12 & 13 February 2015
During a routine inspection
We carried out an unannounced inspection on the 12th and 13th February 2015. We last inspected the service on the 30th June 2013 and we found the home was complaint with the regulations.
2a Waterloo Street is a care home for ten people who live with a learning disability, some of whom also have support needs associated with older age. The home is an old church building adapted for its current use as a care home and it is situated just off the main street in the town of Cockermouth. Accommodation is provided on two floors and there is a stair lift to help people to access the first floor. The home has a range of equipment suitable to meet the needs of people living there. On our visit there were nine people living at the home, and another person was due to move in.
West House, a local not for profit organisation, is the provider who runs the home.
There was a new manager employed at the home and they had applied to be the registered manager 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 and associated Regulations about how the service is run.
Everyone we spoke with told us people were safe and well cared for in this home. This included people who lived in the home, their relatives and professionals visiting the home.
People who lived in the home knew how they could raise a concern about their safety or the quality of the service they received.
Though people we spoke with told us that they felt safe, we judged that staffing numbers were unsafe. A number of people’s care support needs required two members of staff, while at least four other people required increased supervision to keep them safe. At times there were only three staff on duty and two of these were based downstairs; and all staff had to undertake care, cleaning, laundry and cooking duties. This meant there were insufficient staff to meet people’s needs and to keep them safe.
We found that a number of people who had recently moved into the home had not been assessed thoroughly enough to ensure the home could fully meet their current and future needs. We found that this impacted across most of the areas we looked at.
We found that not all areas of risk had been assessed particularly when a person’s condition had changed. For example a person’s mental health need required a risk assessment of how to respond quickly to a change in their health and this was not in place.
Staff told us that while they had a lot of training from the organisation they did not feel as confident and as qualified to support those people with more specialist areas of behaviours that challenge, dementia care and mental health needs.
We found that staff did not have the training and expertise to meet some people’s needs and the environment had not been adequately adapted to meet these needs.
We found examples where staff had failed to report incidents that were potentially forms of abuse. This included reporting these to adult social care as safeguarding alerts for further investigation.
We found that the provider had not properly trained their staff in understanding how the requirements of the Mental Capacity Act 2005 impacted on the people in the home.
People were provided with meals and drinks that they enjoyed. We found that people’s nutritional needs were not routinely assessed on arrival to the home and then monitored from time to time
People in the home had regular access to health care. They went out to health appointments and there was evidence of good measures in place to prevent ill health.
The home was caring. We saw examples during our visit of people being treated with dignity, respect and care. There were affectionate and caring relationships between the care staff in the home and the people who lived there. The staff knew how people communicated and gave people the time they needed to make choices about their lives and to communicate their decisions.
People had limited access to developing occupational skills, being involved in activities and to engage with their local community. This was especially the case for people with a limited mobility.
There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.
The service was not well-led. The recently appointed manager had begun to make improvements in some areas but we found the organisation was slow to respond. The way the service was managed did not always identify risk, and when risk was identified it was not always acted upon.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.