CQC report explained · a residential care home
What the CQC found at The White House Falmouth
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People's care plans, risk assessments and medicines management had improved. However, not all staff had undergone the required pre-employment checks, so the service remained in breach of Regulation 19.
- Effective?
- Requires improvement
- This question was not separately rated in this focused inspection. The report says staff worked with health professionals and people's dietary, mobility and health needs were better understood.
- Caring?
- Good
- This question was not separately rated in this focused inspection. Inspectors found that staff were dedicated, kind and compassionate, and people and relatives spoke positively about the care.
- Responsive?
- Requires improvement
- This question was not separately rated in this focused inspection. Care plans had been updated to reflect people's current needs, although guidance for one person's request for extra mobility support had not yet been developed.
- Well-led?
- Requires improvement
- Leadership had improved with a deputy manager and external support. However, quality assurance systems remained ineffective and daily care records were not consistently completed, so the service remained in breach of Regulation 17.
What inspectors found, April 2023
The White House Falmouth was rated Requires Improvement; safety and leadership had improved, but recruitment checks and care records were still not reliable.
This was an unannounced focused inspection on 20 February 2023. One inspector spoke with five people, one relative, four care staff, the deputy manager and the provider. Records including care plans, medicines records, staff files, rotas and quality checks were reviewed.
There had been important improvements since the previous inspection. Care plans and risk assessments were updated, medicines were managed safely, staffing had improved, fire safety arrangements were better, and the service had made the required applications where people lacked capacity for certain decisions.
However, some recruitment checks were still missing and recruitment records were disorganised. Daily care records were not always completed, and quality assurance systems were still ineffective. These issues meant the home remained in breach of two regulations.
The overall rating was Requires Improvement. Safe was rated Requires Improvement, and Well-led improved from Inadequate to Requires Improvement. The two previous warning notices had been complied with, but the regulator required an action plan and will continue to monitor progress.
Improved care planning
Care plans and risk assessments had been reviewed and now generally reflected people's current needs and risks. Staff said the plans had become more detailed and useful.
“Care plans had been updated since the last inspection and now accurately reflected people's care needs and associated risks.” from the report
Safer medicines
Medicines records were accurately completed, guidance for as-required medicines had improved, and suitable storage had been installed for medicines needing stricter controls.
“At this inspection we found medicines were now safely managed.” from the report
Better staffing arrangements
Two additional night staff had been recruited and agency staff were being booked in advance. Staff were working fewer excessive hours and getting more regular time off.
“This increase in staffing and the appropriate use of regular agency staff, had enabled the dedicated staff team to have more time off.” from the report
Improved leadership
A deputy manager had been appointed and was able to focus on leading the service. Staff understood their roles and recognised that the service was becoming more organised.
“At this inspection the deputy manager was providing effective leadership to the staff team.” from the report
Kind and respectful care
People appeared comfortable and staff were described as kind and compassionate. Relatives were complimentary about the care and people said they felt safe.
“The staff team were dedicated and focused on meeting people's needs.” from the report
Incomplete recruitment checks
seriousSome required information was missing from recruitment files, including previous employment history, references and photographic identification. This meant the home could not always show that new staff were suitable for care work.
“Recruitment records remained disorganised and required information necessary to demonstrate staff were suitable for employment in the care sector was missing.” from the report
Weak quality checks
seriousThe provider's systems for checking the quality and safety of the service were still ineffective. The home had not yet introduced reliable ways to monitor its performance.
“The provider's quality assurance system remained ineffective and accurate daily care records had not been maintained.” from the report
Missing daily care records
needs fixingThere were days when records did not show what support people had received. This makes it harder to confirm that planned care was provided.
“Daily care records had not been consistently completed and there were occasions where no details had been recorded of the support people had received on specific days.” from the report
Fire safety actions still outstanding
needs fixingFire safety had improved and personal evacuation plans were available, but an external assessment had identified further issues. The provider was still developing an action plan to resolve them.
“A number of fire safety issues had been identified and the provider was developing an action plan to address and resolve these issues.” from the report
- 01Have all missing employment histories, references and identity checks now been completed for every staff member?
- 02How do you currently check that daily care records are completed accurately every day?
- 03What quality assurance audits are now in place, and what have they found since the inspection?
- 04Have all the issues identified in the fire risk assessment been resolved?
- 05Are staffing levels now sufficient to cover holidays and other absences without excessive hours or over-reliance on agency staff?
This was a focused follow-up inspection of Safe and Well-led, including infection prevention and control; the other key questions were not separately rated in this report. This explanation was written from the published report of 28 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2023
Overall Requires Improvement; inspectors found caring staff but serious safety and leadership weaknesses, with well-led rated Inadequate.
This was an unannounced focused inspection on 27 September and 10 October 2022. Inspectors spoke with people, relatives, staff, the provider and health and social care professionals. They reviewed care plans, medicines records, staff files, rotas and safety documents.
People and relatives said staff were kind, caring and responsive. Staff knew people well, supported activities and provided food that people liked. Medicines records were accurate, and infection control arrangements were mostly satisfactory.
However, the home was short staffed and some staff worked excessive hours. Checks on newly recruited staff were incomplete, training records were unclear, risks were not properly managed and care plans were out of date. The home also had poor records, weak complaint systems and ineffective quality checks.
The overall rating was Requires Improvement. Safe, Effective and Responsive were also Requires Improvement, while Well-led was Inadequate. The previous overall rating was Good, published on 23 October 2019. The inspection identified breaches of several regulations.
Kind and caring staff
People and relatives spoke positively about staff. Inspectors saw friendly and caring interactions, and people felt able to ask for support.
“The culture of the service was caring and supportive.” from the report
Staff knew people
Although records were poor, established staff had a good understanding of people's needs and responded promptly to requests.
“People received care and treatment from staff who knew them well and had some understanding of their care needs” from the report
Accurate medicines records
Regular medicines were given appropriately, and medicine administration records matched the available records. However, other medicines issues still needed attention.
“MAR Charts had been accurately completed and all medications reviewed, and tallied with records available.” from the report
Activities and family visits
People were supported to join activities and maintain relationships with relatives and friends. Families were able to visit when they wished.
“Visiting by relatives and friends was actively encouraged and people were supported to maintain relationships that were important to them.” from the report
Food and drinks
Staff understood people's food preferences and dietary needs. People were offered drinks regularly and could access them when they wished.
“People's preferences, likes, dislikes, and dietary requirements were understood by the staff team.” from the report
Short staffing and fatigue
seriousThe home was short staffed, and some staff regularly worked excessive hours. Inspectors said this increased the risk of harm and sometimes reduced the time available to support people's independence.
“Working excessive hours with limited opportunities for rest increases the risk people will be harmed.” from the report
Unmanaged safety risks
seriousRisks linked to falls, skin care, weight loss, cleaning materials and fire safety were not managed properly. Fire doors were left unsecured, and personal evacuation plans were missing.
“The provider had failed to manage risks both in relation to people's care needs and the environment of the service.” from the report
Out-of-date care plans
seriousCare plans did not accurately describe people's current needs. This created a particular risk when new or agency staff were providing care.
“People's care plans were inaccurate and out of date.” from the report
Consent and mental capacity
seriousThe provider and staff had limited knowledge of the Mental Capacity Act. People's ability to make specific decisions was not assessed properly, and staff were unaware of some legal conditions.
“The provider had not acted to ensure the rights of people who lacked capacity were protected.” from the report
Weak leadership and records
seriousThere were no managers in post. Records were stored in disorganised piles, quality checks were ineffective and required notifications were not sent to CQC.
“Quality assurance systems were ineffective and had failed to identify the issues identified during the site visit.” from the report
Complaints not followed up
needs fixingThe home did not reliably record or investigate complaints. One relative said a concern had received no response.
“The service did not have systems in place to ensure all complaints received were documented and investigated.” from the report
- 01Who is now responsible for the day-to-day management of the home, and what improvements have been made to leadership?
- 02How many staff are on each shift now, and how do you prevent staff from working excessive hours?
- 03Have all staff, especially recent recruits, had the required checks, training and supervision?
- 04How are current care plans and risk assessments checked and updated when people's needs change?
- 05How are complaints recorded, investigated and answered, and how have the warning notices been addressed?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not separately rated in this report. This explanation was written from the published report of 17 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The White House Falmouth
6 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- April 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2023Requires improvementdown from GoodSafe: Requires improvementWell-led: Inadequate
- October 2019Goodstayed GoodSafe: GoodEffective: GoodResponsive: GoodWell-led: Good
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvement
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- August 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 5 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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10 live-in carers within about two hours of Cornwall
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,200 a week. 8 can care for a couple. 12 years' experience on average.
“He had been a little anxious before she arrived, but has since stated that he would be very happy for her to care for him again”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.