Archived: The White House

The White House is a residential home registered to provide care and support for up to 38 older people including those living with dementia. The service had two lounges, a dining room and a garden to the rear of the service. At this inspection, there were 23 people living in the service.

People’s experience of using this service and what we found

People told us, “They [staff] do everything you want them to do, so it’s not a problem. And they are very good giving choices.” And “Staff are very good, friendly and brilliant’”

People were protected from the risk of harm as robust safeguarding procedures were in place and staff had a good understanding of their responsibilities. Risks associated with people’s care and wellbeing were safely managed.

Staff were recruited safely, and checks were completed. People were supported by staff with the relevant skills and experience, which enabled them to meet people’s needs. Staff also received appropriate training to enable them to carry out their roles safely. Staffing rotas showed there were enough staff deployed to meet people's needs.

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

Medicines were safely managed and administered. Staff received appropriate medicine administration training. Staff understood and demonstrated their responsibilities to raise concerns, to record safety incidents, concerns and near misses, and to report them internally and externally, where appropriate.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted. The registered manager had good oversight of the service and the staffing team.

The provider continued to build links with other healthcare professionals and work closely with them. The registered manager and management team learnt from incidents that had happened. Any incidents were discussed, and trends and pattern analysed to improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 1 July 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Requires improvement to Good based on the findings of this inspection.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The White House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The White House is a residential care home providing personal care and support for up to 38 older people. Accommodation is provided in thirty single and 4 twin rooms for married couples, partners or friends who wish to live together by choice. There are two lounges, a dining room and a garden to the rear of the service. At the time of the inspection there were 20 people living in the service. Most people were living with dementia.

People’s experience of using this service

People’s experiences of living at The White House were positive. Relatives told us that as it was a small home, with a stable staff team, and staff knew people well. They complimented the providers in keeping them up to date with their family members’ care during lockdown. One family member told us they very much appreciated their relative’s birthday being celebrated in their absence and that they could share the photographs around the wider family. Another relative told us, “One thing that really stands out is the care, the way they speak to people is just so kind and respectful, I have observed some lovely care.”

The providers had improved the service since our last inspection and met the shortfalls in risk management, staff training and keeping accurate records of people’s care. They had also made progress in strengthening quality assurance processes. However, we found staff recruitment processes were not robust enough to ensure only suitable people were employed at the service.

Recommendations made at previous inspections concerning using body maps to track pain patches and seeking information about activities had been met. People participated in activities but there was mixed feedback from relatives about if these were sufficient or could be improved further.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood how to apply the principles of the Mental Capacity Act 2005, but records did not always support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 December 2019) and there were multiple breaches of regulation. We carried out a targeted inspection on 24 September 2020 to follow up on these regulation breaches. At the targeted inspection we found not enough improvement had not been made and the provider was still in breach of regulations in relation to staff training, risk management and monitoring the quality of the service. We served Warning Notices with regards to risk management and quality monitoring. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this focused inspection we found enough improvement had been made and the provider was no longer in breach of these regulations. However, we found a further breach of regulation with regards to the recruitment of staff.

Why we inspected

We carried out an unannounced targeted inspection of this service on 24 September 2020. Three breaches of legal requirements were found, and we served Warning Notice with regards to two of these continued breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve the areas of safe care and treatment and well-led.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remain Requires Improvement. This is based on the findings at this inspection. This is the second time the service has been rated Requires Improvement.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The White House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in staff recruitment at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The White House is a residential care home providing personal care and support for up to 38 older people. At the time of the inspection there were 16 people living in the service. Most people were living with dementia.

People’s experience of using this service

Relatives feedback the management team were approachable and staff were kind and caring and knew people well.

However, we found systems to monitor the quality of the service were not effective as there remain three breaches of regulation. Records were being transferred from paper to an electronic system. Staff handover records had improved but other records, such as care plans were not adequately maintained.

The registered provider continued not to fully mitigate the risks to people's health and safety. People did not have comprehensive care related risk assessments such as for diabetes and catheter care.

Staff did not have comprehensive plans to develop their skills and knowledge. Staff had not always received the training, support and guidance they required to meet people’s needs. This included their knowledge in supporting people with dementia, understanding about consent, diabetes and infection control.

Staff gained people’s consent before proving care and treatment. However, there was inconsistent understanding of how to implement the MCA 2005. Staff and the provider’s had not received training in MCA 2005 to ensure it was applied as the legislation intended.

Improvements had been made in how the service acted in response to complaints. Feedback from relatives was that the provider listened and acted on any concerns they raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of three regulations.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on the six breaches of regulations, identified at our last inspection. The provider had failed to effectively: manage risks; monitor the quality of the service; respond to complaints; provide staff with necessary training for their roles; provide people with personalised care; and to act in accordance with the Mental Capacity Act 2005. A decision was made for us to inspect and examine these risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Please see the action we have told the provider to take at the end of this report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, identifying and addressing shortfalls in the service provision and staff training, at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The White House is a residential home registered to provide care and support for up to 38 older people including those living with dementia. At this inspection, there were 26 people living in the service.

People’s experience of using this service and what we found

The registered provider had not fully mitigated the risks to people's health and safety. People did not have comprehensive care related risk assessments such as for diabetes and bed rails.

Medicines were not managed safely. Although there were policies and procedures in place for the safe administration of medicines, medicine competency checks were either not completed or not up to date for staff. Good practice guideline for the administration of patches were not followed. Medicine administration training was not up to date. We have made a recommendation about this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The principles and processes of MCA had not been adhered to. However, the service had policies and systems in the service that supported good practice.

Staff training in the service was not effective. Staff had not always received the training, support and guidance they required to meet people’s needs. We have made a recommendation about this.

Although care plans were individualised, they were disjointed, not detailed and did not provide clear, consistent information about people’s needs and risks. People did not have an up to date care plan which set out how their care and support needs should be met by staff.

Complaints were not always recorded or actioned. The registered provider had failed to take necessary action in response to a concern raised.

Activities people could participate in were limited. The registered provider had not employed an activities coordinator to facilitate activities in the service. We have made a recommendation about this.

There was a system in place to monitor the quality of the service. However, this had not been effective in identifying the breaches we had identified during this inspection. Records were not adequately maintained. For example, care plans were a month or more behind and therefore, did not contain up to date information for staff to follow.

We found no evidence that the registered manager and provider kept up to date with good practice, to share with staff and improve quality outcomes for people.

Despite our findings, people were positive in their feedback. Comments included; “Yes I feel safe, I have never lost a thing from my room”; “The staff know I get quite anxious and hot, they make sure I have some water to drink and get my fan for me” and “I just have to pull the cord and they (staff) come straight away.”

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. However, staff training on adult protection was either out of date or not completed. The provider followed safe recruitment practices.

People received the support they needed to stay healthy and to access healthcare services. These were reviewed regularly.

People told us that staff were caring and knew their preferences, likes and dislikes well. We received good feedback from people, relatives and healthcare professionals about the staff. One person said, “They are all pretty good, always very cheerful.”

We observed people’s rights, their dignity and privacy were respected. Staff supported people with their lunch at a gentle pace whilst engaging with them. People continued to be supported to maintain a balanced diet and staff monitored their nutritional health.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Report published on 16 May 2017). This has now deteriorated to Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The White House is a residential home registered to provide care and support for up to 38 older people including those living with dementia. The home has single and a limited number of double rooms. There are some rooms available with en-suit facilities. It is close the Chatham and has good bus links with the town, and has off road parking. There were currently 22 people living in the service when we inspected.

There was a registered manager 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 and associated Regulations about how the service is run.

At our previous inspection on 07 April 2015, we recommended that the provider sought advice and looked at published research and guidance about providing diverse meaningful activities for the elderly in accordance with their individual needs and choices. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

People were encouraged to take part in activities. Activities met people’s needs and the home was responsive to people’s activity needs.

During this inspection, we found that the registered manager failed to notify the commission about important events happening in the service. We have made a recommendation about this.

One to one staff supervision had not been consistent. There were gaps in supervisions which showed that staff had not sometimes had supervision for a year or more. Yearly appraisals had not been consistently carried out. We have made a recommendation about this.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as mobility and skin integrity. However, there were no comprehensive falls risk assessment in place and the registered manager had not been following their own policy on falls. We have made a recommendation about this.

The environment in the home was not totally dementia friendly which should have a positive impact on people living with dementia. We have made a recommendation about this.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

People had access to nutritious food that met their needs. We observed that people had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives.

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People knew how to make a complaint and these were managed in accordance with the provider’s policy.

Staff were clear about their roles and responsibilities. The staffing structure ensured that staff knew who they were accountable to. Staff meetings were held frequently. Staff told us they felt free to raise any concerns and make suggestions at any time to the registered manager and knew they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

During this inspection, we found a breach of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and a visiting relative, the staff and from looking at records. We also used a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care which helped us understand the experience of people who could not talk with us.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

-Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke to four staff about their understanding DoLS, however, it was apparent that staff did not fully understand what DoLS was and their responsibility regarding the Mental Capacity Act 2005. We saw that not all staff had been trained in DoLS, Mental Capacity Act 2005 and safeguarding of vulnerable adults. We were told these trainings had been booked. Although one member of staff believed one best interest meeting had been held, we found that people's mental capacity had not been assessed and no best interest meetings had been held according to legal requirements. We found risk assessments on the files viewed but these were not comprehensive. The instructions for staff to minimise risk was seen in the plan of care. Although there was no review dates on care plans, they were reviewed monthly.

- Is the service effective?

People's health and care needs were assessed, and families were involved in writing their relatives care plans. Care plans had been reviewed regularly however information in people's plans was not always up to date. Care plans were therefore not able to support staff consistently to meet people's needs.

Staff we spoke with confirmed that people's visitors were able to see relatives in private and that visiting times were flexible.

There was a key worker system at the home. Staff were personally responsible for individual people who lived in the home. They liaised with people's families keeping them informed of people's wellbeing.

- Is the service caring?

We found that people who lived in The White House Residential Home were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. However, we did find that staff gave more time to people who were able to communicate. We saw that staff helped people with their care and support, at mealtimes and during activities with patience and kindness. One person who lived at the home said 'Love helping staff here, staff do a wonderful job, can't find fault with them, always helpful'.

- Is the service responsive?

People had access to daily activities that included quizzes, singing, exercises and reminiscence.

We saw evidence during our visit that the home involved other health professionals when people became unwell; they also informed the respective families. Staff had adapted the provision of care to people's changing in needs. However, we found that care plans did not reflect the changes in care in a timely way.

- Is the service well-led?

People and their relatives or representatives were consulted about how the service was run, annual survey questionnaires were sent and analysed. Staff told us they were able and encouraged to express their views and concerns they may have and were listened to.

We found that policies and procedures were out of date and not easily available to staff. They did not all reflect changes in legislation; we were told that the policies and procedures were being reviewed. However, many were up to six years out of date and they did not address every aspect of the service. This meant that staff did not have access to accurate up to date information when needed.

The manager/provider operated a system of quality assurance and completed an audit to identify how to improve the service. However, the audits failed to show that staff had not received regular supervision or that staff had not undertaken the required training and updates. This meant that the system was not robust and failed to identify areas where improvement was necessary

People who lived in the home told us they were satisfied with the service. They said, "I like living here, they look after us all very well." "I can choose what I want to do; I prefer to sit here in the dining room most of the time" and "I have no complaints at all, everyone is very friendly."

People were provided with appropriate care and support that met their needs and promoted their wellbeing. The meals were well received by the people who lived in the home and a good choice was available.

People mostly received the medication they needed at the time they needed it however, we did find some discrepancies which the manager told us would be addressed.

Robust recruitment procedures ensured that people were protected through the appointment of appropriate staff.

Audits were in place to monitor the quality of the service and people knew who to talk to if they had any concerns about the service.