White Rose House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety.

This service scored 59 (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 always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

There was a lack of consistency in the provider’s approach to learning lessons. The provider did not always use accident and incident monitoring to learn lessons and drive improvement. For example, we looked at the last 10 accident and incident forms completed and whilst they had been signed as reviewed by the registered manager, there was no information about actions taken or lessons learnt to reduce the risk of a repeat of the incident. The audits of accidents and incidents did not evidence that where issues were identified these were followed up by the management team. However, we did see evidence of lessons being learnt from a recent safeguarding incident which resulted in a change in staff practice.

Staff told us they knew what action they would take if they identified an incident or an accident. One staff member said, “I record in the accident book and on the daily notes, report the accident to the senior and manager, also have an incident form, share at handovers. I can report any safety concerns to the [registered] manager, and I feel it would be listened to.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Systems were in place to make sure people’s needs were assed prior to being offered a place at the service. When people were admitted from hospital, the service used the ‘trusted assessor’ scheme which meant the person’s needs were assessed by someone qualified to do so whilst still in hospital. The registered manager told us they had a good relationship with their trusted assessor and found their assessments accurate.

The registered manager assessed the needs of people moving into the service from home or transferring from other services. People were invited to visit and stay for a meal prior to deciding to move into the service.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Safeguarding training was provided annually for staff, and this was completed online. Care staff understood their roles in relation to safeguarding. However, despite the training, staff did not always manage concerns well.

During the assessment, a person told us about an experience they had reported to a senior member of staff. This had not been reported to the registered manager and a safeguarding referral to the local authority had not been made. A referral was made immediately after we reported the information, and the management team took appropriate action to address issues with the person concerned and with staff. We were assured this would be addressed with all staff to avoid the situation happening again.

People told us they felt safe. Their comments included, “Yes, I’m safe, there’s always folk around I know and it’s right enough” and “Yes, I’m safe, there’s always someone around keeping their eye on everyone. Always lots of carers around.”

The Mental Capacity Act 2005 (MCA) outlines how decisions should be made for individuals lacking capacity. However, MCA principles were not consistently followed. Capacity assessments were not always completed, and staff had not always followed the correct procedures in relation to making best interest decisions, which meant people were being placed at possible risk. These concerns were highlighted with the senior management team who gave assurance that this would be addressed as a matter of urgency.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were in place but varied in quality and it was not clear staff had always followed the actions detailed in the assessment to reduce the risk to the person. For example, there was little evidence to show that people assessed as being nutritionally at risk were receiving the high calorie diet or supplements they needed. Two people’s relatives raised concerns with us about their family member’s weight loss. Although we found their weights to be stable, the risk assessments did not include information about current risk or previous weight loss.

Staff knew how to support people’s moving and handling and mobility needs safely, and we observed them providing support to people in line with their moving and handling risk assessments and associated care plans.

There was no evidence of people or, where appropriate, their relatives having been involved in the risk assessment process. A member of the provider’s senior management team told us this was being addressed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Bath and shower rooms were used to store clinical waste bins and laundry skips, sometimes sited next to radiators. This meant the rooms did not always provide a pleasant environment for people to enjoy a bath or shower particularly in relation to the unpleasant odour from clinical waste bins. We also noted call bells in some bathrooms had been tied up which meant people would not be able to reach them if they had fallen. Some of these issues were attended to during the assessment and we were assured by the management team they would take action to address our concerns fully.

The communal environment was pleasant and comfortable with different, well sign-posted areas for people to spend time. This included café areas and smaller lounges for people to enjoy a quieter space. Some work had been done to support people living with dementia to navigate safely around but there were plans for further development of the dementia care unit.

One person told us, “I love the décor and furnishings. There are always painters in touching up”.

The provider made sure there were enough staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were recruited safely and received good levels of training and support. However, we saw some examples of staff not always working in line with their training. Staffing levels were above those suggested by the tool used to calculate the number of staff needed in relation to people’s needs. The management team told us they were considering ways to improve the deployment of staff for people living with dementia, in order to better support their social activity and engagement.

Staff breaks were not appropriately monitored by the person in charge to make sure staff were available to people as needed. The management team was introducing a system to monitor staff break times to ensure continuity of staffing.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Housekeeping staff worked daily, and we observed the majority of the home was clean and tidy. Supplies of personal protective equipment (PPE) were available throughout the home, and we saw staff wore PPE when providing care.

People were supported with appropriate personal care to minimise the risk of infection.

he provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Safe systems were in place for storage, administration and disposal of medicines. Medication administration records (MARs) were consistently completed well and people that were prescribed ‘as and when’ required (PRN) medicines had up-to-date protocols in place to ensure staff knew when to give these medications. More detail was sometimes needed in the recording of why the PRN medicine had been given and how effective it had been.

Medication reviews had been completed by a community healthcare provider to make sure people’s medicines were right for them.