saw staff treating people gently and respectfully. Staff protected privacy and dignity and responded to people's needs promptly.
“We saw staff interactions with people at the home were respectful, kind and positive.” from the report
People's choices and independence
People were supported to choose how they spent their time, where they sat, what they wore and how they received care.
“People were supported to remain as independent as possible so they could live their lives as they wanted.” from the report
Safe staffing and trained staff
Inspectors found enough experienced staff to meet people's needs. Training and refresher training were monitored.
“There was sufficient experienced staff to meet people's needs.” from the report
Open management
People, relatives and staff said the manager was visible, approachable and willing to listen. The manager had started audits and improvement work.
“They had a programme of audits and checks in place.” from the report
Care plans and risk records
needs fixingCare plans and risk assessments did not always give staff enough personalised detail, including how to respond to challenging behaviour and what might trigger it. The manager had recognised this and was reviewing the records.
“Care plans contained supportive information but needed to be more detailed and personalised for staff to help them to provide the individual care people required.” from the report
Unclear resuscitation instructions
seriousFor some people, medical resuscitation instructions conflicted with their decisions. Inspectors said this made the correct action unclear and could lead to unnecessary treatment.
“For others, GP's RESPECT approval conflicted with their decision. This meant the actions to take were not always clear and could put people at risk of unnecessary treatment.” from the report
Limited activities for some people
minorSome people said there was little to keep them stimulated. The manager was working to widen and personalise the activities programme, including developing the garden.
“For others, they felt there were limited activities to stimulate interest.” from the report
- 01How have you improved the detail and personalisation of care plans and risk assessments since this inspection?
- 02How do you check that resuscitation decisions and medical instructions agree and remain up to date?
- 03What activities are now available for people who need more stimulation, including people living with dementia?
- 04How are time-critical medicines and prescribed creams recorded and checked?
- 05Who is currently responsible for managing the home, and has the manager's registration application been completed?
This was a comprehensive inspection covering all five CQC questions, with an unannounced visit on 21 August 2017 and an announced return on 22 August 2017. This explanation was written from the published report of 9 September 2017 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 Waterloo House
3 rated inspections over 5 years: the service has held its Good rating throughout.
- April 2020Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- June 2013
Registered with the Care Quality Commission on 21 June 2013.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Warwickshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £950 to £1,260 a week. 77 can care for a couple. 11 years' experience on average.
“If you bump into her in the night on her way to the bathroom she will still inquire how you are and if everything is alright.”
“I have never met a person who is so kind and thinks about others before himself to such an extent as Chris Malagala.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.