We carried out a review of the data available to us about The White House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The White House Nursing Home, you can give feedback on this service.
The White House Nursing Home is a residential care home providing personal and nursing care to up to 36 people. The service provides support to people aged 65 years and over, some of whom are living with a dementia. At the time of our inspection there were 31 people using the service.
People’s experience of using this service and what we found
Relatives were positive about the care provided to people and told us many positive examples of how staff had helped their relatives. During the inspection we observed positive interactions between staff and people, which demonstrated the kind and caring attitude of the staff team.
Staff were positive about the registered manager and the changes that they had introduced since they started working at the service. Care plans and records were electronic, which allowed staff to easily review people's needs and update information in a timely way. There were detailed assessments in place to make sure people received the correct support.
Care records were accurately completed and reflected the current needs of the person. Relatives told us they were involved with reviews of people’s care needs and were updated regularly. Risks to people had been fully assessed and mitigated to help keep people safe. People's care plans were individual and included involvement from other healthcare professionals.
Staff received regular training and there were enough staff on duty to safely support people. Staff told us they were supported and could access advice/guidance at any time. The provider safely recruited new staff and agency staff.
Medicines were safely managed, and regular checks were in place to make sure people received their medicines as prescribed. Staff administering medicines had their competencies checked regularly.
People were supported to make choices around their care and day to day support. 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 wore PPE and followed government guidance in relation to COVID-19. The home was clean and suitably decorated.
The registered manager had an effective quality and assurance system in place which allowed them to monitor and improve the quality and safety of the care provided. People, relatives and staff were asked for feedback to help improve the care provided. Lessons learned from incidents were also used to improve the service provided.
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 (published 26 August 2020) and there were breaches of regulation. 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
This inspection was prompted by a review of the information we held about this service.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice:
¿ All visitors had their temperature checked upon arrival at the service. Visitors were also asked to complete a brief questionnaire including questions about their current health status. Visitors had access to relevant PPE.
¿ Systems were in place to support people to maintain contact with their family. This was done via telephone and electronic tablets. The registered manager told us plans were in place to support one person to have a 'joint family conversation' with their relatives who lived both inside and outside of the UK. Relatives were currently supported to see their family members via 'window' visits, whilst adhering to government guidelines.
¿ All visitors and staff had access to adequate amounts of PPE. Staff had received enhanced infection and prevention control (IPC) training from the IPC nurse including the correct use of PPE. The registered manager had also received support from the IPC nurse following their visit to the service. Staff we spoke to were knowledgeable regarding the correct process for the use and disposal of PPE equipment.
¿ The registered manager told us both people and staff underwent regular COVID-19 testing in line with government guidelines.
¿ Adjustments had been made to the majority of the environment, for example the spacing of chairs and tables to support with social distancing. One area of the service had not been adjusted to support with social distancing and the registered manager assured us this would be addressed immediately. Staff were seen to adhere to social distancing guidance during the inspection.
¿ Robust cleaning protocols were in place for both daily and more in-depth cleaning. The registered manager carried out regular cleaning audits which allowed for any issues to be identified and rectified.
¿ The registered manager worked well with external professionals including the local authority commissioning team and infection control nurse.
The White House Nursing Home, provides residential and nursing care for up to 36 people. At the time of inspection, 20 people were using the service.
People's experience of using this service and what we found
One person had not received an appropriate level of care during their end of life. Some complaints had not been actioned in line with the provider’s complaint process.
Systems in place had not been effective in protecting people from abuse. The manager had not successfully identified the issues we found during the inspection. This was in relation to some people’s fluid intake not being recorded or monitored. Not all safeguarding incidents had been fully investigated to prevent reoccurrence. Staff recruitment was not always safe, and the provider had failed to follow their own recruitment policy. Staffing levels were not at an appropriate level to ensure people received good care.
Staff had not always received training/refresher training in important areas of care. This included end of life care and oral healthcare. Some staff told us they were not up-to-date with end of life care practice. Some staff told us they were not confident in the use of the provider’s electronic care plan system. The manager had failed to follow the provider's own complaints process on two separate occasions.
The manager was not always a consistent present within the home. As a result, checks were not regularly being done to monitor the quality of care or to ensure staff had access to sufficient managerial support. The manager did not always share information when things had gone wrong.
People, their relatives and professionals told us they felt people received safe care. Risk assessments and building checks had been completed to ensure the premises were safe. People’s medicines were handled safely.
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’s communication needs were identified as part of their pre-assessment. People were supported to maintain contact with their relatives. The manager had recently introduced a booking system which allowed relatives who had not seen people during the COVID-19 pandemic, to visit. The home employed an activities co-ordinator and relatives provided positive feedback about this role.
The provider had completed quality assurance checks at a regional level. These checks had highlighted issues which had resulted action being taken to improve things. Feedback from relatives and professionals obtained via a questionnaire showed positive results.
The manager and the nominated individual were very open and honest with inspectors during and after the inspection process. They listened to all feedback provided and took immediate action to address the concerns which had been raised during and after the inspection.
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 (published 18 October 2018).
Why we inspected
We received information of concern in relation to the level of care one person had received during their end of life care. These issues included a lack of oral hygiene and lack of fluid provided at this time of their life. As a result we undertook a focussed inspection to review the key questions of safe, effective, responsive and well-led only.
As a result of our findings during and after the inspection, the overall rating for this service has changed and has now deteriorated to requires improvement with five breaches of regulation and four recommendations.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good. We saw evidence to show the service was meeting all of the fundamental standards.
There was a registered manager in post who had been registered with the Care Quality Commission (CQC) since September 2014. 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 2008 and associated Regulations about how the service is run.
The registered manager was aware of their responsibilities and submitted notifications to the Commission appropriately. The registered manager worked with the provider to ensure there was a strong strategic lead to provide personalised care to people. There was a robust governance framework in place. Audits and checks were carried out by the registered manager and provider. Any issues identified were acted upon and any identified risks were mitigated. There was a complaints policy in place and we saw evidence of investigations and actions taken from these. The provider also carried out feedback surveys annually with people, relatives and staff to help improve the care provided.
People told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were safely recruited and provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. The staffing levels at the home matched the assessed needs of people but due to the changing needs of people this needed to be reviewed.
The premises were safe and there were regular checks of the environment, equipment and utilities. There were infection control policies in place and we observed staff following these. Medicines were safely managed and there were medication policies and procedures in place. There was a business continuity plan in place for use in emergency situations. These were also reflected in people's care plans with personal emergency evacuation plans (PEEPs) to support the safe evacuation of people in an emergency. At the time of our inspection the lift was under repair and the registered manager had updated all risk assessments and PEEPs to reflect the changed in circumstances in the home.
People’s care plans were personalised and care provided to them was accurately recorded. Risks to people were assessed and mitigated. People’s care plans were reviewed regularly and people and their relatives were involved in care planning. We saw referrals to other agencies, for example the dietician and GP, in people's care files. People were supported to maintain a balanced diet and we saw people had access to a range of foods and fluids throughout the day. The premises were 'dementia friendly' and there was pictorial signage to help people orientate themselves.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. There was an activities co-ordinator employed at the service who supported people to access a range of social activities that were meaningful to them.
We observed caring and kind interactions between people, staff and relatives. People’s privacy and dignity was respected. Staff supported people discreetly. People had access to a range of meaningful activities which were important to them. The service promoted advocacy and there was accessible information available detailing what support people could access to help make choices about their individual lives.
Further information is in the detailed findings below.
We undertook this unannounced focused inspection on 15 December 2016 to check that they had met legal requirements and to confirm that they had followed their action plan and made improvements to the service. This report only covers our findings in relation to those requirements. 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.
The White House is a care home which provides nursing and personal care for up to 33 people, some of whom may be living with dementia. There were 27 people living there at the time of our inspection.
The service had a registered manager. 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.
At our focused inspection on 15 December 2016 we found medicines were managed safely. The provider had followed their plan and legal requirements had been met.
The White House is a care home which provides nursing and personal care for up to 33 people, some of whom may be living with dementia. There were 27 people living there at the time of our inspection.
The service had a registered manager. 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.
We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records and procedures to support and evidence the safe administration of medicines. Appropriate codes for the non-administration of medicines were not always used, prescribed creams were not always recorded as administered, there was no specific guidance around ‘when required’ medicines, and records relating to ‘when required’ medicines were not always accurate.
You can see what action we told the provider to take at the back of the full version of the report.
People told us they felt safe. One person said, “I’m safe because I’m well looked after here.” One relative told us, “I feel [family member] is safe here which is a great help.”
The provider made sure only suitable staff were employed. Thorough background checks were carried out before staff started to work with people who used the service.
Staff we spoke with said they had completed safeguarding training and could describe different types of abuse and signs to be alert to. Staff told us they would report any safeguarding concerns immediately.
Risks to people’s health and safety were assessed and reviewed regularly. Measures to reduce the risks identified were clearly set out in people’s care records. Accidents and incidents were recorded accurately and analysed by the registered manager.
The service was clean, well maintained and felt homely.
People told us they liked the food which was well presented and looked appetising. There were enough staff to support people to eat. People who required specialist diets were catered for. People had access to hot and cold drinks and snacks throughout the day.
The service was working within the principles of the Mental Capacity Act 2005. Deprivation of Liberty Safeguards (DoLS) applications had been made appropriately and contained details of people’s individual needs.
The design of the service supported people living with dementia, such as brightly painted doors, old photographs of the local area on display and gardening and household items on the walls.
People were happy with the care and support they received, and told us staff were caring and professional. One person said, “Staff really are caring.” A relative told us, “I can’t fault the care here. The staff are amazing.”
Care records were personalised to each individual and were reviewed regularly. Staff knew people’s needs and preferences well.
People and their relatives told us the service was well run. In a recent satisfaction survey 100% of relatives who responded said the registered manager was approachable. There was an effective quality assurance system in place to monitor the quality and safety of the service. People, their relatives and staff had regular opportunities to provide feedback on the service.
The inspection took place on 9 and 16 February 2015. The first visit was unannounced, which meant the provider did not know we would be visiting. The second visit was announced. We last inspected this service on 1 October 2014 and we found the home was meeting the regulations we inspected.
The White House Nursing Home provides personal and nursing care for up to thirty six people, some of whom are living with dementia. At the time of our inspection there were 19 people living at the home. The home transferred to the current provider in September 2014.
The home had a registered manager. 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.
Prior to this inspection we received information of concern about the quality of care being provided. Particularly staff not being provided with relevant training, lack of stimulation for people, people sitting in hoist slings all day and people’s toileting needs not being met. Staff were provided with the training they needed to deliver appropriate care. One staff member said training was, “Every fortnight.” We saw on a number of occasions people had been left unsupervised in lounges, without interaction and stimulation from staff. We also observed during our SOFI observation that people did not receive regular interaction from staff. We saw some people were sitting in hoist slings when they were in the communal lounge. Both nurses we spoke with told us this was better for the people’s wellbeing and safety.
People and family members told us the home was safe and were happy with the staff delivering the care. People commented, “Very safe, no concerns whatsoever”, “I do feel safe”, and, “Yes, definitely safe.” One family member said, “Very good staff, I don’t see any neglect about.” People gave us positive views about the environment within the home. They said, “My room is good. I chose the pictures on the wall and I chose the wallpaper.” One family member said the condition of the home was, “Quite good.” Family members told us they had been involved in making decisions about changes to the home. We found the home was clean with no unpleasant odours.
People told us the staff were caring and treated them well. They said, “[Staff] treat you like their family”, “Staff are nice”, “Very good”, “Brilliant, fantastic”, “I am so content here. [My relative] chose well. This one hit the jackpot.” Family members also confirmed their relative’s received good care.
People, family members and staff told us the current staffing levels had a detrimental impact on people’s care. However, the registered manager was aware of this and had recruited additional staff who were due to start their employment imminently. People told us, “Not enough staff, some are overworked”, “Yes enough staff, could do with more for the dining room”, and, “Girls are alright, they can manage. There are times when the girls are overloaded.” There were systems in place to ensure new staff were suitable to work with vulnerable people. This included disclosure and barring service (DBS) checks and requesting references.
Medicines administration records (MARs) had usually been completed accurately. Where we identified gaps in people’s MARs, the provider had been pro-active identifying and investigating these gaps. We saw accurate records were kept for the receipt and disposal of medicines. Medicines were stored safely. Only qualified and competent nurses administered people’s medicines.
Staff had a good understanding of safeguarding adults and whistle blowing. They told us they knew how to report any concerns they had. They also said they would not hesitate to raise concerns they had. One staff member said, “I would feel confident to raise concerns. John [registered manager] would take action.” Staff said previous concerns had been dealt with “really well” and had been “taken through the right channels.” Previous safeguarding concerns had been dealt with in line with the provider’s agreed procedures.
The provider undertook standard assessments to help protect people from a range of potential risks. Separate risk assessments were carried out where staff had identified risks that were specific to the person.
The provider undertook regular health and safety checks and these were up to date. This included checks on gas safety, lifts, electrical safety, electrical appliances, equipment, safety checks of people’s bedrooms and fire safety. The home had emergency evacuation plans in place which were reviewed monthly.
Staff told us they had regular one to one supervision every three months and an annual appraisal. They told these included a discussion about their training and development.
Staff were following the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). Where required, applications had been submitted to the local authority for approval. Staff had a good understanding of their responsibilities under the MCA and knew when MCA applied to a person. People told us they were asked for permission before receiving any care. They said, “I do what I want. Staff don’t demand”, “Sometimes have to wait but not for long. Staff are reliable and will come back”, and, “Staff ask me what would I like.” We found on two occasions family members had signed documents on behalf of their relative rather than the person receiving the care. We saw no evidence from viewing care records that these people were unable to sign documents.
People were happy with the meals they were given. One person said, “Tremendous, best chef in the world.” Another person said, “[The] chef is very capable.” We observed some people did not always receive the support they needed to meet their nutritional needs in a timely manner. For example, one person did not receive support with eating and drinking in line with their agreed care plan. However, when people did receive assistance we saw staff were kind and considerate towards them. The home had received positive feedback following an external audit for improvement in screening people for poor nutrition.
People said they were supported to meet their health care needs. One person said, “Staff call the doctor quickly.” People had access to a range of health professionals including the community nurse, the optician and the chiropodist. Staff said they supported people to attend routine health appointments.
Improvements were being made to adapt the environment to suit the needs of people living with dementia. These included displaying reminiscence and sensory materials on corridor walls, décor, signage and personalised information displayed outside people’s rooms.
People said they were treated with dignity and respect. One person said, “[Dignity and respect] always, at all times”, and, “[Staff] treat you like a human being.” Staff described how they delivered care in order to maintain a person’s dignity. This included closing bedroom doors, knocking on doors before entering people’s bedrooms, always wearing gloves when supporting people, talking to people and explaining what they were doing and seeking consent before delivering care.
People told us staff were responsive to their individual needs. One person said, “No matter what I ask for or ask them [staff] to do, they never refuse. They say it’s your care home, we work for you.”
Staff had access to written information about people’s preferences including their likes and dislikes. One family member said, “We went through likes and dislikes. They wanted to get a feel for [my relative] and what [my relative] was about. They are still learning about [my relative] and tweaking.” Staff had developed life histories for each person which included details of people’s families, where they were born, their previous employment, holidays, interests and preferences in relation to their care. People had their needs assessed when they were admitted into the home. This was a comprehensive assessment that was used to develop personalised care plans. Care plans were reviewed regularly. However, the record of the review was brief and did not provide a meaningful update of the continuing relevance of the support plan to the person.
People had opportunities to take part in activities when these were arranged. These included playing “old-time music”, musical instruments, entertainers, ‘Pets as Therapy’ (PAT) animals such as dogs and miniature horses, movies, bingo and raffles. One person said, “It keeps us going.” One family member said, “[Activity co-ordinators name] does a really good job interacting.” They also said people “seem very involved.”
People and family members we spoke with said they had no complaints about the care provided at the home. One person said they had, “No complaints but they [staff] would act on it straightaway.” Another person said, “I would talk to staff, they would help.” Another person said there was “nothing wrong.” We saw there had been no complaints made about the service.
People and family members had opportunities to give their views about the service including regular ‘Relative’s and friend’s’ meetings and completing questionnaires. The feedback from previous consultation was displayed in the home’s reception area.
The home had a registered manager. People and staff said the registered manger was approachable. One person said there was, “No problem with John [registered manager]. You can see him anytime you want.” Another person said, “The manager is very good, I can talk to him.” Another person said, “The manager is very nice, very friendly. He likes to hear what is going on. If something isn’t right, he puts it right in a nice sort of way.”
Staff told us, and records confirmed regular staff meetings were held and they were able to make suggestions during these meetings.
People and staff said the home had a good atmosphere. One person said, “I really love it here, everybody gets treated the same.” Another person said there was “no nastiness at all.” Another person said, “Homely. Happy go lucky, everybody speaks to everybody.” One staff member said, “I love it, very relaxed. I like working here”, and, “Lovely atmosphere, very homely.” Another staff member said the atmosphere was “pretty good.” Another staff member said the home had a “nice” atmosphere. They said it was, “Small, friendly and close with families.”
We saw on entering the home, information about the home’s approach to ‘Dignity in Care’ was displayed prominently in the reception area.
The provider undertook a range of regular audits as part of its quality assurance programme. This included checks of care plans, staff files, the kitchen, infection control, ‘pressure sores’, medicines and a health and safety audit. These had all been successful in identifying areas for improvement.
The provider’s regional manager also carried out a regular three monthly monitoring visit and the registered manager carried out unannounced ‘out of hours’ visits. The provider and the registered manager had a clear aims for the future direction of the home. These were documented in the homes ‘Strategic Marketing Plan’ and ‘Home Development Plan.’