The White House Falmouth

The White House Falmouth is registered to provide care and support for up to 17 older people. At the time of the inspection the service was supporting 14 people.

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

Disclosure and barring service checks had been completed for all staff employed since our last inspection. However, recruitment records remained disorganised and the required information necessary to demonstrate prospective staff were suitable for employment in the care sector, was absent.

Additional night staff had been recruited and recruitment of day staff was ongoing. This increase in staffing and the appropriate use of regular agency staff, had enabled the dedicated staff team to have more time off. Staff who had previously been working excessive hours were now enabled to have a reasonable work life balance.

People’s care plans and risk assessments had been reviewed and updated since our last inspection. These documents now accurately reflected people’s current needs and gave staff with guidance on how to manage identified risks.

Environmental safety had improved. Fire doors were no longer tied open and cleaning materials were stored safely when not in use. Personal emergency evacuation plans were now available for people detailing the level of support they would need in an emergency. A fire risk assessment had been completed and an action plan was being developed to resolve issues identified by the risk assessment.

People were supported to access their medicines as prescribed and additional guidance had been provided to staff on when ‘as required’ medicines should be used. Additional appropriate storage facilities for medicines that required stricter controls had been installed.

The provider and deputy manager now had an understanding of the requirement of the Mental Capacity Act. Appropriate applications had been made to the local authority for the authorisation where people lacked capacity to make specific decisions their care plans were potentially restrictive. 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.

Effective quality assurance systems had not yet been introduced and daily care records were not been consistently completed.

People were comfortable in the service and relatives were complimentary of the care provided. Staff told us, “I think people are 100% safe and they are happy which is also important”.

The provider had taken action in response to the findings of our previous inspection. A deputy manager had been appointed and the service was accessing additional managerial support facilitated by the local authority.

Staff were complimentary of the deputy manager and recognised the service’s performance was improving. The current responsibilities of the deputy manager were understood by the staff team.

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 the service was requires improvement overall but inadequate in well led. (Published 17 February 2023). At this focused inspection we found both warning notices had been complied with and the service’s rating was changed to requires improvement. Ongoing breaches of the regulations were identified.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

Although we have recognised significant improvements in the service’s performance, ongoing breaches of the regulations in relation to Good governance and the fitness of staff employed were identified at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The White House Falmouth is registered to provide care and support for up to 17 older people. At the time of the inspection the service was supporting 16 people.

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

People told us they felt safe and that their staff were, “as good as gold”. However, we found the provider was not giving effective leadership and that this had impacted on the service’s performance.

The service was short staffed and the dedicated staff team were regularly working additional and sometimes excessive hours each week to ensure people’s need were met. Although rotas were difficult to understand, staff assured us minimum staffing levels had been consistently achieved.

Necessary pre employment checks had not been completed for recently recruited staff. The provider was unable to demonstrate staff training had been regularly updated and senior members of staff had not received regular supervision.

Risk in relation to people’s support needs, the environment and fire safety, had not been managed appropriately. Staff had not been provided with accurate guidance on the management of risks.

Medicines administration records had been accurately completed and staff understood how to support people with their medicines. Facilities for the storage of medicines that require additional security were insufficient and medicines administration on the use of as required medications lacked guidance.

The provider did not understand the requirements of the Mental Capacity Act and people’s capacity to make specific decisions had not been appropriately assessed.

Care plans were inaccurate and did not reflect people’s current needs. Although staff understood people’s needs the records available did not provide sufficient guidance to enable new or agency staff to support people. Information about people’s communication needs was also inaccurate and staff were unable to locate identified communication tools.

The provider did not have systems in place to ensure complaints and concerns reported were investigated.

The personal circumstances of the provider had impacted on their ability to give effective leadership and support to the staff team. Quality assurance systems were ineffective, the service records were disorganised, and information was difficult to access. Necessary notifications had not been submitted to the commission.

People and relatives were complimentary of the staff team and the culture of the service was caring and compassionate. Staff responded promptly to requests for support and relatives told us, “[The staff] have been very good, very caring”.

Staff had a good understanding of infection prevention and control protocols and current COVID-19 guidance was being followed.

People were complimentary of the food, and kitchen staff had a good understanding of people’s likes and needs.

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 the service was Good (Published 23 October 2019). At this inspection we found the service’s performance had deteriorated to requires improvement and breaches of the regulations were identified.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the accuracy of care planning in the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to Person centred care, Need for consent, Safe care and treatment, Premises and equipment, Good governance, Staffing and Fitness of staff employed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

White House Falmouth is a care home that provides personal care for up to 17 predominantly older people. At the time of the inspection 16 people were living at the service. Some of these people were living with dementia.

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

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. People and their relatives told us they were happy with the care they received and believed it was a safe environment.

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 were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm.

The environment was safe and people had access to equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

People were involved in meal planning and staff encouraged them to eat a well-balanced diet and make healthy eating choices.

People and their families were given information about how to complain and details of the complaints procedure were displayed at the service. The provider and staff knew people well and worked together to help ensure people received a good service. People, their relatives and staff told us the provider was approachable and listened when any concerns or ideas were raised.

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 23 March 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 inspected The White House on 20 February 2017. The inspection was unannounced. The service was last inspected in July 2016 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. For example we were told, “In my opinion it is safe,” and “I have never observed anyone being nasty in any way.”

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

There was enough staff on duty, people did not appear to be rushed, and any help people needed was provided promptly.

Staff training was delivered to a satisfactory standard although some newer staff still needed to complete essential training. When staff started to work at the service they received a comprehensive induction. Staff received regular one to one supervision with a senior member of staff, and an annual appraisal.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. There were not records, however, when people last saw a dentist.

Care was provided appropriately and staff were viewed as caring. For example comments received included, “It is like a hotel. Carers are helpful. They go the extra mile. First class,” “They look after me properly, they are very good” and “The staff are without doubt lovely.”

The service had some activities organised. There was an activities organiser. Activities available included arts and crafts, pamper sessions, and making cards and calendars (for example people made these just before Christmas). The service also had external activities facilitators who visited the service such as a singer and an aroma therapist.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were happy with their meals. Everyone said they always had enough to eat and drink. People were not provided with a choice of meals, but staff would provide an alternative meal if people did not like what was on offer. We observed that people received enough support when they needed help with eating or drinking.

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. There were satisfactory quality assurance systems in place to ensure there was a process of continuous improvement.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 previously carried out a comprehensive inspection of The White House on 8, 10 and 14 December 2015. At that inspection we identified three breaches of the legal requirements. This related to how medicines were managed; how the service assessed in accordance with the requirements of the Mental Capacity Act, and sought appropriate authorisation where peoples care plans were restrictive; and ensuring care was appropriate and met people’s needs. We subsequently issued three requirements and told the provider to take action to address the three breaches of the regulations. The provider sent the Care Quality Commission an action plan following the publication of the report. We checked to see if the service had made the required improvements identified at that comprehensive inspection.

We carried out this focused inspection to check to see if the service had made the required improvements identified at that comprehensive inspection.

This report only covers our findings in relation to these topics. 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

During this inspection people told us they received their medicines on time. Medicines were well organised, records kept to a good standard, and staff had received suitable training to administer medicines. Medicines which were not required, and needed to be returned to the pharmacist, were kept securely, and comprehensively recorded in a returns book.

We also found the service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005). For example care plans included information about, where appropriate, people’s mental health needs, and their capacity. Where necessary applications had been submitted to the local authority to request people were assessed in accordance with the Mental Capacity Act 2005 and associated Deprivation of Liberty safeguards.

At the comprehensive inspection in December 2016 we found the majority of people were very well cared for. We did have concerns about restrictions placed on one person, and that these had not been assessed and authorised in line with the Mental Capacity Act 2005. At this inspection we judged everyone was well cared for. Suitable care plans were in place, for example, in respect of the person we had previously had concerns about. Comments received from people included “It is a lovely place,” “The staff are very good,” “Everything is okay with me. No problems at all.” A relative told us: “We think it is a safe environment with well-trained supportive staff that are helpful to us at all times in a happy place.”

We could not improve the overall rating from 'requires improvement' because to do so requires the service to demonstrate consistent good practice over time. We will review the rating during our next planned comprehensive inspection which will occur in the next six months.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, we judged the service was safe.

People told us they felt safe and secure. The people we spoke with were very positive about the staff who worked with them. People told us staff were caring and supportive. For example, one person said were 'I have settled here very well, it is very nice and everyone is very nice,' and 'everyone has been very kind.' Similarly visitors and staff we spoke with, were all very positive about care practice in the home.

We saw that the home was well designed and maintained. Decorations and furnishings were well maintained and comfortable.

On the days of the inspection the home was clean and there were no unpleasant odours. The people who used the service all said they were happy with the standard of cleanliness. For example one person said 'the home is always clean, there is no fault at all' and 'yes, it is always spotless.' People said the laundry service was run to a good standard.

We inspected the staff rotas, which showed that there were sufficient staff on duty to meet people's needs throughout the day and night. People said call bells were always answered promptly. People said staff were unrushed and patient with them.

Records were generally to a satisfactory standard although some of the business records were incomplete and untidy. However care records were satisfactory; for example everyone had a care plan and there was evidence these were regularly reviewed. Records regarding visits from some medical professionals could be more thorough.

Is the service effective?

Yes, we judged the service was effective.

People all had an individual care plan, which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

People said staff met their needs and responded promptly when they needed assistance.

People had access to doctors, district nurses, chiropodists and opticians.

People were positive about the meals provided.

Staff had received suitable training and support from management although records keeping regarding training provision could be improved.

Is the service caring?

Yes we judged the service was caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were taken into account and respected. Activities were available for people who lived in the home.

People who used the service said they were supported by caring and professional staff. We were positive about the care practices we observed. Comments from people who lived at the home included 'I have settled here very well, it is very nice and everyone is very nice.'

Is the service responsive?

Yes we judged the service was responsive.

The people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional and supportive. For example a person who lived in the home told us 'they are very nice'helpful and polite'no one rushes you.' Another person said 'they are fine'good as gold.' A relative told us 'I love it here, they are looking after (my relative) very well, (they) are now much better than when they lived alone'communication is very good with the staff.'

The home had good links with local health services. For example a district nurse told us: 'it is very good'.I only work with two patients here, but the staff are lovely and are more than helpful'care to prevent pressure sores is very good and the staff will always ring up when it is necessary.'

Is the service well-led?

Yes we judged the service was well led.

Staff, people who used the service and their relatives were all positive about the management of the home. People told us the staff and management were approachable, and would resolve any problems if they voiced any concerns. 'Helen's (the owner) main focus is the people not the money.' A person who lived in the home said 'Helen is a lovely lady.'

The home had a satisfactory quality assurance system to monitor the quality of the service and ensure suitable improvements took place where this was necessary.

However we were not presented with a copy of the home's policies and procedures, and the assistant manager was not able to find some of the requested records at the time of the inspection. Some of the records were disorganised.

People told us the staff were 'marvellous' and the food was 'lovely'.

We saw every one who lived at The White House Falmouth had a care plan in place which informed and directed staff on how to care for them.

People who lived at the home were protected form the risk of abuse as the registered manager had ensured staff had received training on safeguarding.

Policies and risk assessments relating to the maintenance and health and safety of people who were living at the home, visitors and staff, were up to date and informed staff how to reduce any potential risks.

Opinions and views from people were gained formally and informally in order for the registered manager to monitor the service. People we spoke with were very complimentary of the whole service.

Care plans informed and directed staff on how to care for the individual and people's preferences were included. Staff appeared caring and compassionate towards the people that lived at the home however their level of knowledge regarding what people liked was not always represented within the care plan.

We spoke to the member of staff responsible for the medication within the home on the day of inspection. We were told that there was a robust medication system in place for people moving into the home. The care plans documented peoples' preferences regarding their wishes for staff to administer any medications.

The lounge was being decorated; tools and open pots of paint were seen to have been left unattended whilst the people that lived in the home were present. We discussed this with the manager. A risk assessment was completed whilst we were there and the items were made safe.

We spoke to the manager who told us there was sufficient staff to meet the needs of the people that lived in the home

Staff told us they felt very well supported by the manager, and formal supervisions are held monthly