Background to this inspection
Updated
10 December 2019
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 Care Act 2014.
Inspection team
The inspection was carried out by two inspectors and two Experts by Experience. One Expert by Experience attended the service on the day of the inspection and spoke with people. The second Expert by Experience made telephone calls to relatives after the inspection. 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
Waterfall House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with four people using the service about their experience of the care provided. We also observed interactions between people and care staff. We spoke with the provider, the registered manager and four support staff.
We looked at the care records for four people and medicines administration records and medicine supplies for nine people who used the service. We also looked at the personnel and training files of five support staff. Other documents that we looked at relating to people's care included risk assessments, staff meeting minutes, handover notes, quality audits and policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We also spoke with three relatives to obtain their feedback about the service.
Updated
10 December 2019
About the service
Waterfall House is a residential care home providing accommodation and personal care to up to 18 people with mental health needs. At the time of the inspection there were 11 people living at the home.
People’s experience of using this service and what we found
People told us that they were happy living at Waterfall House and felt safe. Many people had been living at Waterfall House for several years and considered it their home.
Staffing levels during the day were observed to be appropriate and met people’s needs safely. However, only one member of staff was allocated to work at night. We highlighted specific concerns regarding this to the registered manager and provider, especially in relation to fire safety and evacuation of people.
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. However, we found that where people lacked capacity, a mental capacity assessment and best interest decisions that had been made, had not always been clearly documented within the person’s care plan.
Risks identified with people’s health and care needs had been assessed and appropriate guidance had been provided to staff which enabled them to support people to remain safe and free from harm.
Medicines management and administration systems in place ensured people received their medicines on time and as prescribed.
Recruitment records confirmed that the provider only employed staff members who had been assessed as safe to work with vulnerable adults.
People were supported with their nutrition and hydration needs. People had access to drinks and snacks throughout the day. Where specialist support was required this was provided.
The service supported people to access the services of a range of health and social care professionals where required.
Support staff received the relevant training and support to carry out their role.
We observed positive and respectful interactions between people and staff. People were supported and encouraged to maintain their independence as far as practicably possible.
Care plans were person centred and detailed and focused on people’s needs and wishes.
People knew the provider and the registered manager well. We observed people approaching them with confidence.
A variety of systems and processes were in place to oversee and monitor the quality of care that people received. This enabled the service to learn, develop and improve care provision.
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 9 May 2018).
Why we inspected
The inspection was prompted in part due to concerns we received about the provider, staffing allocations especially at night, the level of care people received and food and drink provisions. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the full report for further detail.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.