Water Mill House Care Home

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.

Water Mill House Care Home is a residential care home providing personal and nursing care to 65 people at the time of the inspection. The service can support up to 70 people.

Water Mill House Care Home has three separate floors, bedrooms have en-suites. On each floor there’s a living and dining facility. The ground floor has facilities such as a bistro, gym, cinema, library and kitchen.

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

Staff did not always use safe infection prevention control measures. Staff did not always use appropriate personal protective equipment (PPE) and where people were isolating risks were not always mitigated. Risk assessments highlighted people's individual needs, however, there were times where staff did not follow these.

People felt safe with the care they received, and staff were knowledgeable about when to report concerns to safeguard people. Where things went wrong, this was shared with staff and lessons were learnt and changes implemented. Medicines were given to people when they needed them, where discrepancies were identified these were actioned appropriately. Professionals were referred to when needed.

The home had recently undergone a change in management, the overall feedback was positive, and the management team were focusing on staff recruitment. However, People felt staff were busy and task focused and did not have time to talk.

People felt they were able to express how they wanted to be supported. The provider ensured that staff went through a recruitment process and all relevant employment checks were completed.

The registered manager had systems in place to manage complaints. Overall, people and relatives said they felt listened to when they raised any concerns. People felt they were able to have open communication between them and the management team. The registered manager had implemented a lot of changes since starting their employment which had been acknowledge by staff as positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 June 2019).

Why we inspected

We received concerns in relation to the management of medicines, staffing and people’s support needs being met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe infection prevention control practices at this inspection.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The service was receiving professional visitors with robust infection control procedures in place. Visitors were received into the reception area where they were provided with guidance, personal protective equipment (PPE) and a health screening questionnaire was completed. Each visitor had their temperature checked by staff.

¿ The service had been providing ‘screened’ visits for people and their families within a designated room. Visits were by appointment only, with times allocated to avoid potential infection transmission with other visitors and to allow for the visiting area to be thoroughly cleaned between visits. At the time of our inspection, visits had been temporarily suspended due to an outbreak of COVID-19 at the service.

¿ The service had taken steps to alleviate the negative impact of the pandemic on people. Staff had provided a wide variety of in-house activities to support wellbeing including celebrations of festivals and events. A monthly newsletter was compiled which was shared with people, family and friends along with an invitation to attend ‘relative’s meetings’ which were held via group video call. The deputy manager told us of the actions taken to boost morale, such as supporting daily virtual visits, exchanging letters and cards with children from the local school and a ‘wave hello event’. This event was where the school children gathered outside with their teachers and waved to the people living at the home with banners and signs they had made.

¿ PPE donning and doffing stations were placed throughout the service, with ample supplies available. Staff were seen to be maintaining social distance and adhering to the PPE guidance and protective measures in place.

¿ The service was clean and hygienic. Robust cleaning schedules were in place, which were methodically completed throughout the service. Daily checks and ‘walkarounds’ of the building, alongside regular infection prevention and control audits were completed by senior staff. Action was promptly taken to address any issues identified.

¿ The provider had developed policies and procedures in response to the COVID-19 pandemic. Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed.

People’s experience of using this service:

Everyone we spoke with told us they were happy living in Water Mill House. People felt staff were kind and their needs were met.

People’s independence was promoted daily and people were supported to develop friendships.

Staff promoted people’s privacy and dignity and their choices were respected. Care and support were delivered in a personalised way by staff who knew people’s likes, dislikes and preferences.

Risks to people’s well-being and health were managed and reviewed to ensure people were safe and protected from the risk of harm. Staff received appropriate training and had their competencies assessed to ensure they were skilled and knowledgeable to meet people`s needs effectively.

The environment was homely, clean and welcoming. Staff used effective infection control measures to protect people from the risk of infections. Appropriate equipment was in place where needed for people to receive support in a safe way.

People had opportunities to take part in organised group activities, pursue their hobbies and interests. Staff had a genuine interest to keep people involved and occupied.

People and relatives told us there were enough staff in the home to meet people`s needs. People felt listened to and they told us they were happy living at Water mill House.

People, relatives and staff praised the registered manager for being approachable, supportive and placing people in the centre of the care and support they delivered.

Complaints and feedback from people and relatives were used in a constructive way and lessons were learned to ensure improvements were made.

The registered manager and the provider used a range of effective audits and governance systems to check the quality and safety of the care people received.

Rating at last inspection: Good (report published 22 June 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and people were positive about the skills, experience and abilities of staff who worked at the home. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People told us they felt safe, happy and well looked after by staff working at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family’s to access independent advice or guidance.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support they received. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.