The inspection took place on 22 June 2016 and was unannounced. At our last inspection on 14 and 16 July, the service was rated as requiring improvement. At this inspection we found that the provider had made the required improvements. Watermill House Care Home is a nursing and residential care home which provides accommodation and personal care for up to 65 older people. At the time of our inspection 61 people lived at the home.

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.

This inspection took place on 30 December 2014 and was unannounced. This was the first inspection since the service registered with the Care Quality Commission (CQC) in September 2014.

Watermill House Care Home is a nursing and residential care home which provides accommodation and personal care for up to 65 older people. At the time of our inspection there were 28 people living at the home. There is a registered manager. 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.

CQC is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at Watermill House Care Home. Staff were familiar with their role in relation to MCA and DoLs.

Staff were kind and caring. They knew people well and were able to give a detailed account of their needs. Care plans were still in progress for people who had recently moved into the home and this was an area which the manager had identified to work on.

Staff were able to recognise abuse and knew how to report it appropriately. There was information available to support them with this. Staff had been provided with training to support them in their role, they also received supervision from their manager.

Robust recruitment procedures had been followed and the service was recruiting to ensure there were sufficient staff available as the beds became occupied. Some people told us that at times staff were busy and were unable to meet their needs. On the day of inspection we saw that people had their needs met in a timely fashion. However, we brought this to the manager’s attention to ensure this was monitored during the transitional period.

People’s bedrails did not always have the appropriate equipment and they were not correctly assessed prior to using them. We looked at the management of medicines and found that this required improvement, in particular in relation to recording administration and the management of controlled drugs.

People had access to health and social care professionals and they were supported to maintain good health. They were positive about the quality and quantity of food and drink available. The food looked appetising and those who needed support with eating and drinking received support in a timely and sensitive way.

People and their relatives felt listened to and the manager took all complaints or concerns seriously and responded to them appropriately. Quality assurance processes were in place and these were used effectively to ensure the continued improvement of the service.

At this inspection we found the service to be in breach of Regulations 9 and 13 of the Health and Social care Act 2008 (Regulated activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 14 and 16 July 2015 and was unannounced.

Watermill House Care Home is a nursing and residential care home which provides accommodation and personal care for up to 65 older people. On the day we inspected there were 40 people living at the home.

When we last inspected the service on 30 December 2014 we found them to not be meeting the required standards in relation to assessing risks to people and the administration of medication. At this inspection we found that they had met the standards.

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

The CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The registered manager and staff were aware of their responsibilities under the MCA 2005 and DoLS. We found that, where people lacked capacity to make their own decisions, consent had been obtained in line with the MCA 2005. The manager was in the process of submitting DoLS applications to the local authority for people who needed these safeguards.

People’s call bells were not always in reach and for people who could not use call bells, there were no recorded regular checks in place.

Records of people’s daily notes, fluid and repositioning charts were not completed as required.

People were protected from the risk of abuse and felt safe at the home. Staff were knowledgeable about the risks of abuse and reporting procedures. Safe and effective recruitment practices were followed which included appropriate background and pre-employment checks.

There were suitable arrangements for the safe storage, management and disposal of medicines.

Incidents and risks were managed well and reported appropriately. People were supported to ensure they received a well-balanced diet to their liking.

People were supported by staff who knew them well and were involved with decisions about their own care. Their independence and dignity was promoted by staff had received appropriate training and were knowledgeable about their care needs.

People felt cared for and supported by the manager and the provider, they felt listened to and that their views were taken into account. There were regular staff meetings for people to express their views. The service had a complaints procedure in place. Issues and concerns identified were improved upon quickly and to benefit the people that used the service.

The service was well led by the manager who supported the staff and provided visible leadership. There was a quality management system in place which included a system of audits to identify where improvements could be made. However, these did not pick up where records were not always completed as required.

At this inspection we found the service to be in breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.