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The White House Residential Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 November 2018

This inspection took place on the 16 October 2018 and was unannounced.

At the last inspection of the service on 23 May 2018, we found that there were breaches of two of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. In addition, we made one recommendation to improve infection prevention and control practices.

At this inspection we found that there were two continued breaches of the fundamental standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.

This is the second consecutive time this service has been rated requires improvement.

The service is required to have a registered manager in post. 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 service had a registered manager who had been registered with the Care Quality Commission since 1 October 2010.

The White House 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 service provides residential care for up to 20 older people including people living with dementia. The service offers accommodation over two floors.

We identified a lack of management oversight. Processes in place did not identify all the issues raised during this inspection. In addition, the provider was unable to evidence sustainable improvements since our last inspection, this resulted in repeat breaches of regulation.

The provider was taking steps to refurbish the home and this was a work in progress during the inspection. We identified several areas where measures needed to be put in place to reduce fire hazards. This included the updating of the fire risk assessment. We shared our findings with Humberside Fire and Rescue Service and they are currently supporting the service to ensure they are compliant with current legislation in terms of fire safety.

Medicines, including sharps were not stored securely. This meant that people were able to gain access to large amounts of pain killers, insulin and various other medicines that were not locked away.

Accidents and incidents management was not proactive in preventing risks to people. There was no overall analysis in place to highlight themes to ensure preventative measures were in place.

Recruitment procedures were not always robust, we found that the provider had not completed additional checks and assessments to ensure prospective employees were of a suitable character to work with vulnerable people.

Infection prevention and control practices were not always effective and we highlighted concerns in relation to odours, mattress cleaning schedules, general cleanliness, fire, food hygiene and environmental safety.

Some risk assessments were in place. However, these did not always contain specific information to guide staff to mitigate risks to people and risk assessments were not always in place for specific risks associated to people’s health conditions.

Information in relation to people’s care and support needs would benefit from more detail to include all health conditions from the pre-admission assessments shared with the provider.

People told us they felt safe living at the service. Staff had received regular safeguarding training and could describe how they would keep people safe from potential harm or abuse.

Staff had completed training as outlined by the company and felt supported by the registered manager. Records showed that staff received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives an

Inspection areas

Safe

Requires improvement

Updated 27 November 2018

The service was not consistently safe.

Medicines had not been stored safely.

Risks to people had not always been identified and sufficient measures were not always put in place to guide staff in mitigating them. Accidents and incidents were not analysed to identify themes to enable preventative measures to be put in place.

Recruitment procedures were not robust and risk assessments were not completed when necessary to ensure staff were suitable to work with vulnerable people.

Effective

Good

Updated 27 November 2018

The service was effective.

Staff told us they received regular training and although there were some gaps in completed training, the registered manager had scheduled training dates for these topics.

People told us that staff looked after them well and were knowledgeable about their needs.

Further improvements had been made to the interior of the building and further work had been scheduled to improve and update the internal and external environment.

Caring

Good

Updated 27 November 2018

The service was caring.

We observed positive interactions between staff and people. Staff approached people in a friendly and relaxed manner, taking time to chat with them.

Staff respected people’s dignity and privacy.

Staff could describe how they maintained people's independence and care plans supported staff with information around people's dependency levels to support this practice.

Responsive

Requires improvement

Updated 27 November 2018

The service was not consistently responsive.

People's specific health conditions were not always included in care plans and patient passports. This meant that staff did not always have guidance on how to support people’s individual needs.

Observations showed staff supporting people to make choices and respecting their preferences.

People knew how to make a complaint and told us they would speak with the staff or registered manager if they needed to.

Well-led

Requires improvement

Updated 27 November 2018

The service was not consistently well-led.

Audits that identified issues did not always have action plans in place with timeframes by which actions needed to be completed.

Some records were inconsistent and did not always include relevant information to support staff to meet people’s current needs.

Quality assurance processes had not identified all the issues we found during the inspection. In addition, we found no evidence of learning lessons, reflective practice and service improvement since our last inspection. Some audits and overall analysis were not in place and where issues had been identified it was unclear to see actions taken by the provider. This demonstrated a lack of management oversight.