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The White House Requires improvement

The provider of this service changed - see old profile

We are carrying out a review of quality at The White House. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 9 December 2019

During a routine inspection

About the service

The White House is a care home that provides personal care for up to 22 older people. At the time of the inspection 11 people were living at the service. Some of these people were living with dementia. There was also five self-contained flats attached to the service that were currently not in use.

This service was registered for the current providers on 9 May 2018. The service was inspected on 4 and 5 December 2018, because of concerns we had received. At that inspection the service was rated as Inadequate overall and for the key questions of Safe, Responsive and Well Led. Breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009 were found.

Following the inspection in December 2018, the service was placed in 'Special Measures' by the Care Quality Commission (CQC).

The purpose of special measures is to:

• Ensure providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made

• Provide a clear timeframe within which providers must improve the quality of care they provide, or we will seek to take further action, for example to cancel their registration.

We asked the provider to complete an action plan to show what they would do and by when to improve.

At the inspection on 22 and 23 May 2019 sufficient improvement had not been made. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009. Some of these were repeated breaches from the previous inspection, although we found the seriousness and risks associated with the breaches had been reduced.

The overall rating for this service was 'requires improvement' and the service remained in 'Special Measures'. This is because one key question has been rated as 'inadequate'. This meant we would keep the service under review and if we do not propose to cancel the provider's registration, we would re-inspect within six months to check for significant improvements.

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 regulation. However, it had only been a short time since the last inspection and these improvements and changes needed to be embedded into the service. The services action plan confirms some issues remain ‘in progress’ and not yet completed. Therefore the service remains ‘requires improvement’.

This service had been in Special Measures since December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or any of the key questions. Therefore, this service is no longer in Special Measures.

The service had been working with the local authority Quality Improvement team to embed positive changes. A new manager has been employed since the last inspection and has been working alongside the Quality Improvement team. The manager was supported by senior management. New management systems had been implemented to better monitor care provision.

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

People told us they were happy living in the home and staff told us they particularly enjoyed working in the homely atmosphere. The manager and staff’s passion for caring for people was clear. Relatives and staff spoke highly of the new manager in post.

People and their relatives told us they were happy with the care they received and believed it was a safe environment. One person said; “Yes I feel safe here.” A relative said; “The staff are always about.” People looked happy and comfortable with staff supporting

Inspection carried out on 22 May 2019

During a routine inspection

About the service:

The White House is a care home without nursing and is registered to provide accommodation and support for a maximum of 22 people. At the time of the inspection there were 15 people living at the service. People living at The White House were older people, the majority living with dementia.

The service is set over three floors, with accommodation for people on the ground and first floors; office services are on the second floor. In addition, the service has six registered beds set away from the main accommodation but on site, offering a self-contained bedroom, and bathroom with kitchen area.

Since the last inspection a new manager had been appointed and had made application to be registered.

Enforcement

This service was registered for the current providers on 9 May 2018. The service was inspected on 4 and 5 December 2018, because of concerns we had received. At that inspection the service was rated as Inadequate overall and for the key questions of Safe, Responsive and Well Led. Breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and and one breach of the CQC (Registration) Regulations 2009 were found.

Following the inspection in December 2018, the service was placed in ‘Special Measures’ by the Care Quality Commission (CQC).

The purpose of special measures is to:

• Ensure providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made

• Provide a clear timeframe within which providers must improve the quality of care they provide, or we will seek to take further action, for example to cancel their registration.

We asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection sufficient improvement had not been made. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009. Some of these were repeated breaches from the previous inspection, although we found the seriousness and risks associated with the breaches had been reduced.

The overall rating for this service is 'requires improvement' and the service remains in 'Special Measures'. This is because one key question has been rated as ‘inadequate’. This means we will keep the service under review and if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

All 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.

People’s experience of using this service:

We found risks to people’s safety were not always assessed and monitored. We found one person with significant dementia was living in one of the flats external to the main building. Staff were locking the person in at night to maintain their safety, and the person would not have been able to leave their room unaided or use a call bell to seek staff assistance. When staff needed to attend to this person’s personal care requiring a hoist, for example when getting up in the morning while the night shift were still on duty, both staff members were needed. This meant instances where both night staff had to leave the main building unattended to support the person. No risk assessments were in place, either to assess the vulnerability of the person or from the lack of staff in the main building. This had left people at risk.

Some other risk assessments, such as for the premises had not been completed, and a notification regarding allegations of unsafe or potentially abusive practice had not been notified to CQC as required by law. Systems for the safe recruitment of staff were not always being implement

Inspection carried out on 4 December 2018

During a routine inspection

What life is like for people using this service.

• People were not always kept safe from harm. We were concerned that one person was not safe and made a referral to the local safeguarding authority and police as we were not reassured the service knew how to best support this person.

• There were not enough staff to meet the complex and changing needs of people. We saw people placed at avoidable risk of harm. There were not enough staff to support people to effectively prevent incidents such as falls.

• There were few activities for people to follow. People were not supported to lead lives that were meaningful to them. We saw three people with needs for positive behavioural and emotional support wandering around the home, showing periods of distress and confusion. They received minimal interaction from staff.

• Medicines were not always managed safely. Care staff were administering medicines in a patient and caring way and recording the medicines given with no gaps. However, there were no protocols in place for covert medicine administration or when it was appropriate to administer a medicine prescribed ‘as needed’. Some controlled drugs were not safely stored.

• Care plans and risk assessments were not up to date with people’s needs, placing people at risk of inappropriate care and treatment.

• People’s preferences were not being met. Choices were offered to some people but care staff did not always offer a choice to those people who might not be able to verbalise their preferences.

• Daily recording and monitoring frequency did not match up to care plans and there were gaps in records. We were concerned some people were not being repositioned as often as they should be and some people who required hourly monitoring to remain safe were not being checked on by care staff regularly enough.

• People were not empowered to have choice and control in their lives. They were not invited to contribute to the running of the home, either through their ideas or taking part in domestic tasks to introduce a feeling of purpose.

• There was insufficient manager and provider oversight into the day to day running of the home. There was a lack of senior staff presence on the floor. We had to intervene and ask for managers to assist after two incidents took place in a short space of time.

• Quality assurance was lacking and did not pick up on some of the issues we found during the inspection.

• The service had not always notified the Care Quality Commission of important events or significant incidents by sending in legally required notifications.

• People were supported by staff who cared about their welfare and spoke fondly of them. Relatives told us care staff were kind. We saw care staff approaching people gently and being patient.

• There had been some efforts to make the environment homely and there were planned redecoration and other maintenance works taking place during our visit.

• People had drinks within reach and were offered warm drinks throughout the day. There was a balanced diet on offer. Some people were not happy with the presentation of the food.

• Staff felt supported and informed by the provider on changes that were taking place. Supervisions were starting to take place. Training had been booked for future dates as there were gaps in staff knowledge and training relating to people’s needs.

• The provider, who had taken over in May 2018 was open to suggestions and had a programme of improvements for processes, the building and staff support planned.

• We found breaches of legal requirements in eight regulations relating to safeguarding, safe care and treatment, recruitment, staffing, consent, person centred care, good governance and notifying us of significant events.

• The service met the characteristics for inadequate in three of the five domains we inspected and the overall rating is inadequate.

• More information is in the Detailed Findings below.

Rating at last inspection.

This was the first inspec