Archived: The White House

Updated 27 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 19 and 20 April 2017; the first day of the inspection was unannounced. One adult social care inspector and an expert by experience (ExE) carried out this inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection, we reviewed the information held about the home. This included previous inspection reports and Statutory Notifications we had received. A statutory notification is information about important events, which the home is required to tell us about by law. Before the inspection, the provider completed a Provider Information Return (PIR). This form asks the provider to give some key information about the home for instance, what the home does well, as well as any improvements they plan to make.

During the inspection, we spoke with 11 people individually and met with most people who used the service. On this occasion, we did not conduct a short observational framework for inspection (SOFI) because people were able to share their experiences with us. However, we did use the principles of this framework to undertake a number of observations throughout the inspection.

We looked at care records for five people to check they were receiving their care as planned as well as how the home managed people's medicines. We reviewed staff recruitment, training and supervision files for three staff. We looked at the quality of care and support provided, as well as records relating to the management of the home. We spoke with seven members of staff, and the deputy manager. We looked around the home, including some people’s bedrooms with their permission, as well as the grounds. We also spoke with five relatives of people currently supported by the home. Following the inspection, we sought and received feedback from three health and social care professionals who had regular contact with the home.

Updated 27 June 2017

The White House is a large detached house set on the outskirts of the coastal town of Teignmouth. The home is registered to provide accommodation and personal care for up to 22 older people who may be living with a dementia or physical disability.

At the time of the inspection there were 22 people living at the home. The home offers both long stay and short stay respite care. The White House does not provide nursing care. Where needed this is provided by the community nursing team.

This inspection took place on the 19 and 20 April 2017; the first day of the inspection was unannounced. The home was previously inspected in February 2015 when it was found to be meeting the requirements at the time.

The home had a registered manager. However, they were not available during this inspection as they were on annual leave. 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.

There was some good practice in relation to the management of medicines. However, we found improvements were needed in relation to record keeping, storage and the deposal of unused prescribed topical applications, such as creams, ointments, and gels when they were no longer required. For example, in the main lounge we found an unlocked wooden cabinet that contained a number of prescribed topical applications dating back to 2013 and 2014, which should have been return to the local pharmacy for disposal. Immediate action was taken to address these issues. People received their prescribed medicines when they needed them and in a safe way. Staff had received training in the safe administration of medicines.

People were not always protected from the risk of harm. We found a number of toiletries and chemicals had been left out and accessible. Risk assessments had not been completed to show this was safe, despite these potentially presenting a risk to people living with dementia who might ingest them accidentally. Immediate action was taken to address these issues. Other risks to people's health, safety, and well-being had been assessed and regularly reviewed. People’s care plans contained detailed risk assessments and management plans, which covered a range of issues in relation to people's needs. For example, risks associated with skin care, poor nutrition and the risk of falls due to reduced mobility had all been assessed.

Staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding (DoLS). People were encouraged to make choices and were involved in the care and support they received. Some people did not have the mental capacity to make complex decisions about their health and welfare. Where decisions had been made in a person’s best interests these were not always being fully documented. We raised this and were assured action would be taken to address this.

The home’s quality assurance and governance systems were not effective. Although some systems were working well others had not identified the concerns we found during this inspection.

People said they felt safe and well cared for at The White House, their comments included “I feel safe here they [staff] look after me well.” Another person said, “I do feel safe, it’s my home.” Relatives told us they did not have any concerns about people's safety. People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. This included first aid, pressure area care, infection control, moving and handling, and food hygiene.

People told us staff treated them with respect and maintained their dignity. Throughout the inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. The home had a programme of organised activities that included arts and crafts, music sessions, exercise classes, card games, and quizzes.

People, relatives and staff spoke highly of the management team and told us the home was well managed. Staff described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns, and were confident they would be taken seriously.

We found breaches 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.