The White House Residential Home

The White House Residential Home is a care home providing accommodation and personal care for up to 20 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people using the service.

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

People were placed at risk of harm as the provider had not identified or mitigated some risks. This included risks related to people's medicines, health and care needs, as well as environmental risks.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People's mental capacity to consent had not always been assessed in line with relevant legislation.

The service had governance systems in place, but these were not always effective to ensure the service was providing safe care to people.

People told us they felt safe, and their relatives felt their loved ones were well looked after. Staff understood their responsibilities to report any safeguarding concerns. There were sufficient staff deployed to keep people safe.

Staff we spoke with knew people well and were positive about the management and support in the home.

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 9 December 2019). The last inspection of the service was 12 February 2021; however, the service was not rated at that inspection.

Why we inspected

We received concerns in relation to staffing levels, security of the building, safeguarding, and restrictive practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The White House Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to consent, safe care and treatment, and good governance. Please see the action we have told the provider to take at the end of this 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.

We found the following examples of good practice:

• Staff had received infection control training. Cleaning schedules had been enhanced to include more frequent cleaning of high touch points, such as handrails and light switches.

• Effective systems were in place to ensure visitors to the service followed government guidelines for wearing personal protective equipment (PPE). Facilities were available for visitors to sanitise their hands and put on PPE. Screening questions and a temperature check were standard requirements for all visitors.

• The service had built a visiting pod for visitors to see their relatives who lived at the service.

• The service had good supplies of PPE that were readily available in stations throughout the service. Clinical waste bins were positioned so that staff could access them when required.

• Staff had received update training on how to keep people safe during the coronavirus pandemic. Staff supported people to understand the procedures in place to keep them safe and the required isolation procedures.

• People and staff received regular coronavirus tests in line with the government's current testing programme. Staff maintained social distancing where possible and the environment promoted people remaining socially distanced.

The White House Residential Home is a residential care home providing personal care for up to 20 older people, some of whom may be living with dementia.

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

People living at The White House Residential Home told us they were safe, happy and well cared for. Staff were aware of the importance of keeping people safe and demonstrated a clear understanding of people’s diverse needs and how to support their independence.

Staff followed best practice guidance to ensure medicines were managed and administered safely. People received support to take their medicines as prescribed.

The provider completed checks on staff prior to commencing their duties to ensure they were suitable to work in the service. All staff completed an induction to their role and were provided with ongoing training, supervision and appraisal. Staff confirmed they were well supported to have the right skills and knowledge to support people safely in line with best practice guidance.

Staff spoke with enthusiasm about their roles and the people they supported. It was evident from discussions and observations staff had a very clear understanding of people’s needs and people were responsive and settled in their company. People had good access to other health professionals to maintain their wellbeing.

Care records were person centred and included information to provide person centred, safe care according to people’s individual preferences. Where people were able to, they were fully involved in their care plans. Where assessments confirmed people did not always have capacity to make decisions, staff understood the importance of offering choice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager and staff were passionate about the service and responsive to any concerns. Staff spoke positively about the way they were managed and the support they received. Everybody told us the management team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 27 November 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.

At the last inspection of the service on 23 May 2018, we found that there were breaches of two of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. In addition, we made one recommendation to improve infection prevention and control practices.

At this inspection we found that there were two continued breaches of the fundamental standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.

This is the second consecutive time this service has been rated requires improvement.

The service is required to have a registered manager in post. 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. The service had a registered manager who had been registered with the Care Quality Commission since 1 October 2010.

The White 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.

The service provides residential care for up to 20 older people including people living with dementia. The service offers accommodation over two floors.

We identified a lack of management oversight. Processes in place did not identify all the issues raised during this inspection. In addition, the provider was unable to evidence sustainable improvements since our last inspection, this resulted in repeat breaches of regulation.

The provider was taking steps to refurbish the home and this was a work in progress during the inspection. We identified several areas where measures needed to be put in place to reduce fire hazards. This included the updating of the fire risk assessment. We shared our findings with Humberside Fire and Rescue Service and they are currently supporting the service to ensure they are compliant with current legislation in terms of fire safety.

Medicines, including sharps were not stored securely. This meant that people were able to gain access to large amounts of pain killers, insulin and various other medicines that were not locked away.

Accidents and incidents management was not proactive in preventing risks to people. There was no overall analysis in place to highlight themes to ensure preventative measures were in place.

Recruitment procedures were not always robust, we found that the provider had not completed additional checks and assessments to ensure prospective employees were of a suitable character to work with vulnerable people.

Infection prevention and control practices were not always effective and we highlighted concerns in relation to odours, mattress cleaning schedules, general cleanliness, fire, food hygiene and environmental safety.

Some risk assessments were in place. However, these did not always contain specific information to guide staff to mitigate risks to people and risk assessments were not always in place for specific risks associated to people’s health conditions.

Information in relation to people’s care and support needs would benefit from more detail to include all health conditions from the pre-admission assessments shared with the provider.

People told us they felt safe living at the service. Staff had received regular safeguarding training and could describe how they would keep people safe from potential harm or abuse.

Staff had completed training as outlined by the company and felt supported by the registered manager. Records showed that staff received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they could see healthcare professionals when they needed to and records showed that people were referred to health professionals when required.

People's nutritional needs were met. People told us the food was good and that staff offered them regular drinks and snacks throughout the day.

People told us they were attending day care facilities and people were out with their relatives or shopping in the local town on the day of our inspection. People we spoke with told us there were activities organised three days a week and that they enjoyed them. Records supported this information.

People were positive in their feedback about staff describing them as lovely, caring and kind. End of life care and palliative care within the service was linked to advance care plans. People and their families, had been included in meetings to plan and agree to the care provided.

People knew how to make a complaint and where there had been complaints these had been dealt with in accordance with appropriate company policy and procedures.

The White 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. The service is located in Driffield, in the East Riding of Yorkshire. It has accommodation for a maximum of 20 older people, some of whom may be living with dementia. During this inspection there were 13 people using the service.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

At our previous comprehensive inspection on 2 June 2016, the service was rated Good overall. We issued one requirement notice for a breach in Regulation 15, premises and equipment. You can read the report from our last inspections on our website at www.cqc.org.uk. The provider completed an action plan to show what they would do to meet the requirements of the regulation.

At this inspection we found the provider had breached two regulations of the Health and Social Care Act 2008. The provider had not always ensured all risks to the safety of people were identified and action taken to minimise these risks. Medicines were not safely managed. The provider's quality assurance systems were not always operated effectively to monitor the safety of the service and to ensure compliance with the regulations.

We have made one recommendation in this report for the provider to review the processes at the home to ensure good practice guidance is consistently implemented in relation to infection prevention and control.

People told us they felt safe living at The White House and with the staff who supported them. Visitors confirmed this. Staff demonstrated that they were aware of their responsibilities with regards to protecting people from abuse through discussions with us and the completion of appropriate training.

People told us staff were kind and caring and they had developed good relationships with people using the service. Staff were aware of the importance of ensuring people's privacy and dignity was respected at all times.

People received good support to access health services when they needed them. The food in the home was good and people said they were happy with their diet. People enjoyed some group and individual activities.

Care plans were person centred. People were given regular opportunities to express their wishes or preferences and these were responded to by staff. People's care was planned in a way that reflected their needs and was regularly reviewed. Staff knew people well and involved them in their care.

Staffing levels were satisfactory and employees were subject to pre-employment checks before they were offered positions at the home. The registered manager maintained records of accidents and incidents which gave them an overview of any trends.

Staff had been supported through the regular use of supervision. Staff had the relevant training and support to care for people in the right way. The staff team were confident.

People, their visitors and staff spoke positively about the registered manager. Staff told us they felt supported. They described the registered manager as ‘approachable’ and ‘supportive.’ Any concerns or complaints were investigated and responded to.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. The registered manager had been notifying CQC of important events.

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

The White House Residential Home on the edge of Driffield provides care to a maximum of 20 older people who may have memory impairment. The service is close to local amenities and has transport links to Beverley, Hull and surrounding East Yorkshire. There are single and shared bedrooms, two lounges, a dining room and a rear garden. There is car parking for five cars.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last three years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed appropriately so that people avoided injury or harm wherever possible.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s needs and we saw that rosters accurately cross referenced with the people that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was safely carried out, but we made a recommendation to the registered provider to ensure that practice was in line with guidance produced by National Institute for Health and care Excellence.

We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and received an appraisal regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitable for providing care to older people, but there was a recommendation made to ensure that all areas that required repair and / or furniture and items that needed replacement were attended to.

We found that people received compassionate care from kind staff and that staff knew what people’s needs and preferences were. People were supplied with the information they needed at the right time, were involved in their care, where possible, and were asked for their consent before staff undertook care and support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain these. This ensured people were respected, that they felt satisfied and were enabled to take some control of their lives.

We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. People had the opportunity to engage in some pastimes and activities if they wished to, but there was insufficient activity to stimulate those people living with dementia. People had good family connections and support networks.

We found that there was an effective complaint procedure in place and people were able to have any complaints investigated without bias. People that used the service, relatives and their friends were encouraged to maintain healthy relationships together by frequent visits, telephone calls and sharing each other’s news.

The service was well-led and people had the benefit of this because the culture and the management style of the service were open and responsive. There was an effective system in place for checking the quality of the service using audits, satisfaction surveys and meetings.

People had opportunities to make their views known through direct discussion with the registered manager or the staff and through more formal complaint and quality monitoring formats. People were assured that recording systems used in the service protected their privacy and confidentiality as records were well maintained and were held securely in the premises.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service safe?

The service was safe, clean and hygienic. Improvements had been made to the standards of cleanliness in the service and additional cleaning hours had been added to the roster so that two cleaners were on duty three days a week and one was on duty the rest of the week, making a total of 40 hours a week. Staff had completed infection control training and they had improved equipment available to them to ensure people were not at risk of harm from infection.

Is the service effective?

Peoples' needs were taken into account with the layout of the service enabling them to move around freely and safely. Repairs identified at the last inspection had been carried out and carpets had been replaced where necessary. The alterations to the main bathroom were still in progress but it meant that peoples' needs regarding their hygiene and comfort would be met once they had been completed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

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

Is the service safe?

We saw staff assisting people with their mobility, nutrition and some social pastimes. Support provided to people was safe and staff ensured peoples' needs were met.

People were not entirely safe because the service had not ensured good infection control was maintained. People that used the service were not as safe as they should be because they were not experiencing a satisfactory environment or using furniture of adequate quality.

People experienced safe practices when receiving support with their mobility.

We have asked the provider to tell us how they'll make improvements and meet the requirement of the law in relation to ensuring people are not at risk from poor infection control and in relation to people experiencing a pleasant, safe and suitable environment.

Is the service effective?

Staff provided effective care and support to people because they had clear instructions in the form of care plans to show them how best to meet peoples' needs.

The service effectively provided suitable nutrition to people that used the service as there was a choice of meals and specialist diets were catered for.

The equipment available in the service was being effectively used to meet peoples' needs.

Staff were appropriately trained and supervised which meant people that used the service were effectively supported and cared for.

Is the service caring?

We observed staff providing people with the support they required to meet their needs in a caring and considerate way.

Is the service responsive?

Staff responded to peoples' direct requests for support and used their knowledge of peoples' preferences and choices to offer the support they required to meet their needs.

Is the service well led?

People had their needs met because the service was led in a way that ensured care plans were followed and reviewed appropriately.

People had opportunities to impact on the quality of the service they received because they were asked their views from time to time. The service was being satisfactorily led by the manager, partly through the use of the quality assurance system, though there was still room for this to improve.

Peoples' needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People were satisfied living at the home. They said, "I am happy here."

We found that people who used the service received their medication according to prescribed instructions and in a timely manner so their health and welfare was well maintained. People said, "The home looks after my medication" and "I would not want to be responsible for my medication".

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. However, while the premises were safe and maintenance was up to date, the environment was generally beginning to look tired.

Staffing levels were adequate, though alternative arrangements had been put in place to ensure care shift were covered. People were satisfied with staffing and said their needs were met.

The provider had an effective system to regularly assess and monitor the quality of service that people received. However, quality assurance was not an area the manager had assessed and developed properly yet during the time they had been in post. We discussed how the system might be developed or improved and the manager gave an undertaking that systems would be developed.