Archived: The White House Nursing Home

The White House Nursing Home is a purpose-built residential care home providing personal care to 35 people at the time of the inspection. The service can support up to 67 people.

The White House Nursing Home is in administration. A supporting provider, The Krinvest Care Group, had been instructed by the Administrators to operate the care home whilst a sale is secured.

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

People were mostly happy with the care and support they received. One person felt some elements could be improved. Staff were kind, friendly and attentive to people’s needs. People told us there were enough staff to meet their needs. Staff felt that there were enough of them to meet people’s needs in a person-centred way. Staff were trained and felt well supported.

People felt safe and staff were aware of how to promote people’s safety. Regular checks were in place to ensure staff worked in accordance with training and health and safety guidance was adhered to. Where there had been an increase in incidents, the manager told us this was due to better reporting from staff. However, the action plan in place to reduce the risk of skin tears, needed to be reviewed as this had not been effective.

There were governance systems in place and these were being used effectively and regularly. The management structure in the home made staff feel they had guidance and support.

There was plenty of communal space for people to enjoy, however, some of these spaces were not used. People living in the upstairs of the house would benefit from accessing the communal areas if possible. People participated in the activities that were provided, however people upstairs needed more opportunities for social interaction.

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.

People were involved in planning their care, along with their relatives. People had end of life care plans in place. Complaints were responded to appropriately. Feedback was sought through meetings and a survey was due to be sent.

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

The last rating for this service was Inadequate (published 17 October 2019). At this inspection the service has improved to Requires improvement.

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.

This service has been in Special Measures since 8 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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 Nursing Home provides accommodation, personal and nursing care to older people. The care home accommodates up to 67 people in a purpose-built building. At the time of the inspection 52 people were living there.

People’s experience of using this service:

Since November 2014, The White House Nursing Home had been inspected seven times prior to this visit being carried out. Out of those previous inspection five of the seven were rated as requires improvement and one was rated as inadequate. Four of those inspections resulted in breaches of regulations. Six of the seven inspections found shortfalls in relation to the governance systems in the home. At this inspection, the eighth inspection in five years, we found that the governance systems remained poor and there were further breaches of Regulations.

Accidents and incidents were not reviewed to help identify themes and trends and it was not clear if all unexplained injuries were recorded, investigated and reported. This was because of the lack of monitoring of these issues. The acting manager showed us that recent unexplained injuries were being managed appropriately, however, we could not be sure this had happened prior to the most recent incident.

Not all staff had attended fire drills and the fire risk assessment had not been reviewed. There was no fire policy available on the day of inspection. Following the inspection this was received but the content was basic and did not clearly set out responsibilities.

People told us that their care needs were met. We found that for people less able to request support for themselves, there may be times when care was delayed. Relatives and staff told us that there were not always enough staff. People who were able to request support told us that there were enough staff most of the time. On the day of inspection, we saw people were still receiving morning care on the approach to lunchtime. Care plans did not reflect that this was people’s choices. Although there had been staffing concerns, particularly at weekends, there were no management plans in place to ensure shifts were not left low in numbers when staff were absent.

Care plans were detailed and included enough information for staff to be able to support people for basic care needs. However, they did not include all elements of people’s needs and some areas were not completed or accurate. For example, there were no plans to support people with any needs which were impacted by living with dementia or the behaviours that may challenge. 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 policies and systems in the service did not support this practice.

Staff knowledge and responses to the needs of those living with dementia needed further developing. For people who were calling out, there were no interventions or strategies to help alleviate people’s anxiety or behaviours. People gave mixed views about the activities available. People who were in their rooms were at risk of being isolated.

People told us that they received their medicines when needed. However, medicines were not always managed safely. People told us that they enjoyed the food.

There were systems in place to help ensure staff were trained and received regular supervision and staff felt supported by the management team. However, some staff was due to be refreshed and some subjects needed more advanced training, such as dementia awareness. The recruitment process was not always completed in a robust way so that they ensured that people were supported by staff who were suitable to work in a care setting.

The service met the characteristics for a rating of “Inadequate” in two key questions and the rating of "Requires Improvement" in three key questions.

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

Rating at last inspection (and update):

The last rating for this service was requires improvement (7 August 2018). At this inspection the rating deteriorated, and the provider was in breach of some regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to governance systems and person-centred care at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

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

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The White House Nursing Home 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. The White House Nursing Home accommodates up to 67 people in one adapted building. At this inspection 59 people were using the service.

The registered manager had recently resigned from their role. 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 and associated Regulations about how the service is run. At the time of this inspection the service was being managed by the deputy manager (referred to as ‘the manager’ throughout the report) with the support from clinical colleagues and the previous registered manager. The provider told us that the service was in the process of being sold and consequently decisions about recruiting a registered manager would be taken by the new provider.

At the previous inspection in June 2017 we had identified some areas that required improvement. At this inspection we found that whilst there had been some improvements made the overall quality of the service provided had not improved sufficiently and further work was still needed.

At the inspection in June 2017 we had identified shortfalls in record keeping and that staff meetings were not always effective. We had found that the provider had not routinely assessed the quality of care that people received or how the home was managed and that incidents and accidents occurring in the home had not been robustly managed and reviewed to identify trends or patterns. At this inspection we found that some processes had been introduced to better manage these areas however, further work was needed.

Staff had been trained in how to safeguard people from avoidable harm however, not all staff were confident in their knowledge about how to report concerns to external agencies if needed. People had personal evacuation plans in place for emergencies such as a fire and regular safety checks were completed however, staff demonstrated a mixed understanding what actions they should take in the event of such an emergency. People and their relatives felt that there were not always enough staff deployed to meet their individual needs in a kind, gentle and timely manner. Some further work was needed to ensure the provider’s recruitment processes were robust.

People were supported by staff to take their medicines in a safe manner however, we found that the amount of medicines in the home did not always agree with the records maintained.

There were systems in place to help promote infection control. People said they felt safe living at The White House Nursing Home. Potential risks to people's health, well-being or safety had been identified, were assessed and reviewed regularly to take account of people's changing needs and circumstances. The manager had developed systems to cascade shared learning from incidents around the staff team.

Staff explained to people what was happening and obtained their consent before providing care and support. However, some staff needed further support to better understand the principles of The Mental Capacity Act 2005 (MCA) and best interest processes. Staff members received supervision from line management to support them in their roles but some felt it was not a meaningful or effective process. People and their relatives told us that there were instances where communication with some staff members was difficult. People and their relatives gave mixed feedback about whether their day to day health needs were met in a timely way and if they had access to health care and social care professionals when necessary. People gave mixed feedback about the food provision and we observed that some people did not always receive good support to eat. Assessments had been undertaken to identify where people may be at risk from poor nutrition or hydration which were kept under review and amended in response to any changes in people`s needs.

The environment was appropriate to meet people’s needs in that there was sufficient communal space available for people to be able to sit quietly, join in activities or have a meeting in private. However, there was little in the home to support people who may live with dementia. People and their relatives told us that the care and support provided at The White House Nursing Home was appropriate to meet people's needs. Staff received training to support them to be able to care for people safely.

People’s dignity, privacy and confidentiality was not always promoted by some of the staff team. People’s choices were not always respected in relation to their care and support needs. People, and their relatives, told us they were happy with the staff that provided their care. Staff took appropriate action to help people feel comfortable. Staff had developed positive and caring relationships with people they clearly knew well. Relatives and friends of people who used the service were encouraged to visit at any time and we noted from the visitor's books that there was a regular flow of visitors into the home.

People's care plans were not always sufficiently detailed to guide staff to provide their individual care needs in a consistent way. Care plan reviews were not always meaningful and not always used as an opportunity to further develop people’s care plans. Care plans showed that people were asked to think about their wishes in relation to end of life care. People, their relatives and staff gave mixed feedback about the activity provision at the home. Some relatives were not aware that meetings were arranged for them to share their views and opinions about how the service was run. The minutes of these meetings did not evidence that they were effective in bringing about changes in the quality of service people experienced. Concerns and complaints raised by people who used the service or their relatives were appropriately investigated and resolved.

People knew the manager by name and felt that they were approachable with any problems. The manager demonstrated knowledge of the staff they employed and people who used the service. Staff reported that the manager was approachable and that they could talk to them at any time. There were informal meetings held between the manager and the provider to discuss such issues as recruitment, the performance of the service and any matters arising. However, these were not documented so it was not possible to confirm that these meetings served to support the manager in their role.

There were a range of checks undertaken routinely by the manager to help ensure that the service was safe. Satisfaction surveys were distributed annually to people who used the service, their friends and relatives and relevant professionals such as social workers and specialist medical professionals. At this inspection we were advised that quality surveys were being distributed to people at this time.

The White House Nursing Home provides accommodation and personal care for up to 67 people. At this inspection 63 people were living at the service.

The service had a manager in post who had recently applied to register with the Care Quality Commission (CQC). 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.

There were systems and processes in place to monitor and address issues at the service. However in some occasions we found that these were not working effectively.

People`s care records were not consistently accurate. We found that some care records gave conflicting information about people’s needs and were not sufficiently detailed for staff to know how to meet people`s needs.

People were supported by staff to eat sufficient amounts. Those people at risk of weight loss were regularly weighed and monitored and referred to specialist health professionals if there was a need for it. However at meal times people did not always receive personalised care, staff often supported three people at the same time and at times staff were not attentive to people who were having difficulties eating their meals independently.

People told us that staff were kind and they received care that met their needs. People who were able to were involved in planning their care. For people who were assessed as lacking capacity their relatives were involved in planning their care. However we found that not all the relatives who consented to people`s care had lasting power of attorney for health and welfare.

Mental capacity assessments were carried out in most cases to assess if people were able to make informed decisions about matters affecting their health and welfare; however we found that these lacked detail about the decisions made.

People were treated with dignity and respect and they developed positive relationships with staff.

There were enough staff employed at the home to meet people`s needs in a timely way. Recruitment processes were robust and helped to ensure that staff working at the home were of good character and suitable for the roles they performed.

People’s medicines were managed safely by appropriately trained staff who had their competencies checked and followed best practice when administering people`s medicines. Staff were aware of the risks to people’s safety and welfare and they knew how to mitigate these.

People were confident to make a complaint if they needed to and told us it would be addressed. There were meetings for people, relatives and staff and their views were listened to and acted upon.

People were offered opportunities to pursue their hobbies and interests in group or individual activities. Staff also regularly spent time with people who were not able to leave their rooms.

Staff had training and support from the management team to carry out their roles effectively. Some staff were trained as champions in areas such as nutrition, dementia, end of life, infection control and they were regularly involved in training and coaching staff to improve their practices.

People, relatives and staff told us that the management in the home was visible and approachable.

The White House Nursing Home provides accommodation and personal care for up to 67 people. At the time of the inspection 58 people were living at the service.

There was a manager in post who was in the process to register with the Care Quality Commission (CQC). 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.

At the previous inspection on 07 June 2016 we found that people’s medicines were not always managed safely and people were at risk of not receiving their medicines as intended by the prescriber. At this inspection we found that medicines were managed safely. Staff were trained and had their competencies assessed in safe administration of medication. People received their medicines on time and as intended by the prescriber.

At the previous inspection we found that people were not always supported by a consistent numbers of staff due to unmanaged staff absence. At this inspection we found that this has improved and the manager had recruited more staff to maintain staffing levels. They built up a pool of bank staff and also planned the rota`s in advance to identify any gaps and booked agency staff in advance if there was a need for it.

People and relatives told us they felt safe and well looked after. They told us staff were available to meet their needs when they wanted and needed this. Care plans were in place which gave staff clear guidance to enable them to support people safely. Risks to peoples` wellbeing were identified and plans were in place to mitigate risks and keep people safe.

Staff were recruited safely and were not able to start their shifts until all pre-employments checks were done and the manager received at least two references from previous employers.

Staff were trained and knew how to keep people safe from all forms of abuse and they were able to tell us how they would report any concerns internally and also externally to local safeguarding authorities.

At the previous inspection we found that there were newly developed systems in place to monitor and address issues identified at the service. However, some of these systems needed further development and more time to be embedded and to work effectively. At this inspection we found that the systems to monitor the quality and the safety of the service provided were effective and identified promptly areas in need of improvement. These were actioned and followed up by the manager to ensure the service was improving.

Staff were positive about the registered manager and the positive changes brought by them. They felt supported by the manager and the nursing staff working at the home.

The White House Nursing Home provides accommodation and personal care for up to 67 people. At this inspection 57 people were living at the service.

The service had a manager in post who had recently applied to register with the Care Quality Commission (CQC). 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.

People’s medicines were not always managed safely and staffing levels were frequently reduced due to staff absence.

People told us that staff were kind and they received care that met their needs. People were involved in planning their care and were treated with dignity and respect. Care plans were in place which gave staff clear guidance to enable them to support people safely.

People were offered a variety of foods and received the appropriate support to eat and drink. People had access to health and social care professionals as needed. The staff had a good relationship with visiting professionals.

People were confident to make a complaint if they needed to and told us it would be addressed. There were meetings for people, relatives and staff and their views were listened to and acted upon. Activities were available for people in the communal areas with some further development needed for people in their rooms. Further thought was needed in regards to the environment and information in easy read format for those living with dementia. The manager was in the process of arranging for a dementia champion who would address this as part of their role.

The manager of the service needed to raise their profile so that people and relatives all knew who they were. However, most people told us that recent changes had been positive. Most staff felt the changes made at the home were positive and felt that they were more equipped and supported for their role.

There were newly developed systems in place to monitor and address issues at the service. However, some of these systems needed further development and more time to embed to be working effectively. The manager and the providers were working to develop these and were committed to providing a good service.

Staff treated people with respect and supported them to retain as much independence as possible. One person said, 'The staff let me be independent and just check on me to see how I'm doing. They offer help if I need it.' Care plans gave guidance to staff so that people's needs were met and people saw other healthcare professionals so that their health was monitored.

Recruitment of staff was carried out well so that only staff suitable to work with vulnerable people were employed. One person said, 'They're marvellous staff. Always trying to help. We couldn't wish for anything better.' People knew how to complain if they needed to and were confident their complaints would be sorted out in a timely manner. We had been notified of deaths as required by the regulations.

We observed care being provided and saw staff communicating with people in a respectful, kind and patient manner. People told us they were involved in making decisions about their care and their day to day life at the home. For instance, they said they could choose what time they got up, where they ate their meals and the activities they participated in.

It was clear from speaking with staff that they knew the people living at the home well and were meeting their needs. However, we found that care plans were not personalised and did not always explain how to meet the needs of the person. This meant that there was a risk that people could receive inappropriate or inconsistent care.

Everyone we spoke with commented on how approachable the manager was. It was clear from his interactions with the people living at the home and their visitors that he was well known to them. We found that people living at the service, and their representatives, were asked for their views about the care provided and these were acted on.