CQC report explained · a residential care home
What the CQC found at White Leaf Support Limited
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found medicines were managed safely, staffing levels were suitable and staff understood how to report abuse, accidents and incidents. Risk assessments supported people's independence while managing risks.
- Effective?
- Good
- Staff had relevant training, supervision and support. People received help with eating, drinking, health appointments and communication, with input from other professionals where needed.
- Caring?
- Good
- Staff were described and observed as kind, respectful and knowledgeable about people's preferences. People and families were involved in care planning and people were supported to make choices.
- Responsive?
- Good
- Care was personalised and reviewed as people's needs changed. People had access to activities, community opportunities and accessible complaints information.
- Well-led?
- Good
- Inspectors found open management, supportive leadership and effective audits. Staff said they could question practice and report concerns.
What inspectors found, September 2018
Rated Good; inspectors found safe, kind and well-managed care, with improvements since the previous inspection.
This was an unannounced inspection on 11 and 13 July 2018. The inspectors spoke with people living at the home, relatives, staff and a social care professional. They reviewed care plans, medicines records, staff training, complaints and quality checks.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found suitable staffing, safe medicines systems, trained staff, personalised support and activities in the home and community.
The home had previously breached regulations about person-centred care, accident records and quality monitoring. Inspectors found these improvements had been made and the home was meeting those regulations at this inspection.
Safe medicines and staffing
Medicines records were in order and audits showed medicines were managed consistently. Staffing was reviewed when people's needs changed, with regular staff used to support continuity.
“Medicine audits showed that staff managed medicines well, consistently and safely.” from the report
Skilled staff
Staff received an induction, training, supervision and appraisals. Training covered areas including safeguarding, autism, epilepsy and food hygiene.
“Staff completed an induction programme which developed over the first 12 weeks of employment.” from the report
Kind and respectful care
People's dignity, privacy and personal preferences were respected. Families and people were involved in decisions about care and support.
“Staff showed kindness and compassion towards the people they supported.” from the report
Personalised communication
The home used communication tools such as pictures, symbols, exchange boards and social stories to help people express themselves and make choices.
“For people with non-verbal communication, the use of exchange boards and picture boards supported an effective way of communication.” from the report
Activities and community life
People were supported to take part in activities based on their interests, including clubs, college, day centres, outings and holidays.
“People were supported and encouraged to have active lifestyles and had access to a range of activities both within the service and in the community.” from the report
Improved quality monitoring
The home had regular audits covering medicines, health and safety, infection control, care planning and risk assessments. Actions were followed up and signed off.
“A robust system of regular audits of the quality of the service was completed and records were kept at the service.” from the report
More activities inside the home
minorOne relative said staff were putting more effort into socialising, but wanted more activities to take place inside the home.
“One relative told us the new staff placed more effort into socialising with people but would like to see more in-house activities take place.” from the report
- 01What activities are currently available inside the home, and how do you respond when someone wants more in-house activities?
- 02How will you support my relative's specific communication needs, including the use of pictures, symbols or other tools?
- 03How do you record and review accidents, incidents and changes in behaviour?
- 04How do you make sure medicines are administered and checked safely?
- 05How will my relative and our family be involved in reviewing the care and risk plans?
This was an unannounced inspection covering the home, the care provided and all five CQC questions, with improvements checked against breaches found at the previous inspection. This explanation was written from the published report of 5 September 2018 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, July 2017
White Leaf Support Limited was rated Requires Improvement; inspectors found kind care and community activities, but serious gaps in medicines, risk management and care records.
This was an unannounced inspection over several days. Inspectors spoke with people using the home, relatives, staff and managers. They observed care and checked care plans, staff files, medicine records and the home's management records.
The home had enough staff and used checks before employing people. Relatives generally felt their family members were safe, and staff understood safeguarding responsibilities. However, medicines records had 41 missing signatures, some risks were not clearly managed, and accidents and incidents were not properly recorded or followed up.
People were treated with kindness and supported to make choices, prepare food and attend activities in the community. But care plans were not always current or personal, communication aids were not in place, some staff training was incomplete, and nutrition and diabetes support were not clearly managed.
The overall rating was Requires Improvement. Caring was rated Good. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. The report found three breaches of regulations and said the provider had to send details of the action it would take.
Kind and respectful care
Inspectors saw people and staff relaxed together. Staff asked for consent and supported people's dignity, choices and independence.
“People received care from staff who respected their dignity and treated them with kindness.” from the report
Community activities
People were supported to take part in social and community activities, including exercise, cinema visits and meals out.
“People were able to attend activities in the community such as FADE club, going to the cinema and going out for meals.” from the report
Staffing and safeguarding
The home had enough staff during the inspection. Staff understood their safeguarding duties, and recruitment included DBS checks.
“The service had sufficient numbers of staff to keep people safe and meet their care needs.” from the report
Choice at mealtimes
People could eat at times that suited them and some people prepared their own meals.
“People were able to have their meals at times that suited them.” from the report
Medicine records
seriousInspectors found 41 missing signatures on medicine administration records. The home did not carry out medicine audits to identify discrepancies.
“We saw a total of 41 missing signatures on medication record charts (MAR) we viewed.” from the report
Diabetes and risk management
seriousOne person's blood glucose checks did not take place for a period because testing strips were unavailable. Guidance about food intake and diabetes was conflicting, and staff could not clearly explain what the person should receive.
“This meant the person was at risk of not having their diabetes managed in line with current guidance and best practice.” from the report
Accidents and incidents
seriousBruising and other incidents were not always explained, reviewed or followed up. Inspectors could not be confident that action had been taken to reduce the risk of recurrence.
“Accidents and incidents were not always recorded or followed up to keep people safe.” from the report
Care records and reviews
needs fixingCare plans and risk assessments were not always current, clear or personalised. Some reviews were overdue and records did not always match the care being provided.
“We did not see that care plans were reviewed on a regular basis or as needs changed.” from the report
Communication support
seriousThe home did not have personalised visual communication tools, such as visual timetables, staff photo rotas or signing systems. This could make it harder for people to express their wishes.
“There was no evidence of alternative communication systems being used with people to aid their communication.” from the report
Quality checks
seriousThe home's audits did not identify problems with care plan reviews or medicine records. Relatives also reported concerns about communication and management.
“The service did not have effective systems to regularly monitor the quality of care people received.” from the report
- 01How are medicine administration records now checked, and how are missing signatures or other errors followed up?
- 02How do you manage diabetes, blood glucose checks, food intake and weight monitoring for people who need this support?
- 03How often are care plans and risk assessments reviewed, and how do you make sure they match each person's current needs?
- 04What personalised communication tools are now available for people who have difficulty communicating?
- 05How are accidents, bruising and incidents recorded, investigated and used to prevent them happening again?
This was an unannounced comprehensive inspection covering Safe, Effective, Caring, Responsive and Well-led, with visits recorded in the report as 12, 13 and 18 April and elsewhere as 12, 13 and 19 April 2017. This explanation was written from the published report of 18 July 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 Leaf Support Limited
3 rated inspections over 2 years: the service has held its Good rating throughout.
- September 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- 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.
- November 2010
Registered with the Care Quality Commission on 11 November 2010.
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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