Water Mill House Care Home

Updated 20 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 3 inspectors, and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Water Mill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Water Mill House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 04 July 2023 and ended on 19 July 2023. We visited the service on 04 and 12 July 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We reviewed feedback provided to us by the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

Through a combination of in person conversations and telephone interviews we spoke with seven people and 13 relatives. We also spoke with 14 staff including 7 care staff, a nurse, a housekeeper, a general assistant, 2 assistant managers, the registered manager and the provider’s business manager. We looked at the care records for 6 people and the medicines records for a further 14 people living at the service. We looked at a range of records relating to the management of the service including quality monitoring and auditing records, recruitment and staff deployment documentation and policy documents relating to areas such as infection control, medicines management and safeguarding people from harm.

Updated 20 September 2023

About the service

Water Mill House is a residential care home registered to provide personal and nursing care to up to 70 people. The service provides support to older and younger adults, people with physical disabilities or sensory needs and people living with dementia. At the time of our inspection there were 64 people using the service.

The service is a modern purpose-built premises organised across three floors. Each floor has ensuite bedroom facilities (mostly single occupancy, but there are some double rooms for couples or people who wish to live together) and large communal spaces. There is a bistro on the ground floor, along with a hair and beauty salon, and large, well-maintained gardens.

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

Care plans and risk assessments were not always accurate, and information was not consistent to ensure staff had the right guidance to provide safe care to people. Daily care records were completed erratically and therefore did not provide a true picture of the care people were offered and received. This put people at risk of harm because it was not possible to monitor effectively to ensure planned care was still appropriate to people’s needs. Where 1 person had been assessed to have lost significant weight, there was no evidence of any action taken to reduce the risk to their health and wellbeing. This put them at risk of harm.

Medicines were not always managed safely. Information about people’s allergies was not recorded on medicines administration records, including allergies to certain medicines. The registered manager took immediate action to address this during the inspection. The provider had not ensured medical devices were maintained appropriately which may affect how they work.

The provider had systems in place to monitor the quality of the service, but these were not used effectively to identify shortfalls and make improvements.

People and their relatives told us they felt safe, and staff cared for them well. There were enough staff to care for people safely and, although busy, we saw they had time to speak with people as well as carrying out their other duties. The service was clean and well maintained.

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.

The provider and the registered manager demonstrated a strong commitment to providing good quality, person-centred care. They were quick to respond to feedback and there was evidence that information was shared with staff when things went wrong to support learning and make improvements. They were clear about their expectations of staff to work in line with the provider’s values, and worked hard to develop the team, providing support to staff who wanted to progress in their career.

People, their relatives and staff spoke positively about their experiences of the service. There was a pleasant atmosphere in the service and people, relatives, staff and management appeared to enjoy positive relationships for the most part.

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 (published16 September 2021) and there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to infection prevention and control. At this inspection, although enough improvements had been made in relation to infection prevention and control, we found new areas of concern and the provider remained in breach of Regulations. The rating remains requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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.

The inspection was prompted in part due to concerns received about infection control, the approach taken by the management team, the culture in the service and the quality of care at night-time. A decision was made for us to undertake a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, we have found evidence that the provider needs to make improvements to some other areas. 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 Water Mill House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risk to people’s health and wellbeing and in how systems are used to monitor the quality of the service and drive improvement.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.