Watford House Residential 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. Overall, the provider assessed risks to ensure people were safe. Staff took action to mitigate any identified risks and people lived in a safe environment. We identified where 1 person required a more specific care plan. This was put in place following our on-site assessment. Overall, people were supported to receive their medicines safely; we identified where further guidelines were needed to ensure people received their medicines consistently. These were put in place following our on-site assessment. The provider learned lessons when things had gone wrong. People were safeguarded from abuse and avoidable harm. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider was working in line with the Mental Capacity Act.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Processes were in place to promote a safety-based culture where concerns were investigated and listened to. The provider followed the duty of candour so that open and honest investigations and any findings were shared appropriately. This meant lessons were learnt and good practice was identified and embedded.

Leaders understood the importance of learning from when things went wrong. They shared information and learning with staff to help embed good practice. They reviewed accidents and incidents and took action to help promote people’s safety. Staff understood the provider’s policy in relation to accident and incident reporting. Staff demonstrated an understanding of their responsibilities to report and record accidents and incidents. They confirmed learning was shared to help them promote people’s safety.

We spoke with 4 people using the service. All of them felt able to raise concerns and had a staff member they could speak with if they were worried. Relatives we spoke with told us they felt the management team were open and approachable. One relative told us, “I do approach them quite often. I’ve emailed them or gone and found one of them if I’m visiting and I always find them very good.” Relatives felt they received full explanations of any issue. For example, 1 relative said, “If I ask, I always get a full explanation of what’s going on. Nothing has gone wrong as such, but initially, [my relative] was having a few problems and they didn’t feel they were managing it as well as they could. They let me know who they were getting in to see them, a doctor and adult social care, and what medication they were trying. I got feedback on the medication and how well it was working.”

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Leaders demonstrated a strong understanding of safeguarding and how to keep people safe. This included responsibility to apply for Deprivation of Liberty Safeguards (DoLS). The registered manager ensured staff remained competent in relation to understanding safeguarding and this was discussed at regular staff meetings. The registered manager made appropriate safeguarding referrals when needed and safeguarding was discussed at provider meetings. Staff confirmed they had received safeguarding training and understood how to recognise and report abuse. Staff were aware of who to contact within the local authority and how to report safeguarding concerns to them. Senior staff were able to provide examples of times they had raised a safeguarding concern. Staff were able to access the provider’s safeguarding policy should they need to refer to it.

Processes were in place to ensure management oversight of safeguarding referrals, outcomes and applications made for any Deprivation of Liberty Safeguards (DoLS). Any conditions granted on authorised DoLS were identified and processes were followed to ensure people received advocacy support when needed. This meant people’s rights were promoted and steps were taken to help protect people from abuse and discrimination.

All of the people we spoke with felt safe living at Watford House Residential Home. They knew who to talk to if they ever felt unsafe and were confident they would be listened to. One person said, “It feels safe here.” Relatives told us they felt their family members were cared for safely at Watford House Residential Home. Relatives also knew who to report any concerns to. One relative told us, “[The manager] made it clear that she would be the person to go to if there was any problem.”

We carried out a short observational framework inspection (SOFI) to help us understand the experiences of people using the service who may not be able to verbally share their feedback. The SOFI showed us staff were monitoring people's safety when supervising communal spaces and were observed to engage with people to support their well-being. The upstairs lounge had been utilised as a quieter space following incidents to ensure a safe environment for people. We observed people to be relaxed in this environment.

We reviewed 4 people’s care plans and relevant risk assessments. At the time of our on-site assessment, the registered manager explained all care plans were in the process of being updated. Overall, people’s risks were identified and assessed. We identified 1 person who did not have a specific care plan or risk assessment in place relating to diabetes. Whilst this was reflected within other care plans, the registered manager assured us a specific care plan would be created. Risk assessments were reviewed regularly, or as people’s needs changed. Care plans showed monthly care reviews were held with people and their relatives. Where assessments identified further support was needed from relevant healthcare professionals, advice was sought. Overall daily notes showed care was provided in line with people’s support plans, but we found further detail within these would support the monitoring of people’s clinical risks. For example, where people required regular repositioning at night, staff would record one entry for the night confirming the person had been repositioned in line with this guidance rather than individual entries with times of every single intervention. However, we did not identify any evidence staff had not provided this intervention.

The SOFI showed us staff followed guidance within people's care plans to keep people safe. For example, monitoring those who were high falls risk.

Leaders used a holistic approach when assessing risks to people and this included working with relevant professionals. They understood the importance of involving people and their families when planning people’s care and support. The registered manager was confident staff knew people well and this meant any changes in their needs were quickly identified. Staff understood the guidance within people’s care plans in relation to their specific needs and risks. Care plans were in the process of being updated and staff confirmed they had time to read these. They told us any updates to people’s needs were communicated with them.

People felt staff knew them well. One person said they had been involved in their care planning and confirmed staff met their needs well, saying, “They see to me beautifully.” Relatives felt involved in how risks were managed and told us equipment such as sensor mats helped staff monitor their family members who were at risk of falls. Relatives told us emergency healthcare was obtained when needed. One relative said, “When paramedics have been called, I’m always told. A couple of months ago [my family member was unwell]. Staff couldn’t work out what had happened, so they called an ambulance. I’m confident that any emergency or situation like that, the home would act quickly.

Regular checks were made on the safety of the premises and equipment used. This included fire safety checks and checks on hoists and slings used. Plans were in place to help maintain a safe service should there be an emergency event, such as, the loss of power or severe weather. These checks and processes helped to ensure the safety of the environment was maintained.

The SOFI showed us that people had access to their specialist equipment, such as walking aids and pressure relief equipment. Staff were observant for potential trip hazards for people who were at high risk of falls.

Leaders followed the processes in place to maintain a safe environment. The provider completed routine health and safety checks. Actions to maintain safety were taken, for example, the registered manager explained they were working to address findings at the most recent fire safety inspection. All staff were aware of the provider’s policy and procedures relating to the reporting of environmental concerns. Staff felt they had enough equipment to carry out their roles safely. Staff understood how they could promote safer environments for people, for example removing trip hazards.

People had access to any equipment they needed to be supported safely. One person said, “I have everything I need all I need to do is ask [staff].” Relatives told us they felt the home was well-maintained. One relative told us, “The home could probably do with being modernised, but overall, it’s safe. When the garden’s open, people can move around safely there too.”

We reviewed the recruitment files of 3 care staff. The provider completed the necessary checks to ensure staff were safe and suitable to work at the service. This included DBS checks. The registered manager completed a weekly dependency tool to help inform the number of staff needed to meet people’s needs. This reviewed people's individual needs and dependencies, but also the environment, any additional identified risks, skill mix of staff and feedback from visitors. We reviewed 3 weeks’ worth of staffing rotas on site. These showed staffing numbers were safe to meet the needs of people using the service. Processes were followed to ensure staff completed an induction and training relevant to their specific roles. The registered manager maintained an oversight of what training staff had completed to ensure people’s needs could be safely met.

The SOFI showed us that staff were visible in communal areas at all times. Staff had time to check in on people's well-being as well as supporting their physical care needs.

The registered manager felt staffing levels met the needs of people using the service and told us they kept this under review. They told us they were able to request additional staff if needed. Staff felt overall there were enough staff to meet people’s needs. Staff felt they worked well as a team. A care shift had been introduced to provide an overlap between the night and day shift and staff felt was this had a positive impact for people. All staff confirmed they felt they had enough training to carry out their roles and received ongoing support in the way of competency checks and regular supervisions. Staff felt the induction process was robust and equipped them with the skills and confidence before starting in the role.

Everyone we spoke with felt there were enough staff at the service and their needs were met quickly. People felt staff had enough training. One person told us, “Staff have had enough training with dementia, I have heard them talking, they are so patient they carry on talking, they are brill.” Most relatives felt there were enough staff. One relative told us, “There’s always plenty of staff, always one not too far away.” Another relative told us, “Every time I’ve been there’s at least 1 member of staff in each lounge room. If people are sitting in the dining area, there are always staff in and out, or the kitchen staff, keeping an eye on things.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People confirmed they were happy with the care staff provided in relation to medicines. One person said, “They make sure I get it at the right time, I would forget.” Relatives told us their family members received their medicines when they needed them. One relative told us, [My family member] has prescribed pain relief for back pain. Staff are aware and make sure they have it whenever they need it.”

The registered manager demonstrated an understanding of reducing the need for antipsychotic medication and was working to reduce this by liaising with relevant healthcare professionals. They explained “We don’t want to go straight to medication” and aimed to explore all other methods to support people. The registered manager attended monthly pharmacy reviews. They explained any medicine errors were discussed at weekly clinical meetings with staff. The most recent medicines audit had identified some actions to help improve medicine management. Staff confirmed they had received medicine training, and their competencies were assessed every 6 months. Staff understood how to report a medicines error.

People’s care plans were reviewed following discussions with the GP about any changes in their medicines. Medicine reviews were routinely held with the pharmacy to discuss people's medicines and whether they remained safe and effective. During our on-site visit we identified some protocols to help ensure consistency for medicines given ‘as and when needed’ were not in place. Whilst records showed these medicines had not been inappropriately administered, lack of protocols increased the risk of staff having insufficient guidance to support them in administering these medicines safely and appropriately. Following our inspection, the registered manager confirmed these protocols had been put in place.