Archived: The White House

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.

We observed the care staffs morning handover and breakfast at the home,

The home appeared clean and smelt fresh. The bedrooms were individually decorated to people's own taste and personalised with their own belongings.

We spoke with staff about their training and support. All the staff said they enjoyed working at the home and felt well supported by their manager. They told us they were encouraged to do 'lots of training' We found that staff received training and support which enabled them to meet the needs of the people who lived there.

We spent time looking at key documents including care plans, daily records and maintenance records.

Relatives told us they were very pleased with the home and the care provided there.

People told us they felt safe comfortable and well cared for.

Staff told us that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes. However, this was not always recorded in people's records.

Staff showed consideration and respect in the way they responded to the needs of those with dementia. There were enough staff to meet people's needs and staff were well supported. We looked at the arrangements in place to recruit staff and saw that the service had effective recruitment and selection procedures in place.

People that we spoke with made positive comments about the way they were looked after. Comments made by people included "I'm very happy living at the White House" and "I've been here a couple of months and we're very well looked after".

We found the home to be clean and tidy throughout. People told us that if they wanted to make comments, raise concerns or complaints they were confident that they would be listened to and appropriate action would be taken where possible.

The provider had an effective system to regularly assess and monitor the quality of service that people received.