Waterside Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 1 breach of regulation in relation to staffing. Feedback from people, relatives, and staff and our observations supported that people’s needs were not always met in a timely manner and in accordance with their preferences.

However, people told us they felt safe when supported by staff. The staff understood their duty to protect people from abuse and knew how to report any concerns they had to the management team. Staff felt supported and received training to meet people’s needs. Systems were in place to learn lessons from incidents that had occurred. Recruitment checks were completed to ensure only suitable staff would be employed. People received their medicines when they needed them.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some people and relatives told us although they knew who to raise safety concerns to, they did not always feel confident that action would be taken. One relative told us, “I have raised concerns about the staffing levels at meetings, but nothing ever seems to change”. One person told us, “I have raised concerns about how long it sometimes takes staff to come to me when I use my call bell, but I don’t know if it makes any difference because I don’t receive any feedback about this.”

Staff told us they knew the process for reporting any safety issues and where needed completed incident forms which were then escalated to management for review. Staff confirmed any lessons learned from incidents were shared with them in meetings. The management team also confirmed to us the processes they followed following any incidents or accidents that had occurred and how these were reviewed to ensure any lessons were learnt to reduce future occurrences.

There was limited evidence to demonstrate what action was being taken in response to feedback about staff deployment. This meant there was a risk people, and staff would stop raising concerns.

Systems were in place to review incidents and accidents. These were analysed for patterns and trends and reports completed and shared with the provider for monitoring. The processes followed included reviewing how incidents could be reduced and risks mitigated. Meeting records from team meetings were in place to show how learning was shared with staff. Daily meetings were also held to enable the registered manager to maintain oversight of the service and to be informed of any recent events. Where needed duty of candour was considered and outcomes shared with relatives. There was a complaints policy in place.

People and relatives told us they were involved in the assessment process when moving into the home. A relative said, “We provided information about [person] and what support they needed, we felt involved, and the move went well.” We observed a person getting ready to go back home, however they experienced a delay due to some arrangements not being in place at their home. The person told us, they were frustrated by this but understood the reasons for the delay.

Staff confirmed they were provided with key information when a person moved into the service. A staff member said, “The initial care plan is uploaded onto the electronic system which we read before providing care to a person. We also receive information about a person’s needs including any risks we need to be aware of during handovers.” The registered manager told us they completed pre-admission assessments and reviewed any referral information so they could make a decision if a person’s needs could be met.

The registered manager told us they worked with partner agencies to ensure admission and discharges to the home were safe. The registered manager advised information had been shared as part of a person’s transition home and how partner agencies had advised that all arrangements were in place. However, the move did not go as planned due to external plans not being effective.

Partner agencies confirmed the management team and staff worked with them to support people’s transitions to and from the service. Healthcare professionals confirmed staff were proactive in making referrals where required and listened to and followed any recommendations about people’s healthcare requirements.

The records we reviewed demonstrated the management team either assessed people’s needs or obtained referral information from partner agencies prior to providing care. Processes were in place for emergency admissions which included sharing of key information. This ensured staff could support people’s needs until a more detailed care plan could be developed.

We received mixed feedback from people. For example, some people told us they felt safe when receiving care and support from staff. Other people said, sometimes they didn’t feel safe due to staff at times asking them to do things much quicker than they would like, making them feel rushed. For example, when people were getting up or when mobilising. However, all people described staff as kind and respectful. A relative we spoke with said, “I have no concerns the staff are good, if I had any concerns I would speak to the manager.”

Staff understood how to recognise and respond to allegations of abuse. A staff member said, “We have had training around safeguarding and abuse and if I had any concerns I would report them straight away to the manager.” Staff also knew which external agencies they could share their concerns with. The registered manager understood how to respond to allegations of abuse, and notifications were shared with relevant agencies. However, we found staff had not always recorded full details about potentially unexplained body marks to ensure these were escalated appropriately.

People appeared comfortable in the presence of staff. We saw staff intervened when people became distressed and provided reassurance and support. Safeguarding information was displayed for everyone to access. However, when we asked about a body mark on a person staff had not previously identified this, and therefore was not able to provide assurances this had been recorded and escalated.

The provider had systems in place for the management and oversight of safeguarding concerns. There were appropriate policies in place to guide staff including a whistle-blowing procedure. However, we found on 1 occasion where a body mark identified on a person had not been recorded and escalated. We also found where body maps had been completed the rationale or action taken in response to the bruising or body marks had not been recorded on these. Therefore, we could not be assured procedures had been fully followed. Staff received training in safeguarding and the Mental Capacity Act. These areas were discussed in meetings and supervisions to check the staff’s understanding and to enable staff to share any concerns.

People told us, they sometimes tried to do things for themselves whilst waiting for staff to come and support them. One person said, “I need help to do things but sometimes I get frustrated waiting for staff, so I try and do it myself and then sometimes I have hurt myself.” However, people and relatives told us staff knew them and the risks associated with their care well.

Staff told us they read people’s care plans and risk assessments and spoke with people and their relatives, so they knew about any risks and how to support people safely. Discussions demonstrated staff knew about the risks for the people they were supporting during our visit. Staff told us, that any changes in a person’s care needs would be escalated to the management team so that care records could be updated accordingly. However, when we reviewed the records, we found not all risks had been updated to ensure staff had access to up-to-date information.

On the first day of our visit, we identified some risks that had not been considered. For example, we saw some beds had been adjusted leaving gaps at the bottom of the bed. The potential risks to people had not been considered. Action was taken to address this when we raised this with the management team.

The provider had recently transitioned from paper to electronic records and staff were getting used to the new ways of recording information. The provider was engaging with the software provider to address any issues identified. We found systems were in place to assess risks to people and the actions staff should take to reduce these were recorded but they were not always effective. We found some care plans and risk assessments were not always updated in response to some recent risks that had occurred. For example, following instances of choking . However, we found action had been taken in response to these incidents such as referrals to healthcare professionals. We also found some care plans did not always direct staff on how to support people when they became anxious or distressed.

We found there had been a high number of falls within the home and systems were in place to review these. Where possible action was taken to mitigate the risks such as the use of technology in people’s bedrooms so staff could be alerted that a person may need support.

Most people told us they were happy with their living environment and their bedrooms. One person said, “It meets my needs, and I like my bedroom.”

Another person however told us, “I have no blinds, so when the curtains are open, and the sun comes round it shines into my room so much I have to wear sunglasses.” We raised this with staff who did close the curtains to enable the person to remove their sunglasses.

Staff were aware of their responsibility to ensure people were safe in their environment. Staff were aware of how to escalate concerns to the management team. The management team told us regular checks and risk assessments were completed to ensure the environment was safe for both people and staff. However, some of the risks we had observed had not been considered or addressed until we had raised them during our visit.

We observed concerns with gaps in people’s beds and we also observed some people’s radiator covers did not fit correctly leaving parts of the radiator exposed. We shared this with the management team who confirmed action had been taken to address these risks.

We saw signage was not available on both units to enable people, relatives and visitors to navigate around the home. Action was taken to address this, and we noted some signage had been displayed on the second day of our visit.

We saw people had the equipment they needed to support their mobility and safety.

Although processes were in place to assess and mitigate any risks associated with the environment, these were not always robust as we found some areas that had not been considered. For example, issues with peoples beds, and the radiators.

We saw fire risk assessments and an external fire audit had been completed. All required actions had been undertaken following the last review. Service records confirmed processes were in place for the regular servicing and/or maintenance of premises and equipment. Various audits and risk assessments were completed to monitor the safety of the environment. Action had been taken to address recommendations made by partner agencies following recent visits. Records demonstrated staff had received the required training to ensure they provided safe care.

People and relatives said there was not enough staff to meet their needs in accordance with their preferences. For example, one person told us, “There are not enough staff, the ones that are here are good, but it is not enough. I would like to get washed and dressed at 8.30am, but it’s normally 11am-11.30am before they get to me.” Another person said, “I like to have a shower so I have to get up early so the night staff can support me as the day staff just don’t have time.” A relative said, “I love this home, the staff are kind, they are like my family, not just [person’s name]. There are not enough of them though, so sometimes [person] and other people have to wait for staff support.”

However, people and relatives described staff as kind, and caring.

Staff told us they enjoyed working in the home. Most of the staff we spoke with said there was not always enough staff on duty to ensure people’s needs were met in accordance with their preferences. One staff member said, “We do our best but sometimes the days are so busy, and we have to focus on people who are at risk so other people do have to wait for us to support them.”

Staff confirmed they received the training they needed for their role. Some staff said they would benefit from more in-depth training in relation to supporting people who may become distressed and anxious.

We observed staff roles to be task focused and some people did not receive the support when they wanted. Some people were not supported to the lounge area until 11.30am after personal care had been provided. We saw a staff member assigned to the lounge area to supervise people, which meant only a certain number of care staff were then available to support people who remained in their bedrooms. On the Dementia Unit, we saw a person became distressed and a relative intervened due to staff being busy.

On the first day of our visit, we saw available staff were not deployed to meet people’s needs and in accordance with their care plan for example, to meet a person’s communication needs. Action was taken to address this after we raised this with the management team.

A staffing dependency tool was in place and updated regularly. This tool was based on criteria detailing people’s needs. Although the tool stated enough staff were on duty the roles of staff had not always been considered as some staff focused on clinical roles as opposed to providing direct care and support to people.

Processes in place ensured staff were recruited safely and necessary checks were completed prior to staff starting. This included reference checks; proof of identity checks as well as Disclosure and Barring Service (DBS) checks. A DBS check is a way for employers to check a potential employee’s criminal record, to help decide whether they are a suitable person to work for them. This protected people from receiving support from unsuitable staff.

People and relatives told us the home was clean. One person said, “My bedroom is cleaned daily, the cleaning staff are very good.” Another person said, “The staff wear gloves and aprons when they support me in the bathroom, and my room is always clean and tidy.” People also confirmed they were supported to access available vaccinations to prevent infectious viruses.

Staff told us they always had access to personal protective equipment such as gloves and aprons. The management team told us they completed supervisions and spot checks to ensure staff worked in line with infection prevention and control principles. Domestic staff had a good knowledge of infection control procedures.

We observed some safety mats that were used by some people were soiled on the first day of our visit. We shared this information with the management team, and this was addressed.

We saw posters displayed to guide staff and visitors on how to wash their hands in accordance with best practices.

Systems were in place to support safe infection control practices. Audits and regular checks were undertaken to monitor the standards within the home. However, the management team’s daily walk-around check did not identify the soiled mats we observed on the first day of our visit.

An infection prevention control policy was in place to guide staff. Staff had completed infection prevention and control training as part of their induction. Cleaning schedules were completed to demonstrate what areas had been cleaned including when certain areas were deep cleaned.

People received medicines safely, as prescribed, and at the right time. Considerations were given when medicines needed to be taken before or after food, or when medicines had specific dose intervals.

Two people living at the home were prescribed insulin for diabetes. The staff regularly monitored their blood glucose before giving them their prescribed insulin.

Electronic medicine administration records were updated accurately and in a timely way when medicines were started, changed, or stopped. People’s preferences of how they preferred to take their medicines were recorded.

People when observed interacted well with staff and were seen to be settled.

Staff were seen to be caring when a medicine round was observed.

Staff understood and followed procedures to ensure people’s medicines were reconciled when they moved between services and when changes occurred, for example from the GP or hospital.

Some care plans on the new computerised system did not have the same medical conditions that were listed on the medication records for 5 people reviewed. A person’s care plan had not been updated to reflect the recent changes in their medicines. These changes had however been updated on their medication record. Action was taken to amend and update people’s records following our visit. A body map for a person who had a skin tear had the tear recorded on the wrong arm. An incident form completed had the skin tear recorded on the correct arm. Oxygen care plans for 2 people on oxygen, did not have details of target oxygen saturation. This is important to be recorded in care plans to be able to know if a person’s oxygen levels continue to remain safe. However, immediate action was taken by the provider to address all these concerns. Fridge temperatures and ambient room temperatures were recorded to ensure the safe storage of medicines. Controlled drugs (CDs) were stored securely in line with legislation and policy. CD stock checks were carried out as per the provider’s policy. The provider had systems to receive and manage safety alerts. When required’ (PRN) medicine protocols were in place to help staff give these medicines correctly and contained information when it was appropriate to give these.