The White House

We found the following examples of good practice.

• The registered manager and staff team were following effective infection control procedures to help manage the COVID-19 outbreak.

• Staff were trained in how to use Personal Protective Equipment (PPE) and we observed them using this appropriately.

• Measures were in place for visitors to help prevent the spread of COVID-19. These included being asked for proof of a negative lateral flow test (LFT). All professionals, staff and contractors were asked to provide evidence of having received the COVID 19 vaccine.

• The provider understood and followed current guidance on visiting both during the outbreak and when there was not an outbreak.

• The service looked clean and smelled fresh. Staff followed cleaning schedules which were

checked by the management team to ensure they were completed effectively. Additional cleaning of highly used areas of the home was carried out frequently throughout the day.

• People who were COVID positive had been supported to isolate in their rooms in line with guidance. This also applied where people had received an inconclusive test result until a second test was completed with a negative result.

• Care was organised appropriately to ensure people confined to their rooms received safe, effective care and were not feeling isolated, while also ensuring other people were not put at risk of infection.

• All staff working at the service were vaccinated against COVID-19 in line with legislation. Staff completed testing for COVID-19 in line with current guidance.

People’s experience of using this service:

Everyone we spoke with as part of this inspection told us they were happy living in The White House because staff were kind and all their needs were met.

People told us they felt safe and well looked after, and their relatives agreed. People had their needs met in a personalised way by staff who knew them well and took account of their likes, dislikes and preferences.

Risk assessments were developed where risks to people’s well-being were identified and these were mitigated effectively.

People told us and relatives confirmed that there were enough staff to support people in a timely way. People’s medicines were administered safely by staff who were appropriately trained and had their competencies checked.

Care plans were kept electronically and this helped keep people’s personal information confidential. Care plans were reflective of people’s current needs, however they needed developing further to include all the personalised details staff knew about people.

The registered manager completed a range of audits to ensure they monitored the quality of care provided. Where actions were needed to improve the service, these were promptly completed.

People were involved in decisions around their care and where appropriate their relatives gave their input in creating the care plans. However, reviews were mainly done by staff and not evidenced how people were involved in these.

Staff knew how to deal with emergencies like fire, and infection control procedures were adhered to.

Rating at last inspection: Good (report published 21 June 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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 any concerning information is received we may inspect sooner.

The White House provides accommodation and care for up to 28 people with a variety of social and physical needs, some of whom may be living with dementia. At the time of our inspection there were 15 older people living at the service.

The manager registered by the Care Quality Commission is no longer employed by the service but has not cancelled their registration. A new manager has been appointed but is not yet registered. 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.

People felt safe in the service. Staff understood their responsibilities with regards to safeguarding people and they had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

There were sufficient numbers of staff on duty to meet people's needs and promote their safety at all times. Safe recruitment processes were in place and had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work. Staff were trained and completed an effective induction programme when they commenced work at the service.

People's needs had been assessed and care plans took account of their individual needs, preferences and choices. There were personalised risk assessments in place that gave guidance to staff on how individual risks to people could be minimised. Care plans and risk assessments had been regularly reviewed to ensure that they were reflective of people's current needs.

People's health care needs were being met and they received support from health and medical professionals when required. Medicines were managed safely and audits completed. People were supported to make choices in relation to their food and drink and a varied menu was offered.

Staff were kind, friendly and respectful. People's privacy and dignity was promoted throughout their care. Staff knew people's needs and preferences and provided encouragement when supporting them. People were encouraged to participate in activities and received relevant information regarding the services available.

The management team were approachable and staff felt supported in their roles. People and staff knew who to raise concerns with and there was an open culture. People and their relatives were asked for their feedback on the service and comments were encouraged. The provider completed quality monitoring audits however it was not always clear how these were used to drive improvements in the service or where actions required to be taken were recorded.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, the staff who supported them and looking at records.

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

Is the service safe?

We spoke with four of the 11 people who lived at the home. They told us that they were happy with the care that they received. We found that care was planned in a way that was intended to ensure people's safety and welfare. The individual care plans we looked at were supported by detailed assessments that identified possible risks to people, such as falling when mobilising on uneven ground, slipping and falling when in the bath or shower rooms and epilepsy.

We saw that the home had an infection control policy that had been updated in February 2012. We spoke with two members of staff who were able to demonstrate that they had a good understanding of infection control procedures. This included hand washing, the use of personal protective equipment, such as gloves and disposable aprons, disposal of contaminated waste and proper practice for soiled laundry.

However, during a tour of the premises we noted that appropriate standards of cleanliness and hygiene had not always been maintained. We saw that there were a number of radiators in communal areas and people's rooms that had decorative covers with cut outs on the front and side covers. These had not been cleaned effectively. We saw that there was a build-up of dust in a number of the cut outs on these covers.

We looked in a communal shower and toilet on the ground floor. We found that the flooring in this had split and had, in one place been filled with silicon. However not all the crack had been filled. The flooring and the coving were also stained with a rust coloured stain. The manager told us that they were waiting for the floor covering to be replaced but did not know when this work would be completed.

We noted that people's personal records were not always accurate and fit for purpose. We looked at the care records of three of the 11 people who lived at the home. We noted that a review of one person's care plan, which had been completed on 21 May 2014 with their social worker, had not been recorded within their care plans or risk assessments.

The manager told us that people would be at risk of harm if they were to leave the building unaccompanied. The door to the home was therefore kept locked. The manager advised that they were in the process of applying for the correct authorisation for the deprivation of people's liberty for their safety. The local authority had indicated to the manager that they were waiting for further guidance on the matter.

We saw that the staffing levels had been determined according to people's needs using a staffing level tool. This was checked by the manager on 19 May 2014. At the level of occupancy on the day of our inspection the tool showed that the home had almost twice the staffing level that the tool suggested was required.

Is the service effective?

One person we spoke with told us, "They are good to me. It is like a big family." Another person said, "It is very nice. I like it here. I am very happy here." They went on to say, "I can honestly say everybody has been really wonderful to me."

We looked at the personal files of three members of staff. These showed that supervision meetings had taken place for each of them every two months. The meetings followed a prescribed pattern during which their performance was reviewed. Future work targets, training support, development and personal needs and any other matters arising from their employment were also discussed. The records showed that staff members were encouraged to identify specific development needs to increase their knowledge and skills.

Is the service caring?

We observed care workers as they interacted with people in the dining room and lounges. We noted that the care workers were patient and caring as they involved people in activities such as games and nail painting. They demonstrated, through their interactions, that they were aware of people's likes and dislikes.

Is the service responsive?

We saw that the manager held regular meetings with people who lived at the home. The minutes of a meeting held on 13 May 2014 showed that people had discussed a variety of topics such as the 'people's wish tree'. menus, outings and activities. We saw that people had requested a change in the menu. They wanted to replace soups and casseroles with salads and quiche and to include ham, egg and chips on the menu. On the day of our inspection one of the choices for the main meal was ham, egg and chips.

People had also asked for the opportunity to grow plants and vegetables in the garden We saw that they had been provided with plant pots and tomato plants which they cared for on the balcony at the home.

Is the service well-led?

The manager showed us the results of a number of comprehensive spot checks that they had undertaken. These included checks of the communication book, food store, medicine storage, kitchen area, household cleanliness, care plans, record keeping and working practices. We saw that as a result of a household cleanliness and tidiness spot check completed on 13 March 2014 the cleaning rotas had been reorganised. These now ensured that deep cleaning was carried out throughout the house and specific tasks were completed each day. This showed that the manager acted on the findings of their spot checks.

We looked at the results of a recent survey of staff members. The results were mainly positive. One person had commented, "I have had a lot of support from both the management and the care staff." Another staff member commented, "I find my manager to be very good." A third staff member commented, "[Name] is a very supportive manager and listens to me." We spoke with two staff members who told us that they felt supported by the manager.

During our visit on the 3 June 2013, we spoke with three people using the service and observed the interactions between people and staff. We looked at two out of 13 care plans and spoke with four staff, including the deputy manager.

We found that people were treated with dignity and respect and they were able to consent to the care they received. We spoke with three of the people living at the service who told us that the staff were very good and kind. One person said "The staff always help me. I can go to bed or get up when I want to."

We observed the lunchtime meal and spoke to people about the food they received. We spoke with three people out of 13 living at the home. They all told us that they liked the food. One person told us, "The food is good. We have discussed the food at our meetings and changed things." Where people had special dietary needs we saw in their care plans that they had been seen by a dietitian. The home had recently been successful in gaining the food first award from the local NHS trust for a further year.

The provider had put in place a system to deal with any complaints. From the records, we saw one complaint had been made this year. We spoke to a person who had made the complaint and they were very happy with the outcome.

We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. There was a relaxed atmosphere in the home, and the staff were courteous and polite in their approach to people and interacted confidently with them. A relative of someone who lived in the home told us "It's brilliant, Mum is happy and feels safe".

We noted that people were encouraged to express their views and where possible were involved in planning their care and making decisions about their support and treatment, and how they spent their time. Within the care files we saw that where possible, care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.