Waterfield House is a residential care home providing personal care and accommodation for up to 76 people. There are two floors and people with more complex needs or living with dementia live on the top floor. At the time of our inspection there were 46 people living at the service. Each person had their own bedroom and had access to communal lounges, dining rooms and a secluded garden.

At the last inspection of 26 April 2016 the service was rated good. At this inspection the service remained good overall and good in the key questions of Safe, Effective, Caring and Responsive. However, we rated the service as requires improvement in Well-led.

Systems in place to record the administration of topical creams and the amounts fluids that people consumed were not always effectively recorded. People were being given sufficient amounts to drink of their choice.

There were clear plans in place to protect people from risks to their safety. Staffing levels of were appropriate to support people meet their assessed needs. There was a robust recruitment process for employing staff appropriately to care for the people living at Waterfield House. Other than the issue of recording the administration of topical creams people was receiving their prescribed medicines.

People were cared for by staff who received supervision and on-going training to develop their skills to support people with their assessed needs. The service had an established induction program in place to support new staff into the service.

People were provided with sufficient amounts and a variety of meals. The staff ensured that people were referred to professionals when they were unwell.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Care was delivered in an understanding and empathic way to meet people’s needs. People were supported by staff to make day to day decisions about their care. The staff respected people’s dignity and privacy.

Each person had a care plan which was based on an individual needs assessment and took into account people’s preferences. The care plans were reviewed regularly to remain up to date.

People were encouraged to engage with a variety of activities which had been developed from listening to the views of the people. People were aware of how to make a complaint and spoke positively about the staff and registered manager’s practice of acting quickly to deal with any concerns raised. The service had consulted with people and their relatives as appropriate to discuss plans of they wished to receive care should they become unwell.

People and relatives reported the service was run by knowledgeable and responsive staff with an open culture to listen to their views. The service consulted with people living at the service and their relatives regularly regarding their thoughts of the service.

Further information is in the detailed findings below.

The inspection took place on 26 April 2016 and was unannounced. The service is registered to provide accommodation and personal care without nursing for up to 75 people.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People were protected from the risk of abuse as staff had attended training to ensure they had good understanding of their roles and responsibilities if they suspected abuse was happening. The manager had shared information with the local authority when needed.

People were supported by a sufficient number of suitably experienced staff. The provider had ensured appropriate recruitment checks were carried out on staff before they started work. The staff had been recruited safely and had the skills and knowledge to provide care and support in to people of their choice.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Positive and caring relationships had been developed between people and staff. Staff responded to people’s needs in a compassionate and caring manner. People were supported to make day to day decisions and were treated with dignity and respect at all times. People were given choices in their daily routines and their privacy and dignity was respected. People were supported and enabled to be as independent as possible in all aspects of their lives.

The staff of the service knew people well and were competent in meeting people’s needs. Staff were supported and supervised in their roles. People, where able, were involved in the planning and reviewing of their care and support.

People’s health needs were managed appropriately with input from relevant health care professionals. People were treated with kindness and respect by staff who knew them well. People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health. Staff ensured that people’s health needs were effectively monitored.

People were supported to maintain relationships with friends and family so that they were not socially isolated. There was an open culture and staff were supported to provide care that was centred on the individual. The manager was open and approachable and enabled people who used the service to express their views.

People knew how to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions about the service. The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

We spoke with five people using the service and three relatives. People told us that they were very happy with their care and that the staff were friendly, nice and kind. One person commented, “Very good service, friendly staff and I can choose what I want to eat and when to join in with activities.” Another person said, “I am very happy at the home, I have no complaints.”

We gathered evidence of people’s experiences of the service by observing how they were treated during our visit. We saw that people’s privacy, dignity and independence was being respected. Staff were observed to be polite and professional as well as demonstrating genuine care, affection and concern for people using the service.

We looked at care records and found that people had appropriate assessments and were cared for according to their needs. We found that staff were recruited appropriately, were well trained and had the skills required to provide safe care.

We saw that there were appropriate arrangements in place to ensure cleanliness and reduce the risk of cross infection at the service. We also found that there were effective systems in place to obtain peoples views about the quality of the service.

Our inspection on 21 March and 02 April 2012 found significant failings relating to assessing and monitoring the quality of service provision. Our return visit on 07 June 2012 found that the provider had made the required improvements, however we identified that there continued to be a risk to safeguarding people who use the service. On this return visit we found that the provider had made the improvements required to achieve compliance with regulations for safeguarding people who use services from abuse.

People spoken with told us that the division of the home, into two units had made living in the home a lot better. One person commented, “It is more relaxing and I don’t get so scared of talking with other people using the service”. One person told us that “Things have improved over the last few months, we had lost the happiness, but now we are having happier days”.

Staff told us that the division of units meant there was less strain on staff. They told us that the atmosphere in the home was calmer, with less incidents of aggression between people using the service. One member of staff commented, “It is a happier place to work”.

Two relatives spoken with praised the service and the staff. They told us that the facilities, food and activities provided were to a very high standard and that, “The staff were very nice and helpful”. One relative commented, “It was an absolute god send that we found Waterfield House”.

People we were able to speak with said they were happy with the way the service manages their medicines. One person told us that staff were "Very good" when giving them their medicines.

We joined a group of ten people finishing their breakfast. We asked people their views of what it was like living in the home. One person told us that, “Everything is going nicely, we get good quality food, it is very good.” Another person commented that they do not eat very much, but what they do have is “Good.” They confirmed that if they did not like what is on the menu, they were able to choose an alternative.

One person told us that they liked the people that they lived with and that this made for “Happy living.” One person said that they had no “Grumbles” about the staff and were not aware if the home was using agency staff. One person told us that some staff were, “More keen than others, however they were not rude.” One person told us, “When I press my button, I have to wait a while for staff to come, and one member was a bit a short with me when I rang for assistance, however all other helpers have been very good.”

We were informed by the manager that people who had bedrooms on the first floor had all been moved and now had a bedroom on the ground floor. We were unable to ask those who had moved about their views because they had dementia and were unable to communicate with us in a meaningful way. However, the manager confirmed that they had been consulted. We asked other people living in the home if these changes had affected them. One person told us that this had not affected the service they received. However, one person told us that since people had been moved down stairs, “I have to listen to the person in the bedroom next door “Shouting Nurse, Nurse all night.” Other comments included, “To tell you the truth, I don’t like it here, I am afraid of some of the people living here,” and there is “A lot of people with dementia here, this is the reason I stay in my bedroom”. One person commented that they were “Lonely” and would like someone to talk to, but felt there were a limited number of people with whom they could have a conversation with.”

One person told us that staff were not always around and said that they found the behaviour of some people living in the home “Upsetting.” One person told us that they were “Frightened” of one of the people using the service, “If you say anything to them, they become aggressive.”

During our visits we met and introduced ourselves to most of the people using the service and gained their views about the care and support they received. We observed the experiences of five of the more vulnerable people living in the home. We spoke with four people and two visiting relatives in more depth to get their views of the service.

Overall people spoken with and their relatives told us that they were happy with the service and that the staff treated them well. We saw that most of the staff treating people with respect; they were attentive and had an understanding of people’s needs. However, we also saw staff who did not do this which meant some people were ignored.

The majority of people spoken with told us that there was “Not enough staff”, and that the home relies very much on agency staff. People said the lack of staff impacted on the care and support they received. People told us that they were bored, as there were limited activities, and not enough staff to facilitate them. One person said, “I do not feel there is enough staff on duty, there are no activities”. They told us that they do visit the life café in the home, but that they only do this when their friend visits so that they can have a cup of tea.

Two people told us they did not have the freedom to access the gardens when they wished. One person told us “They don’t let us out”. Both people told us they always found the door to the garden was locked.

One person felt the organisation of the home could be better and gave an example. They told us that when one of the staff is on holiday there appears to be only one cleaner, and that in these circumstances, they do not get their room, “Cleaned properly, only hoovered and their waste bin emptied”, which they found distressing.

People told us that the food was “OK”, however they did not feel that they were consulted about menus, and did not always “Fancy” what was on offer. One person told us that, “I don’t eat very much, I tend to fiddle with my dinner, I have lost all sense of taste, and the meals are like eating cardboard”. They told us that they would like a cooked breakfast, but this had not been offered.

One relative told us they had, “No problems” with the care their relative received. A second relative told us that they had no concerns over the standard of personal care their next of kin received as they always looked, “Clean and well presented”.