About the service The White House is a residential home registered to provide care and support for up to 38 older people including those living with dementia. At this inspection, there were 26 people living in the service.
People’s experience of using this service and what we found
The registered provider had not fully mitigated the risks to people's health and safety. People did not have comprehensive care related risk assessments such as for diabetes and bed rails.
Medicines were not managed safely. Although there were policies and procedures in place for the safe administration of medicines, medicine competency checks were either not completed or not up to date for staff. Good practice guideline for the administration of patches were not followed. Medicine administration training was not up to date. We have made a recommendation about this.
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 principles and processes of MCA had not been adhered to. However, the service had policies and systems in the service that supported good practice.
Staff training in the service was not effective. Staff had not always received the training, support and guidance they required to meet people’s needs. We have made a recommendation about this.
Although care plans were individualised, they were disjointed, not detailed and did not provide clear, consistent information about people’s needs and risks. People did not have an up to date care plan which set out how their care and support needs should be met by staff.
Complaints were not always recorded or actioned. The registered provider had failed to take necessary action in response to a concern raised.
Activities people could participate in were limited. The registered provider had not employed an activities coordinator to facilitate activities in the service. We have made a recommendation about this.
There was a system in place to monitor the quality of the service. However, this had not been effective in identifying the breaches we had identified during this inspection. Records were not adequately maintained. For example, care plans were a month or more behind and therefore, did not contain up to date information for staff to follow.
We found no evidence that the registered manager and provider kept up to date with good practice, to share with staff and improve quality outcomes for people.
Despite our findings, people were positive in their feedback. Comments included; “Yes I feel safe, I have never lost a thing from my room”; “The staff know I get quite anxious and hot, they make sure I have some water to drink and get my fan for me” and “I just have to pull the cord and they (staff) come straight away.”
Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. However, staff training on adult protection was either out of date or not completed. The provider followed safe recruitment practices.
People received the support they needed to stay healthy and to access healthcare services. These were reviewed regularly.
People told us that staff were caring and knew their preferences, likes and dislikes well. We received good feedback from people, relatives and healthcare professionals about the staff. One person said, “They are all pretty good, always very cheerful.”
We observed people’s rights, their dignity and privacy were respected. Staff supported people with their lunch at a gentle pace whilst engaging with them. People continued to be supported to maintain a balanced diet and staff monitored their nutritional health.
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 (Report published on 16 May 2017). This has now deteriorated to Requires Improvement.
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.