Archived: The White House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of legal regulation in relation to people not being treated with dignity and respect and the lack of person-centred care.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not treat colleagues from other organisations with kindness and respect.

As before, we observed people looking unkempt, had greasy hair and had clothes on that were not matching. People’s clothes in their wardrobe had not been stored in a respectful way and at times, just screwed up at the bottom of the wardrobe. We observed people’s clothes and bedding were very creased. Clean, ironed clothes help maintain a person’s personal appearance, dignity, and self-esteem. In addition, people’s clothes had not been washed with care. We noted in the laundry room that people’s white clothes had been placed in the washing machine with bright coloured clothes. As such all light washing looked grey. Clothes are part of a person’s identity. Wearing discoloured clothing can lead to a loss of self-esteem and comfort for the person.

There was some undignified language in the care notes used by staff to describe people, all of whom were living with dementia. These references included when people were stressed as being in a ‘bad mood’. One note read that person, ‘Got agitated while trying to clean her bum’ and another stating, ‘She messed up with poo’. We also noted in 1 person’s care plan more than 1 reference to where a member of staff had recorded the person was anxious and asking to go home, the member of staff had told the person they had Alzheimer’s as a way to comfort and reassure them. However, dementia guidance states this should not be done as this can cause further agitation and anxiety to remind them of their dementia diagnosis.

As identified on a previous inspection, we found the music in the lounge was very loud and as a result people found it difficult to engage in conversation.

However, we did see some caring interactions between staff and people. We observed 1 member of staff place their arms around a person when they saw the person was anxious. Another member of staff assisted another person gently by the arm to the dining with patience and reassurance. Relatives we spoke with did speak fondly of some of the staff including, “There has been a lot of staff change and yes they are young, but they genuinely care.” Other comments from relatives that were fed back to the manager included, ‘They’re [staff] fine young people, friendly, polite and excellent with my mum’ and ‘They[staff] have shown kindness and compassion when assisting my mum with her activities of daily living.’

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We saw the same statement being used in the majority of people’s care plans under ‘What is important to me’ was almost identical. This included to be treated with respect, patience, kindness and dignity which should be assumed. There was a lack of detailed information around people as an individual. Where it asked in the care plan whether the person followed a particular faith, culture or religion, the majority of these had been left blank.

As noted, we observed that people looked unkept and their hair looked greasy. We saw that people were on a ‘shower’ list and staff told us, aside from 2 people that were routinely offered a shower every day, all the other people were only offered a shower on specific days. One member of staff told us, “We have a rota. Every day except Sunday we shower 5 people. On a Sunday it is 4 people.” Another told us, “For someone like [person] it would be twice a week [offered a shower]. It depends on the rota.” We noted on 2 people’s hygiene records over a period of 28 days; they only had a shower/bath on 7 occasions.

Although we observed staff being kind towards people, there was very little interaction. Staff were caring for people and ensuring their needs were met and although this was observed to be done in a compassionate way, it was mainly task focused.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

We found there was a lack of person-centred activities for people. On the day of the inspection, whilst an external visitor providing a 45-minute activity for people, aside from that, there was very little to engage people. One person told us, “I hate living here. There’s nothing happening and things don’t get sorted. There’s never anything to do.” A relative had fed back to the manager, “One thing I would like to see is more activities for the residents.” Daily notes for people did not detail any other activity being offered to people for the remainder of the week. A visiting professional told us, “They [people] just sit there comatose all week, they are just left on their own.” Daily records for 1 person cared for in bed did not demonstrate that staff had spent time with them other than to carry out routine care tasks. None of the activities planned included taking people out.

However, we did see some people [that were able to] walking around independently in all areas of the service.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff told us that 1 person felt unwell on the day of the inspection, and we noted they were laying on their bed for the majority of the day. Whilst staff told us they gave the person additional pain relief for this, the person’s medicine record did not show any additional medicine (aside from their normal prescribed medicine) had been given to them. A visiting professional from the local GP practice visited on the day of the inspection and we heard staff tell them that there were no concerns with anyone. This was despite staff telling us that the night staff told the day staff that the person felt unwell on the night shift. There was also no record made in the person’s care notes relating to them feeling unwell. The manager and staff failed to follow this up by seeking medical advice and offering pain-relieving medicines.

Leaders did not provide adequate resources to enable staff to understand and offer the right support to people to either prevent distress or when they were becoming distressed. Staff spoken with were not clear on how to support people demonstrating anxiety and, or distress. We saw from care notes, when people showed distressed behaviour, staff did not really understand about diversion strategies, such as redirecting people’s attention away from the viewed negative behaviour towards a different, more positive activity or topic. The solution in the majority of cases, was to ‘leave them to calm down’. Whilst this may be a solution in some instances, care plans and risk assessments failed to identify the triggers causing the person’s distress. Staff should be aware of how to actively support individuals through personalised strategies to anticipate and meet their needs quickly and in ways that reduced and mitigated people’s discomfort and distress. One external professional fed back that, “The understanding [by staff] of dementia and ability to deal with [person] was very poor.”

Whilst people that were awake in the lounge were offered drinks, there were other people dozing in their chairs that were not offered drinks.

However, there were some instances where staff responded positively to people’s immediate needs. One person walked into the lounge, sat down next to us and asked for a cup of tea. This was made for the person by staff who also offered them cake or biscuits.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.