White Hill House Residential Care Home

White Hill House Residential Home for the Elderly is a residential care home which accommodates up to 10 older people. It does not provide nursing care. At the time of our inspection there were nine people living in one adapted building.

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

People told us they felt safe living in the service, but we found concerns which demonstrated they weren’t safe. Risk assessments had not been carried out in relation to the environment, people’s health, medicines and staffing levels at night. The environment was not safe as risks had not been managed. This placed people at risk of falls, trips and objects falling from height. Advice from the fire and rescue service had not been actioned, fire drills had not been carried out regularly and exits were not always free of obstruction. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not 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. Authorisation had not been applied for to restrict people’s exit out of the building. Access to the kitchen was restricted. This was a breach of Regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Employment checks were not always thorough and did not protect people from the risk of unsuitable staff. This meant the provider had failed to protect people against the risk of inappropriate or unsafe care. Staff were not always supported to carry out their roles, there was a lack of supervision taking place and no team meetings. Staff told us they would like these to happen. This was a breach of Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The lack of management oversight and documentation to show improvements were being made to the service, meant there was a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider has a legal requirement to inform us of certain events that occur in the service. We found the service was not always doing this. We have made a recommendation about notifications being sent when appropriate to do so.

People appeared well cared for, and they told us they were happy in the service. People’s appearance was clean, and they were dressed appropriately for the weather. One person told us People told us they were happy with the care, one person told us “I truly haven’t got any complaints.”

People were generally able to communicate verbally about their care, and to discuss if they were happy. Where people were unable to do this their relatives were consulted. People told us “I can assure you I won’t be neglected.” Another said “Staff know us and what we need. …They [staff] listen to you and are prepared to discuss things. We are very happy to just plod along.” There was a lack of activities being offered to people, we have made a recommendation about the provider offering person centred care to people.

People told us they were treated well, and staff showed them respect.

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 10 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Is the service safe, is the service effective, is the service responsive and is the service well led sections of this full report.

Following the inspection, the provider sent us an action plan which detailed how they were to address the shortfalls we found.

You can see what action we have asked the provider to take at the end of this full report.

Please see the action we have told the provider to take at the end of this report.

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.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

White Hill House are not required to have a registered manager in place because they are the sole provider and the registered provider has overall responsibility for the day to day management of the service. Registered persons have been registered with the Care Quality Commission and 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 inspection took place on 12 and 17 July 2017 and was carried out by one inspector. This was unannounced which meant staff and the provider did not know we would be visiting.

People told us they were happy living in the home. One person told us, “I only came here for a short break, that was four years ago”. Another person told us, “It’s not a care home it’s a home.”

A relative we spoke with told us, “It’s very good, dad is happy here and that’s what it’s about.”

Medicines were managed safely staff completed appropriate training and had their competency assessed before they administered medicines. Medicine charts were kept up to date and people received their medicines that had been prescribed by the GP.

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

The service ensured individual risks to people’s health care and welfare had been assessed with risk management plans in place. They were regularly reviewed and updated where changes were evident.

Staff were knowledgeable about the needs of people who lived at the service and what support they required and what they could do for themselves. People were involved in their care and support needs and where appropriate relatives were involved.

Safe recruitment procedures were in place to ensure staff employed were of good character and fit to undertake their role. Staff undertook an induction and on-going training thereafter. Staff we spoke with told us they enjoyed their role and had regular supervisions with the manager. They told us they could raise any concerns at any time and were fully aware of the whistle blowing policy and were confident to raise any concerns to the relevant authority.

Staff were knowledgeable about the Mental Capacity Act 2005 (MCA) and how this applied to their role. However, where people lacked capacity and their liberty was restricted in their best interests, the correct legal procedures had not been followed. We discussed this with the manager of the service who told us this was being addressed.

Feedback received by the service was used to drive improvements. The manager and staff monitored the quality of the service by regularly undertaking a range of audits and discussing any issues with people to ensure they were satisfied with the service they received. There was a complaints procedure in place, people told us they knew how to make a complaint if they needed to but there had been no reason to do this. They told us if something bothered them they would speak to staff in the first instance.

Arrangements were in place for responding to emergencies. Personal evacuation plans in the event of a fire were completed for people living in the home. These were reviewed regularly to ensure they remained up to date.

The provider wrote to us and provided us with an action plan. They informed us they had reviewed the standard of record keeping and put a system in place to regularly monitor people's care records including the food provided and consumed. We were provided with documentation to show weekly audits had been undertaken. We were also supplied documentation to show actions had been taken where any shortfalls in record keeping had been found.

The audits evidenced after six weeks of monitoring there were no further instances of gaps in people's records. This showed people were protected from the risk of unsafe or inappropriate care because accurate and appropriate records were maintained.

People's needs were assessed and the care and support was planned and delivered in line with their individual care plan. The care plans were very individualised and informed of people's individual likes and dislikes and how they wished staff to support them.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

Whilst people were provided with the care and support they required, the provider had not ensured that people were protected against the risk of unsafe or inappropriate care through maintaining an accurate record in respect of each service user's health and support needs.

Activities were provided for those who wished to take part. They included one to one activities and group sessions both within the home and the local community. They were tailored to people's likes and dislikes to ensure their social care needs were met appropriately.

Care plans addressed people's individual needs, were detailed, reviewed and updated regularly. People had access to healthcare professionals and specialist support to ensure they kept healthy and well. The care and support was planned and delivered in line with their care plan.

There were safe established systems in place for the management of medicines and people told us they received their medication on time.

The premises were nicely decorated, comfortable and kept warm. Each person had their own room, which they had personalised to their taste.

People told us they felt safe and they had no concerns about the care and support they received. They found the staff and management approachable and knew who to speak with if they had any concerns.

Daily activities were provided for those who wished to take part. Family and friends were welcomed and invited to occasions celebrated in the home.

Comments we received about the service were very positive. One person said '' It's very nice here the staff are very good and kind they do all I want them to do.'' Another told us ''I have settled in well, I am very happy here.'' A relative told us ''their welcome to everyone is very good. Their level of care is above the call of duty. They truly do care for the residents.''