We inspected the service on 13 November 2018. The inspection was unannounced. Waterloo House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 35 older people with physical and or mental health needs and those associated with dementia.

On the day of our inspection 28 people were living at the service.

At our last inspection on 12 January 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service and were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed, and care plans set out how to minimise any risk identified and were monitored for any changes needed.

People continued to receive an effective service. Staff received all the training and support they required to meet people’s individual needs, including their nutritional needs. Staff worked well with external health care professionals and people were supported to access health services when required. People were supported to make their own choices and staff cared for people in the least restrictive way possible. The registered persons had processes in place which helped make sure that when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

CQC is required by law to monitor the operation of the MCA and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Through our discussions with the registered manager and staff we were assured they understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing day to day support and care to people. DoLS were in place where needed to protect people when they did not have capacity to make decisions and where it was considered necessary to restrict their freedom in some way, usually to protect them from risks. At the time of our inspection, 16 people were subject to an active DoLS authorisation and the registered manager informed us they were awaiting the outcome of one further application which had been submitted to the local authority for approval.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People were involved with assessing and planning for their care needs and regularly reviewing the arrangements in place. They were supported to pursue their individual interests and hobbies, and group social activities were offered. There was a complaints procedure in place and people and their relatives knew how to raise any concerns or formal complaints if they needed to. Staff knew how to escalate any concerns they may have and told us they felt well supported by the registered manager and provider.

The service continued to be well led. People, their relatives and staff were encouraged to give their views on how the service was run. There was an open and transpare

Waterloo House is situated near to the centre of Market Rasen in Lincolnshire. The home provides support and care for up to 35 older people with physical needs and those associated dementia.

We inspected the home on 12 January 2016. The last inspection took place on 24 September 2013 and we found the registered provider was compliant with all of the outcomes we inspected.

There was an established registered manager in place who managed the home on a day to day basis. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff knew how to respond to any concerns they identified so that people were kept safe from harm. People were helped to promote their wellbeing and staff followed the care needs identified for each person in order to reduce the risk of accidents occurring.

Background checks had been completed by the provider before any new staff they had recruited started to work at the home. There were enough staff available over each shift to ensure people’s social and health care needs were met.

Staff had received the right levels of training and guidance and had the skills each needed in order to care for people in the ways required. This included being able to assist people to eat and drink enough to stay healthy. In addition, people had been supported to receive all of the healthcare assistance they needed both from care staff and from external visiting professionals. Clear arrangements were also in place for ordering, storing, administering and disposing of medicines.

People were involved in making decisions about their care and how they wanted to be supported. The registered manager had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken the necessary steps needed to ensure that people’s rights were protected. At the time of this inspection five people had their freedom restricted and the registered provider had acted in accordance with the Mental Capacity Act 2005 (MCA).

Staff understood people’s needs, wishes and preferences and people were treated with kindness and compassion. The registered manager and staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted with regarding the care and support they needed and were offered the opportunity to undertake a range of planned and individual activities in order to help them maintain and further develop their interests and hobbies.

The provider and registered manager ensured the home was run in an open and inclusive way. Staff were encouraged to speak out if they had any concerns and there were systems in place for handling and resolving any concerns or complaints they received from people.

The provider and registered manager had a range of meetings, checks and audit systems in place to enable them to assess, monitor and continually improve the quality of the services they provided.

During our visit we spoke with three people, five staff members and the registered manager.

People we spoke with said they were happy with the care they received. They made comments such as, "I am on first name terms with all the staff and they seem to understand all our conditions" and "There is nothing I can fault. They (staff) go beyond the call of duty."

People experienced individual care and support from staff who respected their privacy and dignity. Staff promoted people's independence by helping them to make choices and decisions about their lifestyles wherever they could do so.

People were supported to have a varied and nutritious diet which took into account personal preferences and choices.

We found the home was clean, tidy and well maintained and provided people with a comfortable and homely environment. Where any safety risks were identified we were told how these were being addressed. Bedrooms were individually furnished and decorated according to people's individual preferences.

We also found there was an effective system in place for the provider to monitor and assess the quality of services within the home.

We talked to four members of staff, one of whom said, "I think the care here is very good, I wouldn't stay if it wasn't." Another said, "I would be more than happy if any of my relatives where here."

People told us they were happy living in the home, one said, "In my opinion, this is one of the best homes around." One resident's relative told us, "I have no concerns at all, absolutely none."

The people we spoke with said they were happy with the care and support they received and felt the home was a safe place to live. They told us staff offered them choice and respected their privacy and dignity while encouraging them to be as independent as they were able to be. One person said, “They are really good at offering you something different if you don’t like what’s on the menu.” Another person commented, “We can have a choice in everything we do.”

People said they also enjoyed the social activities staff provided but it was their choice to join in or not. One person commented, “I’m 90 I don’t want to do any more. I like to just relax, chat and read my newspaper.”

People were complimentary about the staff and said they carried out their work competently. They told us they always asked them what they wanted and listened to what they had to say. One person told us, “On the whole they do a good job.” Another person said, “The girls are lovely they do whatever I need.”

People we spoke with said they felt comfortable raising any concerns they might have with the manager. When we asked people if there was anything they would like improving at the home they told us they could not think of anything. One person said, “I’m happy, I can’t think of anywhere better.”