CQC report explained · a residential care home
What the CQC found at White Hill House Residential Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments were missing or incomplete for the environment, people's health, medicines and night staffing. Fire safety advice had not been followed, fire drills were not regular and an exit was blocked.
- Effective?
- Requires improvement
- People's health needs were not always assessed or explained in care plans. Staff support, supervision and understanding of the Mental Capacity Act were also not consistent.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff listened to people, involved relatives where appropriate and respected people's choices about where to spend their time.
- Responsive?
- Requires improvement
- Care plans covered some needs and communication support was available. However, people reported that there were few activities, and inspectors recommended more person-centred support for interests and daily life.
- Well-led?
- Requires improvement
- Quality checks had not identified important problems. The provider had not notified CQC about two incidents involving injuries, and staff did not receive regular supervision or attend recorded team meetings.
What inspectors found, March 2020
Rated Requires Improvement; inspectors found kind care, but serious safety, consent and management problems.
This was an unannounced inspection on 20 and 21 February 2020. The inspector spoke with people and staff, observed care, and checked care, medicines, staffing and management records.
People said they felt safe and were happy with their care. Inspectors saw respectful and kind care. Food was enjoyed, medicines were stored securely, and people were supported to communicate and make choices.
However, important risks were not properly assessed or managed. These included unsafe areas in the building, blocked fire exits, missed fire drills, night staffing, some medicines, people's health needs and restrictions on leaving the home. Staff checks, supervision, records and quality checks were also not reliable.
The overall rating fell from Good at the previous inspection, published in October 2017, to Requires Improvement. Caring remained Good. Safe, Effective, Responsive and Well-led were rated Requires Improvement.
Kind and respectful care
People said staff knew them, listened to them and treated them with respect. Inspectors observed staff knocking before entering bedrooms and seeking consent.
“People told us they were treated well, and staff showed them respect.” from the report
Secure medicines storage
Medicines were given by trained staff and stored securely. Medication administration records were up to date, although some risk assessments and as-required medicine instructions were missing.
“Medicines were stored securely, and only appropriately trained staff had access to them.” from the report
Food and nutrition
People gave positive feedback about the food. Inspectors saw appetising meals being enjoyed, and records were kept of what people ate.
“From our observations on both days, the food looked appetising and people enjoyed their lunch.” from the report
Recording incidents
Accidents and incidents were recorded and investigated to reduce the chance of problems happening again.
“Accidents and incidents were clearly recorded, and enquiries were undertaken to ensure the risk of repetition was minimised.” from the report
Unsafe environment and fire arrangements
seriousInspectors found trip hazards, risks from falling objects, unclear steps, a blocked fire exit and fire safety advice that had not been acted on. Fire drills were not carried out as often as the home's policy required.
“We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed.” from the report
Restrictions without legal authorisation
seriousPeople were prevented from leaving through a keypad-locked door, and access to the kitchen was restricted. Inspectors found no evidence of the required capacity assessments, best-interest decisions or authorisations.
“There was no documentary evidence people had consented to the key pad.” from the report
Incomplete health and medicines planning
seriousSome people's health needs and medicine-related risks were not covered by suitable care plans or risk assessments. Instructions for medicines prescribed when needed were also missing.
“Care plans and risk assessment were missing for people's health needs.” from the report
Limited activities
needs fixingPeople reported that few activities took place. Staff said domestic chores left them with little time to talk with people or provide activities.
“People told us there weren't many activities happening in the service.” from the report
Weak staff support and oversight
needs fixingSome employment references were not obtained, supervision records were missing and there were no recorded staff meetings. Quality audits had not found the problems identified by inspectors.
“Staff were not receiving support through regular supervision or staff meetings.” from the report
- 01What changes have you made to remove the trip hazards, secure falling objects, mark the steps and keep all fire exits clear?
- 02How do you now check people at night, and what happens if someone becomes unwell or distressed?
- 03Which people have restrictions on leaving the home, and what capacity assessments, best-interest decisions and DoLS authorisations are now in place?
- 04How are each person's health needs and medicine-related risks recorded and kept up to date?
- 05What regular supervision, staff meetings and activities are now provided?
This was an unannounced inspection of the care, premises and management, and the report gives ratings for all five key questions. This explanation was written from the published report of 25 March 2020 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, October 2017
Rated Good overall; inspectors found safe, caring and well-managed support, but the service Requires Improvement in following mental capacity law.
Inspectors visited on 12 and 17 July 2017 without warning. They spoke with people living in the home, staff, the provider, a healthcare professional and a visiting relative. They also reviewed care plans, staff records, medicines, incidents and management records.
People generally said they felt safe and were happy living there. Inspectors found enough staff, safe medicines procedures, suitable risk assessments and proper recruitment checks. Care was kind and personal, and people were supported to make choices, stay independent and take part in activities.
The main shortfall was in the legal process for one person who lacked capacity and was under constant supervision. The home had not applied for the required authorisation or held a best-interest meeting. The provider later told inspectors that an application had been made and was awaiting approval.
The overall rating was Good. Safe, Caring, Responsive and Well-led were rated Good. Effective was rated Requires Improvement because the Mental Capacity Act requirements had not been followed in one person's case.
Safe medicines
Staff who administered medicines were trained and had their competency checked. Inspectors found that medicine records were complete and accurate.
“Medicine administration records were accurate and fully completed.” from the report
Kind, personal care
Staff had built good relationships with people and respected their privacy, dignity, choices and independence.
“Staff supported people in a caring compassionate manner. They were familiar with people's needs and supported them according to their wishes.” from the report
Personalised support
Care plans included people's needs, preferences, life histories and interests. People and, where appropriate, relatives were involved in reviews.
“Care plans we reviewed were personalised and clearly indicated people's individual needs, preferences and wishes.” from the report
Supportive management
Staff described the management as approachable and supportive. The home used audits, feedback and meetings to monitor the service.
“There was an open culture within the service and the provider was keen to receive feedback on the care and services people received.” from the report
Mental capacity and liberty safeguards
needs fixingFor one person who lacked capacity and was under constant supervision, the required legal steps had not been completed. The provider later said an application had been made and was awaiting approval.
“However, the service had not ensured actions were carried out in line with legislation and in the person's best interest.” from the report
Access to shared activities
needs fixingOne person could not leave their room to join activities downstairs because there was no lift or stair lift at the time of the inspection. Inspectors were later told that a stair lift had been fitted.
“However, this does not give the person choice and control in the way they live their life.” from the report
- 01What was the outcome of the application for the required liberty safeguards authorisation?
- 02How do you now record best-interest decisions for people who lack capacity?
- 03When was the stair lift fitted, and can residents use it safely to reach activities and shared areas?
- 04How are care plans reviewed when a person's mental health, mobility or other needs change?
- 05What activities are available for people who prefer individual activities or cannot easily join group activities?
This was an unannounced inspection covering all five key questions and the overall quality of the home. This explanation was written from the published report of 10 October 2017 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 White Hill House Residential Care Home
3 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- March 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at White Hill House Residential Care Home →
- October 2017Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at White Hill House Residential Care Home →
- September 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 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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