The White House

Updated 22 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

The White House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and two relatives about their experience of the care provided. We spoke with six members of staff including the registered manager, deputy manager, chef, senior care workers and care workers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We requested and obtained feedback from health and social care professionals who had worked with the service.

Updated 22 July 2021

About the service

The White House is a care home that provides personal care for up to 22 older people. At the time of the inspection 20 people were living at the service. Some of these people were living with dementia. There were five self-contained flats attached to the service. People living in them were supported by the staff team and spent time in the communal areas of the main house if they wished.

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

Risks associated with people's care had been assessed and guidance was in place for staff to follow. A robust specialised risk assessment was completed before a person could move into the self-contained flats connected to the home. This was reviewed frequently to ensure it remained current and the person was able to continue living there safely. Peoples capacity had been assessed regarding the decision to live in the flats and best interest decisions made when required. Applications had been made appropriately to legally deprive people of their liberty. They were reviewed monthly.

Staff were recruited safely. There were sufficient staff employed and on duty to meet people’s needs and keep them safe over a 24-hour period. This allowed for effective monitoring of people’s welfare in the self-contained flats. Staff were very visible during the inspection, anticipating and responding to people’s need for support. A relative told us how a new member of staff had ‘taken the time’ to sing to their family member, telling us, “It’s the little things they do that make the difference.”

There were robust infection control practices in place. However, government guidance had not been fully understood regarding a member of staff unable to wear a mask for health reasons. The registered manager responded immediately to feedback, taking action to ensure peoples safety.

Care plans were detailed, person centred and reviewed frequently with people, and their relatives where appropriate. They gave staff the information they needed to support people safely in line with their individual needs and preferences. The electronic care planning system ensured information about any changes in people’s needs was shared promptly across the staff team.

Relatives spoke highly of the way the home kept them involved and informed about the service and welfare of their family member during lockdown. They could use the ‘relatives gateway’ to access their relatives’ information on the electronic care planning system. This meant they could see and monitor the care being provided in real time and raise concerns if they had any.

People received their medicines safely, and in the way prescribed for them. The provider had good systems to manage safeguarding concerns, accidents and environmental safety. The service worked alongside external health and social care professionals to support people. Safeguarding processes were in place to help protect people from abuse.

The provider and management team had worked to make significant improvements at the service. Feedback from a visiting professional stated, “I have seen significant improvements in the management, communication and professionalism over the last two years.”

A comprehensive quality assurance programme was in place. The management team were highly visible on the floor, supporting staff and monitoring practice. The providers visited the service weekly and attended monthly quality monitoring meetings.

There was a transparent and open culture at the service. Staff spoke highly of the improvements made and the way the service was managed. Comments included “It’s well managed. They listen. They take on what we are saying. It’s not hierarchical. We are all looking out for each other and work really well together.” Staff were supported to keep their knowledge and skills up to date and continue with their professional development.

Rating at the last inspection (and update)

The last rating for the service was Requires Improvement (published on 10 January 2020).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The White House on our website at www.cqc.org.uk.

Why we inspected

We undertook this targeted inspection to follow up on conditions placed on the providers registration. These were imposed following our inspection in May 2019 and related to the self-contained flats attached to the service. At the time of our last inspection in December 2019 the provider had reduced risks to people by not using the flats. However, the flats were in use again and the provider had applied to have the conditions removed.

We inspected and found improvements across the whole service. We therefore widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.