This comprehensive inspection carried out by one inspector, commenced on 3 September 2018 and ended on 6 September 2018. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and people with physical disabilities.
Not everyone using White House Care Services Ltd receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 14 people were receiving a regulated activity.
A registered manager was in post. 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.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. However, during this inspection, we found they continued to require improvement. This is the third consecutive time the service has been rated requires improvement.
At the last inspection, we found concerns with three areas in the service. These were recruitment processes, the planning of person-centred care and monitoring the quality of the service. Despite some improvements, we found the provider continued to be non-compliant in these areas.
Some steps had been taken by the provider to ensure their recruitment procedures ensured people employed where of good character and had the necessary skills and competence, to carry out their role. However, they failed to carry out any of these checks on the volunteer, who was managing the service whilst they were away from the service. We continued to find some gaps in staff recruitment files, including a missing reference for one staff member and a missing interview record for another.
People had care plans in place and task sheets, which provided information to staff about the things they required support with. The provider had made some improvement to these, since the last inspection about people’s preferred routine and included some of their basic likes and dislikes. However, there was minimal information about people’s life history and important information about people’s health and communication needs were missing. Despite this, staff were able to tell us how they provided person-centred care and people confirmed this.
There was a quality monitoring system, which consisted of audits and checks in some areas, but these did not always lead to improvement being made. There were no audits on care records or recruitment and staff files, which led to shortfalls in the above areas being unidentified by the provider. There was no system in place to collate and analyse people’s views to improve the quality of people’s experiences. Accidents and incidents were recorded, but action was not always taken to prevent similar incidents reoccurring. Some staff told us the manager was unapproachable and one person praised the care and support from staff, but told us they felt the service was not well-led.
People told us staff sought their consent verbally before providing care and support and staff were aware of the importance of this. However, there was no record of people signing consent to their care plans. Following the inspection, the registered manager showed us how they would record people's agreement to their care plan. Staff had awareness of the MCA, but there was no system for recording consent if people lacked capacity.
You can see what action we have asked the provider to take in response to the above concerns at the back of the full version of the report.
We also found further shortfalls, which the quality assurance system had failed to identify, including staff support. The registered manager did not provide recorded supervisions for staff. We made a recommendation on this.
The service had a small staff team, which was sufficient to meet the current needs of people who used the service. Staff were knowledgeable about safeguarding and how to recognise signs of abuse to protect people from harm.
Staff were equipped with the necessary skills to provide effective support. They supported people to manage their medicines safely, as well as supporting them to meet their nutritional needs and healthcare needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to maintain their independence and their privacy and dignity were respected. People were complimentary about staff and said they were kind and caring.
There was a complaints procedure in place. None had been received and people told us they would know how to raise one if required.