This inspection took place on 09 February 2017 and was unannounced.

This was the second scheduled comprehensive inspection carried out at Waterhall Care Centre. At the last inspection on 22 July 2014 we found the provider was meeting the requirements of the regulations inspected.

Waterhall Care Centre is a 56 bed purpose built care home located in Bletchley, Milton Keynes. The home is situated over three floors, the ground floor is leased to the Primary Care Trust and the first and second floors offer permanent care in a residential setting for those with nursing, residential or dementia care needs. They also work in partnership with Milton Keynes Hospital to provide rehabilitation care. Each floor offers recreational and dining areas where activities and entertainment can be enjoyed and there is also a secure garden area. At the time of our visit there were 51 people using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

People were supported by very kind, caring and compassionate staff that often went the extra mile to provide people with excellent, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The whole staff team were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations.

There was a strong culture within the service of treating people with dignity and respect. The staff and the registered manager were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. Staff spent time with people to get to know them and their needs and this had ensured that behaviours that could be challenging for staff and distressing for people were minimised. People and the staff knew each other well and these relationships were valued.

Care was planned around people’s individual preferences and this included their spiritual and cultural wishes. People’s diverse needs were considered and their human rights were respected. The service had also developed a recognised approach to support people at the end of their lives to ensure that it was dignified and comfortable. People received exceptional compassionate care at the end of their life which was planned in advance with them. Health professionals told us the service provided excellent care and they were impressed with the knowledge of staff and their attention to end of life care.

There was a culture of openness and transparency at the service. Staff were extremely positive about the management and leadership which inspired them to deliver a high quality service. Exceptional leadership was demonstrated by the registered manager with a pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. People were looked after by staff who all shared the provider’s commitment to running a good quality service. The staff shared the provider’s vision and values to ensure people benefitted from the best possible care.

Feedback from people who used the service and their relatives was used to make changes to the service and to drive any improvements required to make the service better. Emphasis was placed by the management team on continuous improvement of the service. A robust system of monitoring checks and audits identified any improvements that needed to be made and action was taken as a result.

People felt safe. There were systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding training and underst

During our inspection visit we spoke with up to seven people who used the service, who all confirmed they were pleased with the care and treatment they received. We also spoke with two visitors who confirmed they were very pleased with the care their relative received at the care home. They told us the staff always made them feel welcome and kept them informed about the care of their relative. We spoke with a visiting healthcare professional who told us they regularly visited people using the service and the staff worked well with them in meeting the needs of people using the service.

As part of our inspection we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI observation tool helps us to capture the experiences of people using services with a dementia. It helps us to make judgements as to how people with dementia are respected and involved in their care and treatment.

Using the SOFI tool we spent time observing how people with dementia were supported. We saw that people were positively engaged in one to one and group activities facilitated by the staff. We saw the care staff worked at a relaxed pace and respond to people with warmth, affection and appropriate use of humour. The staff promoted the involvement of everyone who used the service in participating in activities regardless of their mental or physical abilities.

Some people were unable to speak with us because their dementia had impaired their ability to communicate. We spoke with four people in the privacy of their own rooms who told us they were content living at Waterhall Care Centre and felt safe. They told us that the staff were attentive and did their best to make them feel comfortable. They also told us that the food was good and they had plenty to eat and drink.

Comments from people we spoke with included, "The staff are busy but they always have time for you. Always smiling. I could not wish to be in a better place." Another person said, "I cannot fault the care I get here."

One person told us they were well looked after by staff, who were very kind. People said that if changes were made to their care and treatment, staff would talk to them and explain the reasons for the changes.

One relative told us that staff were patient and although they were busy they always came when they needed help. They said “I don't feel rushed and I don't have to explain things all over again.”

One person told us they were well looked after by staff, who were very helpful. They said they were happy living in the home and said they had settled in well thanks to the kindness of the staff.

Another person told us that if they ever had a problem, the staff would do whatever they could to help. We spoke to a relative who said they were happy to leave staff to care for their relative and informed us that the staff were professional and provided good quality care.

We were informed by people that they felt safe in the home and if they were unhappy they would talk to one of the staff or the manager.

People told us that their rooms and their living accommodation were always kept clean and tidy.

One person said ”there are always cleaners around and they come into my room every day.”

Two relatives told us “the place is always clean. I see the cleaners busy every day. Its one of the reasons we chose this home because it’s so clean and there are no horrible smells”.

People told us that they liked the staff who worked at the home and they were always very caring and attentive.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.’

The inspection took place on 22 July 2014 and was unannounced, this meant the provider did not know we were going to inspect. The last inspection took place on 25 July 2013 during which we found there were no breaches in the regulations.

Waterhall Care Centre provides nursing and residential care for up to 56 older people, including people living with dementia. On the day of our visit there were 51 people using the service. The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A registered manager was in post at the time of this inspection.

During the visit we spoke with people using the service, care staff, visitors, the registered manager and deputy manager. We also looked at records in relation to people’s care, staff recruitment, staff training and management audits.

People were safe at Waterhall Care Centre and staff knew what to do if they had any concerns about their welfare. Records showed that staff had received training on safeguarding adults, the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew how to manage risks to promote people’s safety, balanced with people’s rights to take risks.

People were supported by appropriately recruited and trained staff who knew the needs of the people they supported. People’s likes, dislikes and preferences were central to how their care was provided and the staff worked in a way so as to promote people’s choice and independence.

People told us that they were pleased and happy with the care and support provided at the service, they also told us they were supported to make choices about all aspects of their lives. We saw that people were encouraged to socialise and take part in a range of activities both in and out of the home.

Staff took prompt action in response to any concerns about people’s health or well-being.

People had access to visiting and external health and social care professionals as and when they needed.

Management audits were carried out on all aspects of the service, these included reviews of people’s care records, staff recruitment records, maintenance records and health and safety checks to the premises and grounds. The service encouraged feedback from people using the service and their representatives, which the service used to identify and make improvements.