The White House Care Home

The White House Care Home is a residential care home providing personal care for up to 34 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection there were 30 people using the service.

The White House is an older style property based near the centre of Bodmin. Accommodation is spread over 3 floors.

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

There were enough staff to support people safely. Staff were unhurried in their approach and responded to call bells quickly. The registered manager was proactive in their approach to recruitment; for example, they had sourced accommodation for new employees moving into the area.

People received medicines safely and as prescribed. Staff administering medicines had received training which was regularly refreshed. Competency assessments were completed to ensure staff continued to follow good working practice when administering medicines.

Staff were aware if people were at risk due to their health condition. Risk assessments contained guidance on how to minimise risks. Where necessary external health care professionals worked with the service to help ensure people’s health was safely monitored and action taken to support people appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager was supported in the service by two deputy managers. All were visible in the service and worked alongside staff as needed. This meant they were aware of the culture of the service and able to check staff reflected their values.

There were systems in place to gather people’s feedback. Although there was no formal system for gathering relative’s feedback there was a suggestion book in the foyer. Managers told us they spoke with relatives regularly.

The provider's operations director visited the service regularly. They completed audits covering all aspects of the management of the service. Action plans were then developed to help drive improvement. In addition, they spoke to residents and completed dining room observations. This meant people’s experience of living at The White House was captured.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 11 August 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

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, which will help inform when we next inspect.

The White House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The White House accommodated up to 34 people, and the service had no vacancies at the time of the inspection.

The service had a registered manager. 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 service was viewed by people we spoke with as very caring. We received positive comments about the service about the attitudes of staff. For example we were told, “Staff are very good,” and “kind.” A relative told us, “I am extremely pleased. (My relative) has said it is really, really nice being here. All the staff are kind and friendly.”

People told us they felt safe. A relative told us: “Yes I think it is most definitely safe.” and an external professional told us: “The home has always felt safe, and all the care I have witnessed has never caused me concern.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. The service had a suitable recruitment procedure, and appropriate checks were carried out on new staff to ensure they were suitable to work with vulnerable people. Staff were suitably trained. Staff received a comprehensive induction when they started to work at the service, and they received regular supervision to provide them with feedback and guidance about their work.

The medicines’ system was well managed, medicines were stored securely, and comprehensive records were kept regarding receipt, administration, and disposal of medicines. Staff who administered medicines received suitable training.

The service was exceptionally clean and hygienic. Relatives told us, “It is clean and tidy,” and “General cleaning is very good. My relatives en suite is cleaned daily.” The building was well decorated, well maintained and well furnished.

Assessment processes, before someone moves into the service are comprehensive. These assisted in helping staff to develop detailed care plans. The managers and staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.

People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard, although we did witness some delays when food was initially served. Meal times were very well organised, and were a sociable occasion. Comments about food included, “It is very nice,” “Excellent,” although some people made less positive comments such as “It is nothing special but I get enough to eat.”

The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. External professionals were very positive about the standards at The White House. For example we were told, ““We have a good relationship with the home,” and, “The White House is proficient in continuing with recommended treatment and rehabilitation. They strive to give people as much independence as possible.”

Some people lacked capacity due to their dementia. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. No physical restraint techniques were used at the service. Staff had received suitable training about mental capacity.

Everyone we saw looked well cared for. People were clean and well dressed. People told us, “Staff are very good. They are kind,” “Wonderful,” and “They do their best.” We observed staff working in a caring and respectful manner, respecting people’s privacy and dignity. A relative said, “I have always been very impressed with the staff and the kindness and service they provide. They are kind, considerate and practical, providing a happy and outgoing attitude at all times.”

The service had a comprehensive activities programme. Activities included external entertainers, trips out, baking and arts and crafts.

The registered manager, and the management team were well respected by people, relatives, staff and external professionals. Relatives described the manangement team as, “Surpass(ing) my expectations.” Staff commented “They are ideal,” and “They are good.” External professionals commented “The manager is always so efficient and responds as quickly as possible to my requests,” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.

There was a suitable quality assurance system in place. An annual survey was completed, and the results of this were positive. The managers had a hands on approach, and had a comprehensive system of checks and audits in place.

Relatives said communications were good between the service and them. They said they were always informed and consulted about their relative’s care. We were told “They always keep us up to date, for example if (my relative) falls or is ill. Communication is very healthy. I do not feel left out of the loop.”

The White House Care Home, known locally as The White House provides care and accommodation for up to 34 people who are living with old age, dementia, mental health issues or physical disabilities. Accommodation is provided over three floors, most rooms are en-suite and there are also shared lounges and dining areas. There are spacious gardens surrounding the building. At the time of the inspection the service was full and there were a number of people with their names on a waiting list.

The White House has a registered manager 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.

We observed consistently positive, warm and caring interactions between people and staff. Staff took the time to stop and chat with people to make them feel involved and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection. One staff member said; “I love it here. The people are the best bit”. Staff creatively used specialist and personalised communication skills to interact with people and make them feel part of what was happening. The registered manager was committed to sharing best practice and finding innovative ways to promote the rights of those living with dementia.

People’s care plans were highly detailed documents which contained information about their background, history, like and dislikes. Staff confirmed that the care plans contained the correct guidance and information in order to support people and provide high quality, personalised care. Life story books had also been developed to help staff to know and understand the people they care for. Staff referred to these and used them to assist them in communicating and engaging with people.

People enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people told us they had their medicines as prescribed and on time. People were supported to see a range of healthcare professionals including district nurses, chiropodists, doctors and social workers.

People were kept cognitively and socially engaged through a range of activities, both inside the service and in the local community. There was something on offer each day. People were involved in planning the activities and the atmosphere at the service whilst activities were being undertaken was pleasant and vibrant.

People were kept safe by suitable staffing levels. People told us there were enough staff on duty. This meant that people’s needs were met in a timely manner. Interactions between people and staff were unhurried. Staff recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff had sufficient training to carry out their roles effectively. Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. Staff were supported by a comprehensive induction and there was an ongoing programme of supervision, competency checks and appraisals.

Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, process ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal processes had been followed. People were involved in planning their care and staff sought their consent prior to providing them with assistance.

There was a safeguarding adults policy in place at the service and staff had undergone training on this subject. Staff confidently described how they would recognise and report any signs of abuse, including which external agencies they would contact if required. There were policies in place around the duty of candour and whistleblowing which staff were aware of and applied to their practice. This encouraged an ethos of openness and honesty.

People, staff and relatives were encouraged to give feedback through a variety of forums including team meetings, residents’ meetings and questionnaires. This feedback was used to drive improvements within the service. There was a system in place for receiving and managing complaints. People and relatives said they felt confident that if they raised concerns these would be dealt with appropriately. There was an effective quality assurance system in place with a range of audits including, medicines, call bell answering times and staff and resident satisfaction.

We spent time with the registered manager and two staff. We reviewed the records for seven people who used the service and checked the medicine records to reach our judgement.

We found people's care needs had been assessed and care and treatment was planned and delivered in line with their individual care plan.

We found people received their prescribed medicines at the appropriate time.

We found the White House had reviewed their record keeping procedures. Care records we reviewed were clear and concise, and had been reviewed to take account of any changes in people's needs. Accidents and incidents were recorded in accordance with the Date Protection Act 1998.

We found people expressed their views and were involved in making decisions about their care and treatment. Observation during the inspection showed staff supporting people to make their own choices.

People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided.

We found people were not protected from the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found there were enough qualified, skilled and experienced staff to meet people's needs at the White house.

We found complaints were responded to appropriately and in a timely manner.

We found records were not always kept accurately, reviewed or monitored in order to identify any issues or concerns.

People expressed their views and were involved in making decisions about their care and treatment. Observation during the inspection showed staff supporting people to make their own choices.

People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We saw that staff had received most mandatory training. Formal supervision of staff was ongoing. Annual appraisals were underway with a view to being completed by the end of June 2013.