Archived: White Rose House

White Rose House is a residential care home, registered with the Care Quality Commission (CQC) to accommodate a maximum of 64 people. At the time of this inspection, 32 people used the service, some of whom lived with a diagnosis of dementia.

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

There were sufficient numbers of staff to meet people’s needs, but there was a reliance on the use of agency staff to ensure safe staffing levels were maintained. The provider had been proactive in seeking to address the staffing issues with a number of strategies put in place.

People were protected from the risk of acquiring infections. Personal protective equipment (PPE) was readily available to staff and all staff were following the latest guidance for the prevention and control of infection.

People had oral health care plans which were reviewed on a regular basis but we did not always see evidence of staff documenting that visual checks had been completed. Access to a dentist was mostly reactive rather than proactive. We have made a recommendation to the provider about this in the full report.

The lunchtime service was calm, relaxed and overall a pleasant experience. People’s individual preferences were readily accommodated with plenty of menu choices available.

The registered manager had a good understanding of their role and responsibilities. The provider had good oversight of issues within the home and improvement plans were robust. Throughout the inspection visit, staff were open, honest, transparent and engaging.

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 11 November 2019).

Why we inspected

The CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels and leadership and management. A decision was made for us to inspect and examine those risks. Whilst no concerns were raised with us about access to food and drink at mealtimes, we observed mealtime service to be a positive experience and therefore worthy of reporting on.

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

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.

White Rose House is a care home providing personal care to 45 people at the time of the inspection. The service accommodates up to 64 people in one building.

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

People told us they felt safe. One person said, “There’s always someone [staff] with you, the girls are excellent. I’m frightened of slipping, they give you lots of towels, they’ve been excellent with me, they helped me feel safe. Give [staff name] a gold star, they helped me have the courage to have a bath.”

Staff had a good understanding of how to safeguard people from abuse.

Person-centred care was promoted and people told us the staff knew them well and responded to their needs in a person-centred way.

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 told us staff were kind and sensitive. One person said, “Staff are kind, caring, they listen to you.” A relative added, “The carers are respectful, kind and caring.”

Person-centred assessments and care plans had been completed which reflected people’s needs, wishes and preferences. Staff knew people well and told us how they identified if people's needs changed or if they needed additional support.

Systems and processes had been reviewed to ensure the service was compliant with regulations. Although governance systems had improved we still noted room for further improvement as audit systems were not always robust enough.

Staff said they were happy working at the service. They said it had improved considerably over the last few months since the registered manager had been in place who was bringing stability and organisation to the service and support for them.

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 17 October 2018) and there were two 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 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.

White Rose 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.

White Rose House provides nursing and personal care for up to 64 older people. The home has two floors, with the ground floor providing residential care and the first floor providing residential care for people living with dementia.

At the time of our inspection the home did not have a registered manager and instead a ‘turnaround manager’ was in day-to-day charge of the home and they had been in post from March 2018.

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 last inspection in May 2017, we found two breaches of the regulations relating to consent to care and good governance. We found the registered provider had not consistently applied the correct mental capacity assessment or obtained consent from the relevant individual where a person lacked capacity. Contemporaneous care notes were not kept for people nutritionally at risk or in receipt of pressure care and there was a lack of quality oversight due to minimal use of audit tools. The registered provider had not ensured all staff received an induction, ongoing support or the necessary training to be a skilled workforce.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of effective and well-led to at least good. At this inspection we still had concerns regarding assessments of people’s capacity which were not decision specific and people were assessed as having capacity when this should be assumed as stated in the Mental Capacity Act (2005). We found the oversight of the home had not been effective as there were still concerns regarding the use of topical creams. We found people had developed pressure areas and there were gaps in people’s repositioning records. The turnaround manager told us these pressure areas were either improving or were fully healed at the time of our inspection.

Communication in the home had not been effective and we found one person had been inappropriately assisted to move as a result of this.

People told us they were supported by staff to access healthcare services. However, we saw examples through records of complaints where access to healthcare had not been promptly supported.

Staff received training in a number of areas and ongoing support was provided through individual and group supervision. We found staff appraisals were not taking place, although a plan to address this was in place.

Staff were able to describe how they would identify abuse and report this. We looked at safeguarding records and found this information had been appropriately acted on.

People told us they were satisfied with the quality of food provided, although they wanted more choice in their afternoon meals. We observed the dining experience and found this was positive.

The activities provision within the home was a strength of the service with both regular and one-off events being held. Weekly trips were taking place, but we found these were limited to a small number of people who were more independent and required minimum support.

People were complimentary about the staff who provided their care. We found staff respected people’s dignity and privacy.

Care plans were person-centred with details about people, their life history and care preferences, although some gaps were found in the recording of people’s care needs. We found limited evidence of people’s involvement in care planning.

Complaints were fully investigated and written responses had been sent out within identified timescales. We saw examples of lessons learned from complaints and evidence of this learning shared with staff.

The turnaround manager held regular ‘surgeries’ for people and relatives to approach them with any comments or queries. Regular meetings for people and their relatives, as well as staff meetings, were held in the home. Satisfaction surveys were sent out annually to people, their relatives and staff.

The majority of staff spoke positively about the turnaround manager and the influence they had at White Rose House.

We found two breaches of the regulations. You can see what action we took at the back of this report.

White Rose House Care Home provides nursing and personal care for up to 64 older people. All the bedrooms have an en-suite facility. There is a coffee lounge, library, hairdressing salon as well as landscaped gardens. Car parking is also available.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). However, they were no longer in day to day control of the service. A new manager had been appointed in January 2017. 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.

Since our last inspection a new manager and area director had been appointed. During our inspection we were able to see improvements had been made in this period of time. However, the management team need to review the records kept in the home as the home was not keeping contemporaneous care records and there was a lack of provider quality oversight. People had opportunity to comment on the quality of service and influence service delivery. Effective systems were in place which ensured people received safe, quality care. We saw complaints were appropriately managed.

We found medicines were well managed; although, the administration process and recording for the application of creams needed reviewing. People attended regular healthcare appointments. However, the process for people’s weight management needed strengthening.

Although the provider was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS), further work was needed to ensure, where needed, mental capacity assessments had been completed.

There were no activities available on a day to day basis. A new activity coordinator was due to start in mid-June 2017. A contingency was needed for the provision of activities when the activity coordinator was not available. People’s care plans contained sufficient and relevant information to provide consistent support; however, the management team needed to make sure all the care plans contained the most up to date information.

We found people were well cared for and supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. Staff received the training and support required to meet people’s needs. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understaffing of safeguarding and knew what to do to keep people safe. People’s mealtime experience was good and their nutritional needs were met. People’s equality, diversity and human rights were respected.

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

White Rose House provides nursing and personal care for up to 64 older people. On the day of inspection there were 53 people living in the home, 16 of whom were in receipt of nursing care.

There was no registered manager available on the day we inspected. However, there was a relief manager in post who had been in the home for three weeks. 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.

People told us they felt safe and the staff we spoke with were able to explain what may lead them to report a safeguarding concern. Risk assessments were not always reflective of a person’s needs which meant key aspects of minimising these risks to people in delivery of their care could be missed.

We found staffing levels were satisfactory in regards to meeting people’s needs and staff responded promptly to call bells. However, we did highlight to the registered provider the issue with the call bell defaulting to an emergency alarm immediately which put staff under additional pressure to respond quickly as they were unable to determine the urgency of a call. They said they would take immediate action to rectify this.

Medicines were stored appropriately and people received their medication safely and in line with their prescriptions. This included any PRN (as needed) medication where the home had specific protocols in place to identify when this might be needed.

New staff had not received an induction prior to the start of the relief manager but this had been subsequently arranged. We found that ongoing supervision and training had not been given to ensure staff were suitably skilled and competent.

The home had a number of Deprivation of Liberty Safeguards (DoLS) authorisations in place. We found errors in a number of mental capacity assessments which conflicted with other information in people’s care records which meant the service was not compliant with the requirements of the Mental Capacity Act 2005.

Recording was poor for nutritional intake and pressure care relief, especially on the residential unit as there were no specific pressure care records for staff to follow. Pressure care was recorded in people’s daily notes which meant it was harder for staff to determine what pressure care had been given and at what time.

We did see a much improved dining experience for people in both the communal areas and for those eating in their rooms from our previous inspection. Staff were caring in their approach with people, mindful of acknowledging them and respecting their privacy. It was evident that there had been consideration about how to support people with dignity.

The activities co-ordinator was a positive role model for the home and people spoke highly of their contribution. Care records were detailed but there was sometimes too much information which meant navigation around the file was difficult. This posed a significant risk as the service was using agency staff and they needed to be able to access key information quickly. Reviews were recorded separately to the care plan which again meant key information was not integrated and heightened the likelihood of this being missed.

People told us they liked living at the home and staff felt supported, especially by the relief manager. However, due to the inconsistent management over the past eight months there were lapses in quality assurance processes which had missed key areas for improvement.

We found breaches in Regulations 11, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, their relatives, staff members and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were some systems were in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. However, we found that audits of care records had not been carried out in the last five months.

We found many areas at the home were unclean and equipment was not always well maintained.

Staff rotas took people's care needs into account. However, there were several times where the home had less staff members on shift that was required, particularly during nights, where there were many staff shortages that had not been covered.

We found some issues within care records we looked at and asked the provider to make a referral to the local safeguarding team for these issues.

Is the service effective?

People's care records were not always assessed with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people's care records were not always up to date and, at times, contained incorrect or inaccurate information.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People's preferences, interests, aspirations and diverse needs had been recorded in some care records, but not others.

Is the service responsive?

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges with no interaction from staff members for a considerable length of time. People who lived at the home told us they would like more activities to partake in.

People, or relatives of people, knew how to complain if they were unhappy. We saw evidence that complaints were dealt with in a timely manner and responses sent to the complainant.

Is the service well-led?

The service had quality assurance systems in place and, where shortfalls were identified, actions were identified. We found some issues with the completion of audits, where audits had not been carried out on care records in the last five months. We also found many areas of the home were dirty, though this had not been identified during audits of the environment at the home. We spoke with the manager about this, who told us audits had not been carried out recently due to them being relatively new in post. The manager said they would ensure that audits were carried out regularly.

Staff told us they were clear about their roles and responsibilities. People who lived at the home and some staff we spoke with said they felt carers were 'stretched' and did not have a lot of time to carry out their duties.

At the time of our visit there were 62 people living in the home. We talked with 13 people who used the service, two visitors, seven staff and the manager.

During our observation we found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people.

People's social needs were assessed and care was planned to meet their needs.

People's health, safety and welfare were protected when more than one provider was involved in their care and treatment. This was because the provider worked in co-operation with others.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

Comments from people who used the service about the care they received included:

"The staff look after you very well indeed.'

'I can go to bed and get up when I want. I am quite happy with my room and can go there when I wish. The staff are all lovely.'