Waterhall Care Home

We found the following examples of good practice.

• Staff had received training and refresher on infection prevention and control and how to use personal protective equipment (PPE).

• Posters and guidance were on display about good hand hygiene. These measures helped keep people, staff and visitors stay safe.

• There were ample supplies of personal protective equipment (PPE) including disposable facemasks, visors, gloves, aprons and disinfectant wipes. Hand sanitiser points were readily available throughout the home.

• PPE stations were placed outside each person’s bedroom. They contained ample supplies of PPE for staff to put on before entering the rooms to support people with personal care. Used PPE was disposed of immediately in clinical waste bins to reduce the risk of cross infection.

• Enhanced cleaning and disinfection took place throughout the home to further reduce the risks of the spread of infection. This included frequent cleaning of high touch areas such as, light switches, call bells, keyboards, door handles and handrails. Cleaning checklists were used to record and monitor that cleaning tasks had been completed.

• A regular programme of testing for COVID-19 was in place for people using the service and staff. This meant swift action could be taken if any positive results were received.

• Infection prevention and control (IPC) audits took place, and the registered manager had good oversight of all aspects of infection control systems within the service.

• The laundry area was well organised and clean. Soiled linen was kept separate and cleaning schedules were closely followed and recorded. Systems were in place to ensure laundry from different areas of the service were laundered separately.

• Policies, procedures and risk assessments related to COVID-19 were up to date, which supported staff to keep themselves and others safe.

• The registered manager and the staff team routinely reviewed the impact of COVID-19 and the actions taken to reduce the risks of any outbreaks. Meetings took place with staff and other healthcare professionals to reflect upon and learn from outbreaks. Heightened infection control measures were implemented to contain and manage outbreaks.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Waterhall Care Home on our website at www.cqc.org.uk.

Waterhall Care Home is a residential care home providing personal and nursing care for up to 56 older people. They also work in partnership with Milton Keynes Hospital to provide rehabilitation (step down) care. At the time of the inspection the service was supporting 50 people.

The home is situated over three floors (the ground floor is leased to the Primary Care Trust and falls under a separate registration from Waterhall Care Home).

The home offers permanent, respite and rehabilitation (step down) care. One of the areas specialises in providing care to people living with dementia. Each floor offers recreational, quiet and dining areas and there is a secure garden with several seating areas.

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

The registered manager and staff team continued to provide people with an exceptionally personalised service. People received excellent high-quality care from a dedicated staff team that were caring and compassionate and often went the extra mile. The staff team were fully committed to treating people with dignity and respect, and person-centred care was at the very heart of the service.

The whole of the staff team were extremely passionate about providing people with support that was centred around individual needs. Staff worked closely and creatively with people, this enhanced people's quality of life, boosted self-esteem, and promoted and protected people’s overall wellbeing.

People received exceptional compassionate end of life care that was planned with people and their families, in advance and centred around their individual wishes, spiritual beliefs and cultural needs. Relatives and health professionals all commented how impressed they were with the knowledge of staff and their attention to detail when providing end of life care that fully respected people's diverse needs and human rights.

A culture of being open and transparency was embedded in the service. The service worked closely with other healthcare professionals. The registered manager was extremely pro-active in encouraging ideas and feedback from people using the service, relatives, staff and other professionals, to continually drive up improvement. A robust system of quality monitoring checks and audits were used to continually review all aspects of the service and timely action was taken in addressing areas identified for further improvement.

People benefitted from receiving care from a stable staff team that continually worked towards the provider's vision and values in providing high-quality person-centred care. There was a shared commitment to ensuring strong links with the community and an emphasis on enhancing people's lives through the provision of meaningful, imaginative activities and opportunities.

Staff were extremely positive about the support they received from the registered manager, saying their leadership style, inspired them to take a strong pride in their work and deliver a high-quality service.

The whole of the staff team invested time in really getting to know people. Through this they were able to identify and respond appropriately to behaviours that had the potential to place people at risk of harm. Staff were skilled in anticipating behaviours and discreetly intervened to subtly dispel potential incidents. They provided interventions that soothed and calmed people and lowered incidents of distress.

Accidents and incidents were responded to following the providers procedures and used as learning opportunities to reduce the risk of repeat incidents. The registered manager ensured all serious incidents were reported to the relevant authorities and the Care Quality Commission (CQC).

Staff understood their responsibilities to report any unsafe care. Robust and safe recruitment checks were carried out to ensure suitable staff were employed to work at the service. The staffing arrangements ensured people were provided with support as needed. Staff worked at a relaxed pace and spending time with people was their priority, this was embedded in the culture of the home.

Medicines systems were organised, and people received their medicines when they should. The Nursing and care staff responsible for administering medicines received training to ensure they had the competency and skills required to safely administer medicines. Our observations and review of records showed that staff followed current good practice protocols for the safe ordering, receipt, storage, administration and disposal of medicines.

Staff had the skills, knowledge and experience required to support people with their care and social needs. They were well supported by the registered manager and had regular one to one supervision and annual appraisals.

Nutritional assessments were carried out and food and drinks were provided based on people's individual needs and preferences. Soft and puréed meals and thickened drinks were provided for people at risk of choking. All meals and snacks were fortified. Mealtimes were a social experience staff and people using the service often took their meals together.

Staff worked closely with other professionals within the multi-disciplinary team to ensure people's health and well-being needs were fully met and to ensure that where possible, any rehabilitation goals were met.

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 environment met people's diverse needs. Dementia friendly signage aided in signposting people to independently orientate themselves around the home. There were points of interest around the environment to support people to independently navigate their way around, both inside and outside of the home. A range of sensory items were available for people to engage with.

Information was made available for people, relatives and others in accessible formats on how to raise any concerns or complaints. The registered manager and the provider promoted a culture of being open and transparent and took all concerns brought to their attention seriously. This meant people received safe, compassionate care, and any lessons learnt were used to continually develop the service.

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 outstanding (published 5 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

This was the second scheduled comprehensive inspection carried out at Waterhall Care Centre. At the last inspection on 22 July 2014 we found the provider was meeting the requirements of the regulations inspected.

Waterhall Care Centre is a 56 bed purpose built care home located in Bletchley, Milton Keynes. The home is situated over three floors, the ground floor is leased to the Primary Care Trust and the first and second floors offer permanent care in a residential setting for those with nursing, residential or dementia care needs. They also work in partnership with Milton Keynes Hospital to provide rehabilitation care. Each floor offers recreational and dining areas where activities and entertainment can be enjoyed and there is also a secure garden area. At the time of our visit there were 51 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

People were supported by very kind, caring and compassionate staff that often went the extra mile to provide people with excellent, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The whole staff team were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations.

There was a strong culture within the service of treating people with dignity and respect. The staff and the registered manager were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. Staff spent time with people to get to know them and their needs and this had ensured that behaviours that could be challenging for staff and distressing for people were minimised. People and the staff knew each other well and these relationships were valued.

Care was planned around people’s individual preferences and this included their spiritual and cultural wishes. People’s diverse needs were considered and their human rights were respected. The service had also developed a recognised approach to support people at the end of their lives to ensure that it was dignified and comfortable. People received exceptional compassionate care at the end of their life which was planned in advance with them. Health professionals told us the service provided excellent care and they were impressed with the knowledge of staff and their attention to end of life care.

There was a culture of openness and transparency at the service. Staff were extremely positive about the management and leadership which inspired them to deliver a high quality service. Exceptional leadership was demonstrated by the registered manager with a pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. People were looked after by staff who all shared the provider’s commitment to running a good quality service. The staff shared the provider’s vision and values to ensure people benefitted from the best possible care.

Feedback from people who used the service and their relatives was used to make changes to the service and to drive any improvements required to make the service better. Emphasis was placed by the management team on continuous improvement of the service. A robust system of monitoring checks and audits identified any improvements that needed to be made and action was taken as a result.

People felt safe. There were systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care. There were risk management plans in place to protect and promote people’s safety. Robust and safe recruitment checks were carried out to ensure suitable staff were employed to work at the service. We found there was sufficient staffing levels to provide support to people as needed. We also saw that staff members could undertake tasks without feeling rushed when supporting people. Staff told us they had time to spend with people and this was promoted by the registered manager.

We saw that competent staff dispensed medicines, without interruption and at the correct times they should be administered. Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they always received their medicines at the times they needed them.

Staff received training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs. They were well supported by the registered manager and had regular one to one supervision and annual appraisals. Staff demonstrated an awareness of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. We observed they had positive relationships with people who lived at the service to support them to have as much freedom as possible.

People were supported to access suitable amounts of nutritionally balanced food which met their dietary needs. A variety of meal options were available for people, which included specific health and cultural dietary requirements that were based upon their specific dietary needs. Staff worked closely with other professionals within the multi-disciplinary team to ensure people’s health and well-being needs were fully met and to ensure that where possible, any rehabilitation goals were met.

The environment had been adapted to help to meet people’s needs, in particular people living with dementia, and promote their independence. People had access to appropriate space at the service to see and look after their visitors, for meaningful activities and to be alone if they wished.

People received a personalised service which was responsive to their individual needs and there was an emphasis on each person's identity and what was important to them. There was a commitment to ensuring strong links with the community and an emphasis on enhancing people's lives through the provision of meaningful, imaginative activities and opportunities.

People felt they could raise concerns and any were taken seriously, investigated and followed up to develop the service.

As part of our inspection we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI observation tool helps us to capture the experiences of people using services with a dementia. It helps us to make judgements as to how people with dementia are respected and involved in their care and treatment.

Using the SOFI tool we spent time observing how people with dementia were supported. We saw that people were positively engaged in one to one and group activities facilitated by the staff. We saw the care staff worked at a relaxed pace and respond to people with warmth, affection and appropriate use of humour. The staff promoted the involvement of everyone who used the service in participating in activities regardless of their mental or physical abilities.