The inspection of Waters Park House (“Waters Park”) took place on the 12 and 13 March 2018 and was unannounced.

We last inspected Waters Park on the 2 and 3 February 2017. We had rated the service as Requires Improvement having found issues as to whether the service was safe, responsive and well-led. We found breaches of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we had not received all notifications as required and the leadership and governance of the service was not ensuring the quality of the service and people’s records were not always accurate, complete or showing the complete story of people’s care. Notifications are specific events registered persons have to tell us about.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the areas above to at least good.

On this inspection, we found the concerns from February 2017 had been addressed in full.

Waters Park is registered to provide care with nursing for up to 23 people. They support people who have experienced a brain injury or a diagnosis which impacts on the brain such as Huntington’s or a stroke. People may have mental health, physical disabilities or a sensory impairment due to the impact of their condition.

Waters Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in place to manage and oversee the running of the service. 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 registered manager was also the provider. They were supported in their role by a care manager, a nurse manager and a multi-disciplinary team (MDT). The MDT was made up of qualified nurses, occupational therapists, a physiotherapist, a psychologist, a speech and language therapist and rehabilitation assistants.

Following the last inspection the MDT had worked hard to address the concerns. The MDT were passionate about the needs of people and supporting them to reach their potential in life. This support and caring included the family and friends. People were supported to communicate in their chosen way and every effort was made to ensure this happened. Staff also made sure they understood people well so any concerns could be picked up and resolved quickly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs. People had their medicines administered safely. Errors were picked up quickly and action taken to keep people safe. This was one example of how the service demonstrated they learned from events

The service was responsive to people’s needs and they were able to make choices about their day to day routines. People had access to a range of activities which provided them with mental and social stimulation. People’s faith and cultural needs were met. People could access the community safely.

People felt safe at the home and with the staff who supported them. There were systems and processes in place to minimise risks to people. These included a robust recruitment process an

The inspection took place on the 2 and 3 February 2017 and was unannounced. We last inspected the service on the 13 February 2015 and found all requirements were met. The service was rated as ‘Good’ in all areas.

Waters Park House (known locally as ‘Waters Park’) is registered to provide care with nursing for up to 23 people. They support people who have experienced a brain injury or a diagnosis which impacts on the brain such as Huntington’s or a stroke. People may have mental health, physical disabilities or a sensory impairment as a result of the impact of their condition.

There was a registered manager appointed to oversee the service. 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. They were supported by a care manager, nurse lead and multi-disciplinary team. Carers, speech therapists, a physiotherapist, occupational therapists, nurses and a psychologist were all employed in assessing and meeting people’s complex needs. These make up the MDT (multi-disciplinary team).

Prior to the inspection we received a number of concerns through whistle-blowers. This raised concerns about some staff having the language skills to meet people’s needs. Also, concerns were raised in relation to staffing and whether people were having their one to one care as required. We also received concerns from families about whether their loved ones were receiving appropriate care and how the service responded to concerns when they were raised. We raised these issues with the registered manager and care manager and reviewed them as part of this inspection. We found some problems in respect of people’s records and leadership, but did not find evidence to support all the matters that were raised with us.

We found improvements were needed to the way the provider monitored the quality and delivery of their services. This included how they sought feedback from people about their care and the services they received.

The registered manager was not telling us of events in the service they are required to tell us about by law. We were not being told about serious injuries, safeguarding incidents and all decisions on deprivation of liberty applications.

The service had a personalised approach to managing the risks people faced. There was a strong emphasis on people being able to understand the risks associated with their condition, behaviour or/and lifestyle in respect of their rehabilitation. However, improvements were needed to records of risk assessments.

People’s medicines were administered safely. Staff managed medicines in a way that kept people safe. Medicines were stored securely. We saw nurses and senior carers gave medicines to people in a caring and encouraging manner. Some medicines were prescribed to be taken when required (PRN). The written guidance for PRN was not as robust as it could be, but we observed that staff knew people well and therefore, were able to make decisions with them about whether a medicine was needed or not. The nurse manager told us that she was developing personalised written guidance for staff about when to give ‘when required’ medicines. An audit was in place to check on the safety of medicine administration. Any issues identified were followed up.

People were supported by a sufficient number of competent staff to meet their needs and keep them safe. Staff told us they felt there were enough staff on duty to enable them to meet people’s needs. Staffing levels ensured people had their allocated one to one care staff with them as reflected in their care records Staff were recruited safely. People were assessed on admission to ensure staff could meet their complex needs. Staff had the necessary training to meet people’s needs and w

Waters Park House provides intensive rehabilitation support for up to 23 people who have an acquired brain injury. The home provides accommodation in the form of 22 units with en-suite accommodation, and several units offering self-contained accommodation. On the day of the inspection 21 people were living at Waters Park House.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Waters Park House on 20 November 2014. At the previous inspection we found it was not clearly evidenced that people had consented to their care and treatment. At this inspection people told us they were asked for their consent prior to any treatment or activity. New forms had been devised which clearly evidenced the person had understood what they were agreeing to and that they consented to how they care would be provided.

People felt safe living in the home. People said they were happy talking to staff and that senior management were particularly approachable and they had confidence that any issues or concerns would be addressed. Staff were aware of how to report any suspicions of abuse and believed appropriate action would be taken.

People told us staff were; “kind,” and “they are a lovely bunch.” They told us they were completely satisfied with the care provided and found staff to have; “great skill” and looked after them well. People told us they were treated with respect and dignity. They considered that privacy issues were particularly well addressed.

People told us they had choices in how to spend their day and there was opportunity to attend a range of activities in the home and in the community .One person told us they chose when to get up and go to bed, and this was still the case even when support was required to do this. This showed staff fitted in with the person’s wishes. People were involved in the current review of activities on offer and the suggestions for future activities.

People said they enjoyed the food, comments included the food was “Delicious”, “Very good” and another that they would “Give the chef 100%”. A kitchen area with equipment specifically adapted for people with mobility difficulties was available for people to use to help people gain further independence and life skills.

Staff had attended appropriate training to ensure that their skills and knowledge were up to date., This included moving and handling, safeguarding and areas related to individuals specialist health needs

People felt at times there were “too few” staff on duty but confirmed staff responded to their calls for support or assistance promptly. The manager reviewed people’s dependency needs to see if additional staffing was needed to ensure the correct level of support was available to meet peoples changing needs. Staff told us “on the whole” there were sufficient staff on duty at all times. We found that there were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs.

People thought their medicines were well managed and always given on time. Some people managed their own medicines others received support from staff. Staff had been appropriately trained to ensure medicines were administered, stored and disposed of safely.

The manager and staff had a sound understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the home involved family and relevant professionals to ensure decisions were made in the person’s best interests.

Staff told us they were supported by managers. They attended regular meetings (called supervision) with their line managers. This allowed staff the opportunity to discuss how they provided support to people, to ensure they met people’s needs and time to review their aims, objectives and any professional development plans. Staff also had an annual appraisal to review their work performance over the year.

People were involved in the development of their care plans which identified their care and health needs and described how they wished to be supported. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. Records showed staff had discussed within their multi-disciplinary team when care needs had changed. This could result in referrals to relevant healthcare services being made.

We saw the home’s complaints procedure which provided people with information on how to make a complaint. The policy outlined the timescales within which complaints would be acknowledged, investigated and responded to. People said if they had any issues they felt able to address them with the management team.

There was a management structure in the home which provided clear lines of responsibility and accountability. There was a clear ethos at the home which was clear to all staff. It was very important to all the staff and management at the home that people who lived there were supported to be as independent as possible and live their life as they chose. The provider had an effective system to regularly assess and monitor the quality of service that people received.

People who lived at Waters Park House and their relatives told us staff were helpful. We saw staff were helpful, caring and understood people's needs well.

We saw staff were polite and respectful to people who used the service. When people were in communal areas, we saw people were offered support in a manner that was discreet and respected their dignity.

The care records we saw were detailed and directed staff as to the care and support people needed. Rehabilitation plans and risk assesssment were comprehensive and up to date. We saw that the mutidisciplinary team employed by the home was supported by a number of other healthcare professionals.

We saw there were robust systems in place to enable people to report any concerns to the local safeguarding department. All staff had safeguarding and Mental Capacity Act (2005) training.

On the day of the inspection we saw a multidisciplinary team of staff on duty who were attentive to people's needs and able to maintain people's daily activity plans. We saw that the staff group had regular departmental meetings and there were support systems and relevant training place for the different health care professionals employed at Waters Park House.

We found there were robust quality monitoring systems in place . The provider had an ongoing system of maintenance in place to maintain and improve the environment. We saw that peoples rooms were personalised and reflected people's personalities.

We visited Waters Park (referred to as ‘the home’) as part of our scheduled inspection process. There were 18 people living in the home when we visited. We spoke with three people and five relatives about their experience of the home. We also spoke to four staff members.

The registered manager was not available during the inspection. The Care Manager however supported us during our visit as did other members of staff as required.

We found that people’s consent to care and treatment was not being sought on each occasion or routinely recorded. People and family told us they had not read a recent care plan or been asked to sign it.

We people’s care needs were being met and there was evidence of good practice from staff supporting people with complex needs.

We found that the home was ensuring people were protected by following adequate infection control procedures and processes.

We found that the staff were suitably trained and supported to deliver care that was safe and appropriate.

Waters Park had a clear complaints procedure in place that was made available and issues were taken seriously and resolved. Relatives told us “I don’t have any problems with Waters House”.