This inspection was unannounced and took place on 28 and 29 November 2016.

Waterloo Care Home provides accommodation for up to 36 older people living with dementia who require personal care and support; they do not provide nursing care.

The last full inspection of the service was carried out in April 2013 when we found some medicine administration procedures were not fully safe. Following that inspection the provider sent us an action plan and we re-inspected the home in October 2013 looking specifically at the issues raised. At this inspection we found there had been a marked improvement in the management of medicines within the home.

At the time of the inspection there were 36 people living in the home. There was no registered manger in post, however the new manager had sent their application for registration to CQC and were awaiting a response. 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.

The provider’s staff recruitment procedures helped to minimise risks to people who lived at the home. Training had been given to all staff to make sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home and with staff. One person said, “Yes I feel very safe living here.”

There were sufficient numbers of staff to keep people safe and to provide care and support in an unhurried manner. People told us staff were always kind and caring. Throughout the inspection there was a cheerful, relaxed and caring atmosphere. There was a consistent staff team with some staff working at the home for up to ten years. It was evident staff knew people well.

Medicines were administered safely. Medicines were administered by staff who had received suitable training. Safe procedures were followed when recording medicines. Medicines administration records (MAR) were accurate. There were no unexplained gaps in the medicines administration records. Audits of medicines had been completed and appropriate actions taken to monitor safe administration and storage.

People had their nutritional needs assessed and received meals in accordance with their personal preferences and needs. Where people required physical assistance to eat this was provided in a dignified manner. We saw people were supported to eat in line with the recommendations made by healthcare professionals. The experience at meal times for people living with dementia was good with people being able to see the meal options available to them and make an informed choice. People told us the food was always good. One person told us they had enjoyed their lunch but it was sometimes a bit large.

People were supported to take part in activities of their choice. A full activities programme was advertised. Care staff carried out activities throughout the day. They organised news discussions, conversations, quizzes, jigsaws and a sing-along. Visiting entertainers also came to the home. One person said they were looking forward to the singer in the afternoon.

The management of the home was described as open and approachable and we were told by people and staff that they would be comfortable to raise any concerns. Where concerns had been raised within the home, appropriate action had been taken to make sure people were fully protected.

The manager had plans for the future development of the home. They told us they wanted to run a happy home where people felt safe and as healthy as possible and for staff to feel part of a family group. They wanted families to feel it was their relative’s home rather than a care home. We could see these plans in action with staff supporting relatives to continue to be involved with people’s care.

People told us they received care and

We spoke with two people who used the service. One person told us "The staff are very kind, they do not rush me and encourage me to do things for myself." One relative told us "My mother has been ill several times but the staff have always kept me updated and the care they have given has been very good."

People were protected from the risks associated with medicines and the provider had appropriate medication administration training in place for staff.

People’s care needs and risks were assessed and care was delivered to meet their needs. Care plans were reviewed and updated when changes occured.

We spoke with people who used the service and people’s relatives. People who lived at the home told us that their needs were met and spoke positively about the staff within the home. Two people’s relatives told us that the home met the needs of their family member.

People’s needs were assessed and daily care was delivered in line with their wishes. We saw the home was clean and there were systems in place to promote good practice in relation to infection prevention and control. There were also enough staff on duty to meet people’s personal care and medication needs.

Medicines were appropriately stored, however the correct procedures for reporting the refusal of medicines had not always been followed, and the recording of administered medicines was not specific regarding the dose administered. There was no evidence to demonstrate that staff competency in the administration of medicines had been assessed or monitored.

People’s privacy and independence was respected. We saw that a window had been obscured and doors were closed when people were being assisted with personal care. One person told us, “I do everything myself, I tidy the room myself, I don’t need any help.

People’s care records contained accurate information. People’s care needs were assessed and care and support was delivered in line with their individual care plan. One person said, “Staff help you with your nails and a chiropodist also comes in.”

Appropriate checks were carried out prior to staff starting work. There were sufficient numbers of staff who had received appropriate training. Staff were aware of the need to report any allegation of abuse.

We completed an inspection of the home unannounced on 11 September 2012. We did this because of concerns raised by Dorset County Council in regard to the care and welfare of people living in the home.

Most of the people who lived at Waterloo Care Home had dementia and were not able to tell us about their experiences. To help us to understand people’s experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they receive and whether they had positive experiences.

There were a few people who were able to tell us about their care. We spoke with a number of people who told us that staff were kind. One person said: “The staff are very good at looking after me”. One person told us: “I have a red button in my room I can press, they come right away”.

In response to a question about medicines, one person said: “The staff give me a calcium tablet every morning, they remember, they are quite good, and again at night, they don’t forget”.

One person told us “They clean my bedroom every morning.

We saw staff understood people's need for privacy, knocking on doors before entering and ensuring doors were closed while personal care took place. We also saw occasions when their dignity and privacy was not maintained.

We observed one person in bed. There was a light box style window in their room that looked into the corridor. The window was not covered. We were told the person chose not to have the window covered. In the morning the person had a visit from a healthcare professional. People could look in this window and the person's dignity would have been compromised. We observed a member of staff walking into one person's room, while they were being seen by a healthcare professional. They did not knock, collected some protective gloves and left the room.

We observed lunch time. There were seven people in dining room and other people were in their bedrooms. We found that people were not receiving the support they needed to eat and drink.

We found that people's needs were not properly assessed and that care plans were not updated when their needs changed. People were not being care for in a way that was appropriate and safe.

One the day of our visit the cleaner was not working in the home. We spoke with a member of staff who was covering the cleaning duties. They were observed cleaning bathrooms and toilets and emptying waste paper bins in people's rooms. They were not observed cleaning people’s bedrooms.

We found that staff were not recruited through effective recruitment procedures.

On the day of our visit there were a variety of health care professionals assessing people’s care needs in the home. This may have affected staff's ability to respond quickly to the care needs of people in the home. However, we observed that staff had pagers and checked when they went off and staff were observed discussing who was able to respond particularly when more than one person was calling for assistance.

We undertook four visits to Waterloo Care Home. Three of the visits were in relation to information of concern that we had received. The visits were carried out on 29 November 2011, 4 January 2012, 29 March 2012 and 2 April 2012.

Most of the people who lived at Waterloo Care Home had dementia and were not able to tell us about their experiences. To help us to understand people’s experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they receive and whether they had positive experiences.

We spoke with three relatives. Two relatives said they had been informed about the care their relative received. One relative felt that they had not been involved in the care planning for their relative.

We observed that people were supported by adequate numbers of staff and people had a choice of food and drink.

Care records were in the process of being audited on a monthly basis. However, routine reviews of the care records had not been done consistently to ensure care plans were always up to date and accurate.

Medicines were not always handled safely and staff were unable to clarify what supervision they had had in medicines management.

The home’s manager was reviewing the quality of the service provided, although some action plans were not fully completed