This inspection took place on 15 and 20 June 2016, and was unannounced. The White House residential home provides accommodation and personal care for up to 33 people. At the time of our inspection there were 29 people using the service.
There had not been a registered manager in post for four months. 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. The current deputy manager in post had made an application to become the registered manager, and this was being processed.
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
During this inspection, we found that the registered provider was in breach of four regulations 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.
The provider had not ensured that people were receiving safe and effective care provided by sufficient numbers of skilled and knowledgeable staff. Staffing levels were not always adequate to ensure that people were kept safe at all times. People did not always receive the time and attention they needed to fully meet their needs. At times care was task focussed and hurried with staff unable to respond to people as quickly as they would like.
There were gaps in how the service assessed and monitored the quality of its provision. While there were some quality assurance mechanisms in place, these had proved ineffective at identifying areas for improvement, and not all aspects of the service were being effectively monitored. Where issues were identified, such as equipment which was faulty and the need to increase staffing levels, action had not been taken promptly. The provider did not have robust oversight of the service's operations.
Risk assessments were completed to ensure that people were kept safe. These included risk assessments in relation to people's personal care, moving and handling and medicines. However, we found that the level of information held was not consistent across the service, and this meant that staff did not always have up-to-date and clear guidance to help them support people safely.
Care plans for people were not always reviewed or reflective of people’s current needs. Information held in people’s care plans was not consistent across the service and there was a risk that staff did not have the most appropriate information to enable them to tailor the care they provided to people.
Infection control procedures and audits were not effective, and did not identify the issues we found.
Activity provision was not sufficient to meet the individual needs of people using the service.
Staff were trained in areas relevant to their role, however, the induction for newly recruited staff was not robust enough to ensure they felt confident to do their job and care for people safely. Staff supervision was not routinely provided, which supports staff to improve their practice.
Whilst staff worked within the principles of the Mental Capacity Act 2005 (MCA), some MCA assessments and DoLS [Deprivation of Liberty Safeguards] authorisations were out of date and had not been renewed.
Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse, and who they should report this to.
Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.
People’s medicines were administered and stored safely.
People’s individual needs were not met by the adaptation, design or decoration of the service, which could compromise the ability of people moving around the service independently. We have made a recommendation about how accommodation can be adapted to meet people’s needs more effectively.
The dining experience was not conducive to an enjoyable mealtime and did not give opportunity for social interactions. We have made a recommendation about improving the dining experience for people.
People and relatives said if they needed to make a complaint they would know how to. There was a complaints procedure in place for people to access if they needed to. However, complaints and feedback received were not comprehensively recorded or used routinely as an opportunity to learn and improve.