About the service:

Watford House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to 40 older people, including people living with dementia.

On the day of our inspection 38 people were using the service.

People’s experience of using this service:

The home did not have a registered manager. However, the provider had appointed a manager and they told us they had been made permanent on 1 February 2019, they were applying to be registered with the CQC.

People were not always protected from the risk of infection. We found the service was not kept clean and was not well maintained. The adaptation and design of the building did not meet people’s needs who were living with dementia. The manager had identified some of the issues as part of the quality monitoring, but the monitoring tool was not effective to ensure all issues were identified. We also found the provider had not acted on the actions identified by the manager so there was lack of governance and oversight by the provider. Although since our inspection the provider has confirmed that works will be commenced to ensure the environment is improved.

People were safeguarded from the risk of abuse. Processes and practices protected people from abuse, there were enough staff to ensure people’s needs were met. However, from talking with staff and people who used the service it was not clear if staff were deployed effectively to meet people's needs in a timely way.

The recruitment of staff followed safe practices. Staff were supported and received effective training.

Safe medicine management procedures were in place. However, we identified some minor issues that were continually occurring. This put people at risk of not receiving their medicines as prescribed.

Risks to people were identified and managed in a way that did not restrict their freedom. Staff supported people to make their own decisions and choices. Staff we spoke with were knowledgeable and understood the principles of The Mental Capacity Act.

People were supported to receive a nutritious and balanced diet. People spoke positively about the care and support they received. People told us staff were kind and caring, maintained their dignity and respected them.

People received care that was predominantly responsive to their needs. Care plans were developed with the people who used the service and included their decisions and choices. People were supported at the end of their lives.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People we spoke with said they had no concerns but would not hesitate to talk with staff if required.

More information in Detailed Findings below:

Rating at last inspection:

The service was previously rated good and the report was published on 16 July 2016.

Why we inspected:

This was a planned inspection based on the previous rating of the service. At this inspection we found the service had deteriorated and is rated requires improvement.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates based on the rating given at this inspection

The inspection took place on 5 and 13 April 2016. It was unannounced. The service was last inspected on 10 May 2014 and was compliant in all areas.

Watford House Residential Home is located in the town of New Mills in the High Peak area of Derbyshire. It is a care home for up to forty people. Some people were living with dementia. At the time of our inspection thirty nine people were living there.

There was a registered manager in post. 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 and their relatives were satisfied with the care provided in the home and were complimentary about the support they received. They felt all their needs were being met and they were involved in the planning of their care. People were treated with kindness and respect and felt safe using the service. Relatives we spoke with confirmed this.

People were supported by a staff team that understood their individual needs and took the time to ask what people wanted. We saw staff were friendly, kind and treated people with dignity. Staff knew how to safeguard people from abuse.

Staff recruitment procedures were effective in ensuring appropriate staff were employed. Staff received a thorough induction to work in the home. They received training in a wide range of areas and felt they had support for their continued professional development. The registered manager was being supported by the provider to undertake a degree in dementia care.

There were sufficient numbers of staff on duty to support people with their needs and to ensure they remained safe. Care was provided to people in a safe and thoughtful way.

The registered manager had a good understanding of the Mental Capacity Act 2005 and how important it was that people were given the opportunity to consent to their care and treatment. We saw this happened throughout the day.

People told us they enjoyed the food and people's dietary requirements were catered for. There was a choice of meals available so people were able to eat what they enjoyed. The daily menus were rotated regularly so people could enjoy a variety of food and eat a balanced diet.

People experienced care and support from staff who enjoyed their role and were fully aware of what their responsibilities were. Staff were competent in incorporating the principles of dignity and choice into the way they provided care and responded to people’s needs.

The registered manager had a clear vision for the home and was motivated to improve the quality of the service. There was an effective quality assurance system in place. Staff and people had confidence in the management of the home.

As part of our inspection we spoke with two people receiving care and staff working at the home. We also observed people receiving care and looked at records at the home.

Below is a summary of what we found.

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. The manager explained to us how the different accidents and incidents were followed up and what actions were taken to minimise further risks. This reduced the risks to people and helped the service to continually improve. We saw that policies and procedures were in place in relation to receiving, administering and storing medication. This meant people were protected because the service provided instructions so that staff handled medication safely. People's records, staff records and other records relevant to the management of the services were up to date, accurate and fit for purpose. Records were kept securely and could be located promptly when needed.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary and equipment needs had been identified in care plans where required. People told us they liked the food and were offered choices. People told us, "This place is very good" and "I have to say the staff are great here". We saw that people were provided with the appropriate support and encouragement they required to meet their nutritional needs.

Is the service caring?

Staff communicated well with people and were attentive when they need support. We saw that care workers showed patience and gave encouragement when supporting people. People using the service, their relatives, friends and other professionals involved with the service completed a satisfaction survey and provided regular feedback. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People’s views of the service were sought and we saw the manager responded where improvements were needed to the service.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service at all times.

We found that appropriate steps were taken to plan and deliver people's care at Watford House. We saw that people and their families were involved in planning and making decision about their care. We saw that complaints and comments about the service were responded to appropriately by the manager.

We saw that people's medicines were managed safely and that equipment at the home was safe and fit for use.

We saw that staff received training to meet people's needs and that they were well supported by the manager.

We inspected Watford House on10 December 2012 to check whether necessary improvements to care at the home from our previous inspections in June and September 2012 had been made. We spoke with managers, staff and people who were cared for at the home, and also examined records and care files.

We found that there had been changes to the structure and management of the home, and that improvements had been made in the necessary areas.

We found that repairs had been made to the building to make it safe, and that new systems of care planning and assessing risks had been introduced. We saw that consent was now being sought for people’s care, including where they were not able to consent for themselves, for example due to dementia. We also saw that risks that could affect people were being appropriately assessed, and that care plans had been introduced that contained detailed guidance about the person’s care.

We saw that staff had received relevant training and were being supported in supervision and team meetings by the manager. We also saw that systems had been introduced to monitor quality and safety at Watford House, and also that people’s views were being obtained and taken into account when assessing the quality of care at the home.

We found that although some systems and ways of working were continuing to be developed, that Watford House had made the necessary improvements to meet required standards of care and safety for people at the home.

We spoke to three people who resided at the home but gained little feedback as most people with dementia were not able to tell us about what it was like at the home. We observed the interactions between staff and people living at the home and spoke to three relatives. We also spoke with three staff and the registered manager to find out staff were recruited and supported in their role.

We observed people readily approaching staff to speak to them. People were often smiling when speaking to staff and they appeared to be at ease.

One relative told us that they considered that some staff help people move better than others. They said they found the quality of care delivered to be variable and that “sometimes the care was perfect but at other times it wasn’t”. The relative told us they felt they could identify which staff had dressed their relative according to the attention to detail that was given.

We spoke to one person who told us that staff always knocked on the bedroom door before entering. Another person told us that that staff sometimes ask what they would like to wear but mostly staff make the decisions about clothing.

We generally received positive comments about the food in the home. One person told us ‘its not too bad, you get a choice of meals’.

One relative told us the home was always spotlessly clean when they visited.

People gave us a range of comments and opinions about the staff: ‘the staff are good’, ‘there are always staff around and I get on well with them’,

We were told 30 out of the 35 people living in the home had varying degrees of dementia. As the majority of people had memory impairment this affected their ability to tell us about the service, where possible we did gain people’s views and also observed staff interactions with people. We spoke with six people who lived at the service as well as managers and three staff members.

One person said the staff were nice, and another person said that they were quite happy there. We were told that there were regular activities offered and a church service was held each fortnight. One person told us that staff allowed them lots of time when they were helping them with their care needs. One person we spoke with could not verbally tell us much about the home but appeared to be happy and cheerful. Two people we spoke with told us the home was clean.

Whilst we received positive feedback from the people we spoke with during our visit we found a range of concerns in the home. These are documented in the relevant sections of the report but affect the monitoring of quality and safety in the home where we found insufficient systems were in place.