Watersmead care home provides accommodation and personal care for up to 50 older people. At the time of our inspection, 44 people were living in the home. The home was last inspected in February 2015 and was found to be requiring improvements in the effective and responsive domains. At this inspection we found the service had made the required improvements.

This inspection took place on 15 May 2017 and was unannounced. We returned on 16 May 2017 to complete the inspection.

There was a registered manager in post at the service. 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 2008 and associated Regulations about how the service is run.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management.

People told us they felt safe living in the home. People received their medicines on time and the management of medicines was safe. There were systems in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were providing care for. People's needs were set out in care plans which they had been involved in developing and people were involved in reviewing their support. Staff followed people’s care plans, which helped to ensure people received care in the way they preferred.

Staff were appropriately trained and had the right skills to provide the care people needed. Staff had a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people's needs and wishes. People's views about their care and support was listened to and acted upon. There was an effective complaints procedure in place.

The provider regularly assessed and monitored the quality of care provided at Watersmead. Feedback from people and their relatives was encouraged and was used to make improvements to the service.

We looked at five care records which confirmed people’s mental capacity had been assessed prior to moving into the home. There were signed consent forms regarding agreement to have their photograph taken and sharing information about their health with third parties, for example, their GP or other healthcare professionals in an emergency situation.

A standard format of records was used throughout the home and there was a section entitled "my life history” which was written to reflect the person's life story. This included a contribution from the person and their family.

There was enough equipment to promote the independence and comfort of people who used the service. We saw information in people's assessments about the equipment that they needed to meet their needs.

Training was organised and run by the provider with some from external training companies. We saw the programme for the months ahead and the date’s staff were planning to attend.

People we spoke with confirmed that if they wanted to change anything in their room or in their routines the staff would act upon their wishes. There was a comments leaflet in each person’s room and we saw that there were numerous “thank you” cards and notes on display.

People told us they liked living in the home. One person said “you couldn’t find anywhere better”, another “if you’ve got to be somewhere, this is the best”. People told us how much they appreciated the care given to them by the staff. One person told us “they’re all really good”. A person told us “you can ring your bell if you need them, they don’t take long to come”.

We saw improvements in the way care was provided. We saw staff consistently treated people with respect and consulted them about their care. People’s care plans were clear and included all relevant information about their needs. Records for people who had dementia care needs were written in a person-centred way and did not include judgemental language.

The home was much cleaner than at our last inspection and staff told us about the improvements made by the new manager. One domestic worker told us the new manager was “really good and had got us everything we need”, so they could perform their role effectively.

People and their relatives told us about the improvements in the home. A relative described the new manager as “very good”. This was echoed by staff who told us there had been “big change” in the home and the atmosphere was “so much better now”. Staff reported the new manager was very approachable, one member of staff saying, “we can go and see her about anything”.

We visited Watersmead on 4 July 2012 as part of a review of compliance and to review improvements the home told us it had made in two areas identified in our review of 20 December 2011.

We spoke with 14 people, five visitors and 11 members of staff during our inspection. People said they liked living in the home. One person told us “I decide what I do”, another “they talk to me about what I want”, and another “I’m comfortable here”. However one person told us “I feel trapped”, as they could not get out of the home as they wished.

People’s relatives commented on the quality of the services. One family member told us their relative had “settled in really well and the care has been excellent”, another said “staff are very, very helpful, so patient and tolerant” and another said “I feel X is safe here”.

Some people felt there were enough staff, making comments such as “I ring the bell, they do come”, but others did not feel this was the case, commenting “staff are busy, busy”. This was echoed by staff, their comments included “we need more staff”. The home did not have formal systems for ensuring people’s dependency was taken into account when deciding on staffing levels.

We observed that since our last inspection the home continued not to assess or re-assess people’s care. Care also continued to be inconsistently planned and not delivered in line with people’s individual care needs. We found attention was needed to a range of areas relating to hygiene and cleanliness, including bathroom hoists and cleaning equipment in sluice rooms. The provider had a system for auditing quality, but this was not effective, as it had not identified a range of areas where we found the service was not meeting the essential standards of quality and safety. Where the quality monitoring system had identified shortfalls, action had not been taken to remedy those shortfalls. Some records necessary for the effective running of the home were not available for audit and others had not been accurately completed.

People told us they liked living in the home. One person said “it’s extremely good here” and another described the “lovely lot of staff”. People’s relatives echoed this. One relative said “anything X wants in particular they do for them” and another told us they were “highly, highly satisfied” with their relative’s care. We observed staff being kindly and helpful to people, taking time to support people who had memory loss difficulties, always making sure a person was comfortably settled before they went on to support another person.

Although some people were positive about the care provided, we observed the home were not supporting some frail people in the way they needed. This particularly related to people who spent much of their time in bed and were unable to move or give themselves fluids without assistance. We observed the home had not yet instigated certain necessary improvements following safeguarding investigations. Verbal complaints were not all brought to the home manager’s attention and investigated.

Watersmead is a residential care home providing accommodation for up to 50 people, some of whom may have a dementia. At the time of our visit there were 47 people living at the home. Watersmead is a purpose built property on one level.

The service had a registered manager who was responsible for the day to day operation of the home. 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. The registered manager was present on the day of the inspection.

People and their families praised the staff and registered manager at Watersmead for their kindness. People had developed caring relationships with staff and were treated with dignity and respect.

Staff worked closely with health and social care professionals for guidance and support around people’s care needs. People's care needs had been assessed and reviewed on a monthly basis. Care records were not completed to a consistent standard. Some records lacked sufficient detail or it was unclear which information was current.

Staff were not confident in their understanding of how the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards should be applied in their roles. Assessments of capacity and best interest decisions were not always recorded when people lacked capacity to decide on their place of residence, care or treatment.  

Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Staff received training which was considered mandatory by the provider and in addition, more specific training based upon people’s needs such as, dementia awareness.