CQC report explained · a residential care home
What the CQC found at Waterloo House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Premises, equipment, safeguarding, staffing and medicines had improved. However, some risk information was out of date or contradictory, and infection control was not consistently effective.
- Effective?
- Requires improvement
- Staff training, moving and handling, nutrition and partnership working had improved. However, best-interest decisions for bedrails were not properly recorded for at least two people, and some care plans still contained inaccurate information.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- The new manager had gained staff trust and started to create a positive culture. However, quality checks had not reliably found or corrected problems, and Regulation 17 remained breached.
What inspectors found, November 2022
Waterloo House is rated Requires Improvement; inspectors found clear progress but continuing weaknesses in records, legal decision-making and quality checks.
This was an unannounced focused inspection on 29 September and 5 October 2022. Inspectors spoke with people living in the home, relatives, staff, the manager and a company director. They reviewed care plans, staff records and checks on quality and safety.
The home had improved since its previous inspection, when it was rated Inadequate. Inspectors found safer moving and handling, better support for special diets, improved recruitment checks, safer premises and better staff training. Medicines were managed safely, staffing levels were sufficient and people generally felt safe.
Important problems remained. Some care plans and risk records were out of date or contradictory. Mental Capacity Act requirements were not always followed when bedrails were used. Infection control was not always effective, and the provider had not notified CQC about six Deprivation of Liberty Safeguards re-authorisations.
The home remained in breach of Regulation 17 about good governance. However, it was no longer rated Inadequate or placed in special measures. The overall rating is Requires Improvement, and CQC is continuing to monitor progress.
Improvement since the last inspection
The provider had addressed three of the four previous breaches. Improvements included safer moving and handling, better special-diet support, recruitment checks, premises and staff training.
“At this inspection we found improvements had been made. The provider had addressed 3 of the 4 breaches of regulations.” from the report
Safe medicines practice
Inspectors found medicines management and stock control were safe. An electronic medicines record had reduced the likelihood of errors and shortages.
“Medicines management was safe. Relevant staff received medicines training and senior staff completed regular checks to ensure their administration practice remained up-to-date and safe.” from the report
Enough staff
People and relatives told inspectors there were enough staff, and staff said they could take their time when providing care.
“People told us there were sufficient staff to meet their needs without rushing.” from the report
Staff training and support
Mandatory training compliance was very high. Staff had improved moving and handling training, regular supervision and support from senior staff.
“When we reviewed training records we saw compliance with mandatory training was very high, at 98.4%.” from the report
Positive management culture
The new manager had been in post for only a few months but had gained the trust and respect of staff. Inspectors described the manager and directors as open and responsive.
“Despite being in post for only a few months, the manager had won the trust and respect of their team.” from the report
Care records were not reliable
needs fixingSome care plans and risk assessments contained out-of-date or contradictory information. This could increase the risk of ineffective or unsafe care.
“Information in some people's care plans was contradictory or out-of-date which also increased the possibility of poor care.” from the report
Infection control was inconsistent
needs fixingInspectors saw a meal being carried uncovered through the home. One staff member also wore a mask below their chin on two occasions, although the manager acted promptly.
“However, on the first day of our inspection we observed an uncovered meal being carried through the home to a person's bedroom.” from the report
Missed regulatory notifications
needs fixingThe provider had not notified CQC about six recent Deprivation of Liberty Safeguards re-authorisations. Retrospective notifications were submitted, and CQC was considering its response.
“We identified 6 recent DoLS re-authorisations which the provider had not notified us of.” from the report
- 01Have all care plans and risk assessments now been checked and corrected, and how often are they reviewed?
- 02What records are now in place for people using bedrails who may lack capacity to consent?
- 03How do you check that infection control procedures are followed at every meal and by all staff?
- 04What changes have been made to make sure all events that must be reported to CQC are notified on time?
- 05What progress has been made against the action plan, and when will the next quality review be completed?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward into the overall rating. This explanation was written from the published report of 29 November 2022 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 2022
Waterloo House was rated Inadequate and placed in special measures after inspectors found serious safety, care and management failures.
Inspectors visited without notice from 30 March to 5 April 2022. They spoke with four people, 11 relatives and 11 staff. They observed care and reviewed care plans, medicine records, staff files and health and safety records.
They found people were at risk of injury because mobility needs were not safely assessed. The home also had environmental hazards, problems with repairs and cleaning, medicines that were not securely stored, and failures to report and investigate safeguarding concerns.
Inspectors found weaknesses in staff training, dietary information, diabetes care and referrals to health professionals. They also found that quality checks and management oversight were not effective. The home was rated Inadequate for Safe, Effective and Well-led.
The last rating was Good, published in December 2018. The overall rating changed from Good to Inadequate. The home was placed in special measures, and the CQC said it would monitor the service and require an improvement plan.
Dignity and respect
Staff were observed treating people respectfully and adapting how they communicated. Relatives also described staff as kind.
“However, we found that the staff treated people with dignity and respect.” from the report
Choice and consent
Staff sought consent and supported people to make choices, including about food and medicines. The report says care was provided in the least restrictive way and in people's best interests.
“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;” from the report
Mealtime support
Inspectors saw people receiving appropriate help to eat in a calm and unhurried setting. Staff supported people in a dignified way.
“We observed lunchtime at the service and found that people had appropriate support from staff to eat.” from the report
Staffing levels during the visit
Inspectors found enough staff on duty during the inspection. The provider used a rolling rota to plan staffing in advance.
“We found enough staff on duty to meet people's needs during the inspection.” from the report
Unsafe moving and handling
seriousMobility assessments were carried out by staff who were not sufficiently trained or qualified. Inspectors found that a person had been placed in a sling that was too large after falling from a hoist.
“People were at risk of injury as their mobility needs were not safely assessed.” from the report
Safeguarding failures
seriousThe provider did not always identify, refer or investigate incidents that might involve abuse. Safeguarding concerns were not always reported to the local authority or the CQC.
“People were not safeguarded from the risk of abuse.” from the report
Unsafe environment
seriousInspectors found exposed wiring, trailing call-bell wires, damaged bathrooms, leaks and other repair problems. Some areas were accessible even though they could harm people or could not be cleaned properly.
“The loft area was accessible to people and had evidence of a fly infestation, leaks, damaged areas and was full of equipment and stored items.” from the report
Medicine storage
seriousMedicines were kept in a cupboard secured only by a bolt that people could reach. This increased the risk of error or misuse.
“We found medicines stored in a cupboard locked only by a bolt which people could reach.” from the report
Diet and diabetes information
seriousKitchen staff did not have enough written information about diabetes, swallowing difficulties and other dietary needs. This increased the risk of choking and health complications.
“This meant people were at increased risk of health complications and choking.” from the report
Weak management checks
seriousThe home's quality systems did not identify or address important problems. Incidents and accidents were not consistently reviewed, so the home did not learn enough to reduce future risks.
“The provider's governance and quality assurance systems were not effective in monitoring and improving the quality of the service.” from the report
- 01What independent training have staff now completed for moving and handling, hoists and slings?
- 02What urgent repairs have been completed, including the bathrooms, flooring, leaks, exposed wiring and trailing call-bell wires?
- 03How are safeguarding concerns now identified, reported to the local authority and CQC, and investigated?
- 04How are people's diabetes, swallowing and other dietary needs recorded and communicated to kitchen staff?
- 05How are falls, accidents and incidents now reviewed, and what changes have been made as a result?
This inspection rated Safe, Effective and Well-led; Caring and Responsive were not rated in this inspection, and the report says previous ratings were used where questions were not inspected. This explanation was written from the published report of 25 May 2022 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
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- November 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2022Inadequatedown from GoodSafe: InadequateEffective: InadequateWell-led: Inadequate
- December 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 January 2011.
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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9 live-in carers within about an hour of Lincolnshire
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.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
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.