White House Home Care Services Limited

White House Care Services is a small domiciliary care agency. It provides personal care to people living in their own homes and flats in the community. At the time of the inspection the service was providing personal care to 11 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People who used the service and relatives were positive about the care and support provided by White House Care Services. They felt the service was well-run and were pleased that their loved ones were supported by a small team of familiar staff. They told us support visits were not missed and staff stayed the full length of the visit.

The registered manager and care staff were approachable, and people told us they felt able to raise any concerns with them. The service had not received any recent complaints. As well as managing the service, the registered manager carried out support visits alongside support workers. This gave her the opportunity to regularly review people’s support needs and also check that staff were working to a good standard.

Thorough recruitment checks had been carried out on new staff to ensure they were of good character and suitable to work with vulnerable people. Staff told us they felt supported and received the training they needed for their role. All staff were regularly supervised. However, we found there was no supervision schedule in place to ensure these were carried out at regular intervals. We have made a recommendation about this in the effective section of this report.

People were helped 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. Person-centred care plans and risk assessments were in place which identified the support people wanted. However, it was not obvious that people or their relatives had been involved with reviewing their care plans.

Staff treated people with dignity and respect and promoted their independence. Staff supported people with meal preparation where needed. They liaised with health and social care professionals effectively and sought advice quickly if people became unwell.

People told us they were happy with the way the service was run. The registered manager had improved the governance systems since our last inspection and there was better oversight of 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 (report published 23 October 2018). 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 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and people with physical disabilities.

Not everyone using White House Care Services Ltd receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 14 people were receiving a regulated activity.

A registered manager was in post. 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. However, during this inspection, we found they continued to require improvement. This is the third consecutive time the service has been rated requires improvement.

At the last inspection, we found concerns with three areas in the service. These were recruitment processes, the planning of person-centred care and monitoring the quality of the service. Despite some improvements, we found the provider continued to be non-compliant in these areas.

Some steps had been taken by the provider to ensure their recruitment procedures ensured people employed where of good character and had the necessary skills and competence, to carry out their role. However, they failed to carry out any of these checks on the volunteer, who was managing the service whilst they were away from the service. We continued to find some gaps in staff recruitment files, including a missing reference for one staff member and a missing interview record for another.

People had care plans in place and task sheets, which provided information to staff about the things they required support with. The provider had made some improvement to these, since the last inspection about people’s preferred routine and included some of their basic likes and dislikes. However, there was minimal information about people’s life history and important information about people’s health and communication needs were missing. Despite this, staff were able to tell us how they provided person-centred care and people confirmed this.

There was a quality monitoring system, which consisted of audits and checks in some areas, but these did not always lead to improvement being made. There were no audits on care records or recruitment and staff files, which led to shortfalls in the above areas being unidentified by the provider. There was no system in place to collate and analyse people’s views to improve the quality of people’s experiences. Accidents and incidents were recorded, but action was not always taken to prevent similar incidents reoccurring. Some staff told us the manager was unapproachable and one person praised the care and support from staff, but told us they felt the service was not well-led.

People told us staff sought their consent verbally before providing care and support and staff were aware of the importance of this. However, there was no record of people signing consent to their care plans. Following the inspection, the registered manager showed us how they would record people's agreement to their care plan. Staff had awareness of the MCA, but there was no system for recording consent if people lacked capacity.

You can see what action we have asked the provider to take in response to the above concerns at the back of the full version of the report.

We also found further shortfalls, which the quality assurance system had failed to identify, including staff support. The registered manager did not provide recorded supervisions for staff. We made a recommendation on this.

The service had a small staff team, which was sufficient to meet the current needs of people who used the service. Staff were knowledgeable about safeguarding and how to recognise signs of abuse to protect people from harm.

Staff were equipped with the necessary skills to provide effective support. They supported people to manage their medicines safely, as well as supporting them to meet their nutritional needs and healthcare needs.

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. People were supported to maintain their independence and their privacy and dignity were respected. People were complimentary about staff and said they were kind and caring.

There was a complaints procedure in place. None had been received and people told us they would know how to raise one if required.

The provider is a small domiciliary care service which is registered to provide personal care to people in their own homes. Currently the service provides support with personal care for 17 people who live in Hull and East Riding; all the people fund their own support from the service. The main office is situated in a residential area in Hull; there is on street parking. At the last inspection on 26 July 2016, we had concerns about the lack of a quality monitoring system. At this inspection, we found improvements had been made in this area but there was some way to go before the service was fully compliant.

The service had a registered manager in post. 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 concerns with three areas in the service. These were recruitment processes, the planning of person-centred care and, despite some improvements, monitoring the quality of the service.

A good recruitment process had not been followed which had led to a lack of important records being in place prior to the start of staff’s employment. Some staff didn’t have references, gaps in employment history had not been explored and disclosure and barring checks were not always returned to the service before the member of staff started work. There was no record that an interview had taken place to assess the skills, knowledge and values of potential staff.

People who used the service had assessments of their needs completed and task sheets developed to guide staff in how to meet them. However, the assessments and task sheets were very basic and did not provide full information about people’s needs nor full guidance for staff in how to support people in line with their preferences. This meant there was a risk that important care could be missed. When we spoke to staff they told us they knew how to look after people.

There was a quality monitoring system which consisted of audits, checks, and seeking people’s views. However, the audits had failed to identify shortfalls in the assessments and task sheets and staff inconsistency in the use of codes on the medication administration records. There was no audit completed for recruitment documentation.

You can see what action we have asked the provider to take in response to the above concerns at the back of the full version of the report.

The service had a small staff team, which was sufficient to meet the current needs of people who used the service. Staff had travelling time in-between calls and there was an electronic system in place which enabled the registered manager to know when staff had arrived at the call and when they left. This helped to minimise the risk of missed calls.

People told us staff were professional, friendly and listened to them. They also said staff respected their privacy and dignity and delivered personal care in ways they preferred. Staff supported people to make their own decisions and had an understanding of the need to gain consent prior to carrying out care tasks.

People who used the service all had capacity and were able to make their own decisions. The registered manager had an understanding of mental capacity legislation and knew what action to take if people were assessed as lacking capacity and important decisions were required.

Staff had received training in how to safeguard people from the risk of harm and abuse. They could recognise the signs and symptoms of abuse and knew what to do if they had concerns.

There was evidence staff monitored people’s health care and nutritional needs. They supported people with the preparation of meals, prompted them to take medicines as prescribed, contacted health professionals on people’s behalf or informed relatives of concerns so they could liaise with the person’s GP or district nurse. Staff knew what to do in emergency situations.

Staff had access to training, supervision and support. They said management was supportive and they felt able to raise issues with them. The registered manager was in the process of sourcing two training courses that new staff had not completed yet.

People who used the service were provided with a copy of the complaints process. This explained how they could make a complaint and how quickly it would be investigated. People told us they felt able to make complaints but they had not needed to; they gave the registered manager’s name and the director’s name as the people they would contact if they had concerns.

This was the first inspection of the service since it registered with the Care Quality Commission (CQC) in January 2014. The registered provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to speak with us.

This inspection of White house home care took place on 21 July 2016 and was announced. We subsequently carried out a further inspection visit on 26 July 2016 which was also announced. This was to enable us to meet some people in their own homes. At the time of our inspection the registered provider was supporting 13 people living in their own homes, eight of which required support with personal care.

The service had a registered manager in post. 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 did not have a clear understanding of their requirements to notify CQC and we found they had failed to notify us of certain events and incidents that had occurred. This was a breach of Regulation 16 of the Care Quality Commission (Registration) Regulations 2009.

The registered provider had no systems in place to monitor and improve the quality of the service provided. We saw there was no evidence of audits to drive continual improvement and to learn from any incidents that occurred at the service. You can see what action we have asked the registered provider to take at the back of the full version of the report.

Sufficient staff were employed by the service, however they had not always been recruited in line with the registered provider’s recruitment and selection policy.

The training records evidenced that some staff had completed parts of induction training and training on the topics considered to be essential by the service. However, we saw gaps in both the training and induction that staff had received.

People were protected from harm or abuse by staff who had received training in safeguarding adults and understood the signs of abuse to look out for. They knew how to report any concerns and were aware of the whistleblowing procedure.

People were involved with the planning and delivery of their care. Reviews were held at regular intervals to enable people to provide feedback on the support they received. The registered provider had a complaints policy in place that was provided to people when they started using the service. We saw the service received very few complaints.

Staff gained people's consent before care and treatment was provided. The service worked in-line with the principles of the Mental Capacity Act.

We found that people were cared for and supported by kind and caring staff that were knowledgeable about people’s individual care and support needs. Care files were updated regularly and information shared so that staff were aware of changing needs. People’s privacy and dignity was upheld at all times and their personal details were kept confidential.

People who used the service received additional care and treatment from health care professionals in the community.

The people who used the service expressed their satisfaction with the support they received with medicines, meal preparation, cleaning, personal care and support with activity.

People and staff told us the management team were approachable, supportive and listened to their views regarding the service.

You can see what action we have told the provider to take at the back of this report.