This inspection took place on 22 and 27 March 2017 and was unannounced. Waterside House is registered to provide accommodation for people who require nursing or personal care. At the time of our inspection there were 57 people living at the service. Most people were living with dementia.

There was a registered manager in post at the time of the inspection. 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.

At our last inspection carried out 22 February 2016 we asked the provider to make improvements to the staffing on one unit and also to the quality assurance processes. At this inspection we found the provider had taken action to make the improvements required, however there were some further concerns identified with regards to staffing levels at this inspection.

People told us they felt the service would benefit from additional staff, we saw examples of where insufficient staff available meant people had to wait for their care and support. However people told us they felt safe with staff. Staff understood how to identify abuse and report any concerns. People had risks to their safety assessed and reviewed and staff used this information to keep people safe. People received their medicines as prescribed from staff that had been trained to administer them safely.

People received support from staff that had been trained and had the skills required to meet their needs and preferences. Staff told us they felt confident in their role as the induction and training prepared them well to meet people’s needs. People were asked for their consent to care and support and staff understood how to apply the principles of the MCA to their practice. Staff understood how to make decisions in people’s best interests where they lacked capacity. People were supported to have a choice of food and drinks and risks associated with their diet were identified and appropriately managed. Staff understood these risks and provided appropriate support. People were able to access support with their health from relevant professionals, staff sought support and always followed the advice given.

People had good relationships with staff and spoke highly of the service they received. We saw staff were caring in their nature and offered support in a person centred manner. People were supported to make choices about their care and support, staff understood the importance of this and could give examples of how they supported people to make decisions/choices. Independence was encouraged by staff, people were supported to continue to do as much for themselves as they were able.

People were involved in their assessments and care plans. Staff engaged people in all aspects of their care and responded to any changes which presented. People had access to activities and could follow their individual interests. Complaints were used to drive improvements and people understood how to make a complaint and felt confident these would be addressed.

People spoke highly of the service and said they felt the registered manager was approachable. Staff said they received support from the registered manager. The quality of the service people received was monitored by the registered manager. Any issues raised were used to make improvements to the service. This included peoples feedback, which was gathered in a range of different ways.

This inspection was unannounced and took place on 22 February 2016. At the last inspection in December 2014 we found the provider was meeting all of the requirements of the regulations we reviewed, however improvements were needed in areas such as medicines and record keeping. At this most recent inspection we found improvements had been made in these areas, however there were other areas where improvements needed to be made.

Waterside House is registered to provide accommodation for up to 60 people who require personal care and support. The home is divided in to four units, each accommodating up to 15 people. On the day of the inspection there were 56 people living at the home. The service had been without a registered manager since October 2015. 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. A new manager had been appointed in January 2016 and was present on the day of the inspection. They told us they planned to submit an application for registration once they had completed their period of probation.

There were not always sufficient staff to respond to people’s needs and support people safely. Relatives and staff expressed concerns about staffing in one of the four units at the service. Staff knew how to recognise and report potential abuse. People’s medicines were stored and managed safely and people received their medicines as prescribed by their GP.

People expressed their confidence in the staff team who they felt had the skills and knowledge required to meet their needs. Assessments of people’s capacity had been carried out but were not always recorded in a way that gave adequate guidance to staff to support decision making. People were happy with the variety and quality of food and drink provided and people were supported to access healthcare professionals when they required them.

People felt they were supported by staff who were friendly and caring. People diverse needs were understood and met by staff and other visiting professionals. Staff supported people in a way that maintained their privacy and dignity and were aware of people’s fears and anxieties.

Staff had a good understanding of people’s life histories and personal needs and preferences. People and their relatives were happy with the way they were involved in their care and support planning. People and their relatives knew how to complain and the provider had a system in place to manage complaints.

Staff expressed concern about the lack of consistent management over recent years. People had been asked to share their views, however, relatives expressed mixed views on whether they were given opportunity to contribute to the service. The provider had carried out audits to assess the quality of care, however these had not always been effective in improving the standard of care provided.

The visit took place on 30 December 2014 and was unannounced. We last inspected the service on 8 August 2013. At our previous inspection the provider was not meeting the law in relation to consent to care and treatment, staffing and records. Following our August 2013 inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that improvements had been made in respect of the issues previously identified.

Waterside House is registered to provide accommodation and support for 60 people. At the time of our inspection there were 39 people living at the service for long and short stays. The service contained four units, although only three of these units were in use at the time of our inspection.

There was a registered manager in post at the home. 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.

People we spoke with were complimentary about the service and its staff, describing them as kind and caring.

The service was clean and well- presented. People were happy with the level of cleanliness maintained by staff. However, we found that staff did not consistently wear personal protective equipment when handling food.

We found that medicine records were not always completed, which meant it could not be demonstrated that people had received this medicine as prescribed. Medicines were otherwise stored and used as per the prescriber’s or manufacturer’s directions.

Staff knew how to identify and report abuse. Staff were recruited in a safe way, which meant they were of appropriate character to care for people. There were enough skilled staff to support people safely.

Records showed that people were assessed to establish their ability to make decisions for themselves, where necessary. However, decisions that had been made in people best interests, where they were not able to make the decision for themselves, were not recorded.

We found that people were supported to eat and drink. We saw that robust records of people’s intake of food and drink were not always maintained to demonstrate this had been provided consistently.

We saw some staff using techniques which ensured people understood and could effectively communicate choices they wished to make. These included the use of visual aids. However, some staff did not use these techniques, although they would have aided communication with the people they were speaking with.

People’s health was supported with appointments with external healthcare professionals. These included appointments to promote people’s health in the context of conditions they had, such as diabetes.

People’s care records were personalised. Care records were regularly reviewed to ensure they were up to date. This meant that staff had access to the latest guidance on how to support people.

Most staff supported people’s dignity, privacy and independence and encouraged people to complete tasks safely for themselves. However, we saw some examples of staff failing to support people’s dignity by ensuring information about their needs was kept private.

Staff demonstrated that they knew people’s preferences and what was important to them. We saw staff supporting people to participate in activities they enjoyed. Staff communicated with people’s relatives to ensure they were kept up to date with developments and that issues were discussed as appropriate.

Care planning took into consideration people’s spiritual needs and important relationships. We saw people being supported in a way which took into account their cultural preferences and diversity.

Although no-one we spoke with told us they had raised a complaint; the provider demonstrated that they dealt with complaints in line with the advertised complaints procedure.

The provider undertook audits concerning the quality and standards of care at the service in order to improve the service provided. A new registered manager and deputy manager had been recruited since our last inspection. While some improvements were on-going, staff were positive about the changes the new management team were implementing in improving people’s experience of the service.

There were 43 people living at the home on the day of the inspection with four different units. We spoke with 15 people, five relatives, nine staff members and the home peripatetic manager.

We found that people who lacked capacity did not have regular assessments to review their ability to make decisions. People we spoke with told us that they were asked for their consent on different aspects of their care.

People’s care was delivered in a way which met their needs. One person said, “This place is great.” We found that people received care and treatment from other external professionals.

There were not enough staff to look after people at the home. One staff member told us, “It is rushed and means we cannot spend enough time with people.” We saw that people’s needs were not always met in a timely manner.

We found that systems were in place for people and their relatives to complain. One relative told us, “I have never had to complain.”

Records were not always complete and fit for purpose. People did not always have a plan of care for their specific health conditions.

We carried out this inspection to check on the care and welfare of people. The home was unaware that we would be carrying out an inspection on the day. On the day of the inspection visit there were 47 people living at the home. The home was split into four different units. Each unit had people with varying levels of care requirements. We spoke to seven people, five relatives, five staff, and the deputy manager.

There was a pleasant and friendly atmosphere in the home. One relative said, “It is the kind of place I would live in myself.” We saw that people wore clothing that reflected their individual choices and preferences. People we spoke with told us that staff treated them with respect and that staff supported them. One person said, “They always respect us, and they have a laugh and joke with us.”

One relative told us, “The carers are kind, loving, and caring.” We saw that people’s care was delivered appropriately and that people’s care records were reviewed and updated regularly. People had a range of activities that they could take part in throughout the day, so that they continued to have a meaningful and stimulating lifestyle.

We found that arrangements were in place to ensure that any allegation of abuse was identified, managed, and reported appropriately. We saw that efficient systems were in place to ensure people’s finances were safeguarded.

We found that staff were supported through supervision, appraisals, training and staff meetings. People we spoke to were complimentary about the care that staff provided.

We found that there were effective systems to assess the quality of services. People were given opportunities to provide the home with their views and we saw that these were taken seriously. People and their relatives knew how to complain, although everyone we spoke to had no complaints and were complimentary about the home.

People were unable to tell us about their experiences of living at the home, so we spent time observing and finding out how staff supported and cared for them. We also spoke with visitors who told us their opinions of this home.

Comments made by visitors confirmed that their relatives were being “well looked after and had their needs met by the staff team”.

Visitors told us they did not have any concerns about the way their relative was being cared and about the staff practices.

All visitors felt confident to raise any concerns they may have with the management team.

We observed that staff were attentive to people’s needs, and maintained their privacy and dignity. Staff were observed to use positive approaches when encouraging people to participate in activities. Staff appeared to know people’s needs and the best ways to approach and support people.

Many people in this service were unable to communicate with us due to their support needs. But we were able to speak to some people to gain their views about living in this home. We also spoke with a person who was visiting their relative during our visit.

People told us they are looked after well and described staff as good.

We observed that staff were attentive to people’s needs, and maintained their privacy and dignity when they supported them in tasks. When supporting people with their mobility staff were also observed explaining to people what was going to happen to them, which is good practice.

We had an opportunity to speak with a visitor, who told us “This is a good home and my relative is looked after very well”. They told us the staff were skilled and competent in their role and they had no concerns about the service their relative received. They also told us the staff were welcoming and kept them up to date about their relatives well being.

We observed that staff were aware of people's individual needs, such as supporting them with daily living tasks, and ensuring people had appropriate assistance with eating and drinking. Staff spoke calmly to people and supported them to make appropriate choices, such as with their drinks, meals and where they wanted to sit.