An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?At the time of our inspection, 26 people were living at The Whitehouse Residential Home. We spoke with four people who lived at the home and two relatives of people who visited that day. We spoke with the manager, the regional manager, two senior care workers, a care worker, the activities co-ordinator, the cook and a housekeeper. We spoke with two district nurses who attended the home on the day of our inspection. We also reviewed relevant records which included five care files, incident reports, meeting minutes and other relevant documentation.
Below is a summary of what we found. The summary describes what people we spoke with told us, what we observed and the records we looked at.
Is the service safe?
There were some risk assessments in place where required for people using the service in relation to their support and care provision. However these were not always reviewed and amended as necessary to ensure that risks were minimised. Some people who displayed challenging behaviour did not have information relating to this in their care files. There was potential for the behaviour to continue as staff had no information to refer to in order to find out what action to take to attempt to minimise and reduce events of this behaviour occurring. This meant there was a risk to people's safety and of people receiving unsuitable care.
The home had suitable measures in place to help minimise the risk and spread of infection.
Systems were not in place to make sure the manager and staff learned from events such as accidents and incidents. Although policies and procedures were in place to make sure unsafe practice was identified and people were protected, these were not always followed. We found that potential safeguarding incidents had not been referred to the adult protection team. We asked the manager to contact the adult protection team to seek guidance and to ensure relevant incidents were submitted.
CQC monitors the operation of DoLS (Deprivation of Liberty Safeguards) which applies to care homes. No applications had been made by the home as none had been required to be made. The manager had received training in the MCA (Mental capacity Act 2005) and DoLS but the rest of the staff had not. However, staff we spoke with demonstrated some understanding of MCA legislation. The manager told us that training was due to take place shortly for senior staff and that she would ensure other staff also received this relevant training. This was especially important following a recent change in legislation which could have an impact on applications within the home under DoLS processes.
Is the service effective?
People at the home were happy with the care they received and felt this was suitable for their needs. Staff knew people well and we saw that referrals were made to other professionals such as district nurses, GPs and dieticians so that people's holistic needs were met.
People received a varied, well balanced diet and measures were in place to ensure people received adequate nutrition and hydration. Everyone we spoke with was complimentary about the food. Comments included, 'meals are very very good. We've had the same cook for several years and the food is very varied, there's always a choice' and 'the food is very good, we don't get the same thing every day'.
Staff received regular training and supervision and said they felt supported by the manager, however they did not receive annual appraisals. This meant staff did not have opportunities to have a review of their performance overall, set out their longer term goals and identify key strengths and weaknesses.
Is the service caring?
During our visit we saw care workers interacted positively and gave encouragement whilst supporting people. People said, 'Very happy here, it's a first class home. The staff are superb, it's unnatural how they get so many good carers. We couldn't be in a better place', 'I think it's very nice, very caring. I've never had it so good, they're [staff] very amiable and obliging', 'staff are good, very good humoured, better than we've encountered before'. No one we spoke with had any concerns with the care provided and the staff at the home
We undertook observations to help us understand the experience of people who could not talk with us due to their health condition. We saw that staff were kind and caring in their interactions with people who in turn responded positively to staff.
Is the service responsive?
People's needs had been assessed before they moved into the home. Care plans were in place for each individual covering a number of areas including mobility, eating and drinking, mobility, social activities and communication. Information was, in the main, reviewed monthly and in response to any changes in needs. However some information was not reflective of people's needs as important information was omitted. Changes to people's needs were not always updated. For example when one person's personal care needs had changed due to illness, this was not updated in their relevant care plan.
We saw activities taking place on the day of our inspection and we were told about various entertainment that occurred within the home. We saw some people doing a jigsaw, people chatting amongst themselves and some people singing and dancing. During afternoon refreshments, a care worker asked a person at the home if they would like to go around and offer biscuits to people which they did so and they enjoyed this task. This meant that people had opportunities for social and mental stimulation and to engage in meaningful activities.
Is the service well-led?
The home had an internal quality assurance system and records seen by us showed that identified shortfalls were addressed. This meant that actions to improve were in place. A regional manager attended the home regularly to undertake a sample of audits also and feedback to the manager areas for action.
Questionnaires were sent annually to relatives and advocates of people using the service as an opportunity for people to provide feedback about the service. Feedback was also sought by way of daily discussions and and residents meetings.
Team meetings took place regularly and important information was also disseminated by way of memos for staff. Best practice, improved ways of working and training needs were common throughout formal team meetings and informal discussions.
Services are required to notify the CQC of certain notifiable incidents and events as set out in the Health and Social Care Act 2008. We had not received any statutory notifications for the home about any incidents of abuse since our last inspection in 2012. However, from viewing the incident forms since this period, a number of the incidents were notifiable under regulation 18 of the Health and Social Care Act. This meant the home had not fulfilled its duties regarding notifications and CQC were not kept informed of relevant information as required. We also found that the process for managing risks within the service was not sufficient .