CQC report explained · a residential care home
What the CQC found at White Lodge Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2021
White Lodge Care Home is rated Requires Improvement; inspectors found risks, staffing, medicines and management systems needed improvement.
This was a focused inspection on 26 February 2021. Inspectors looked at Safe and Well-led because of concerns about medicines, staffing, falls, moving and handling, leadership and culture. They spoke with people, relatives and staff, observed care, and checked care plans, medicine records, recruitment files and management records.
The home did not always assess risks properly or give staff enough guidance. Concerns included choking, seizures, falls, weight loss, constipation and skin and mobility needs. There were also problems with staffing levels, staff training, recruitment checks and the management of some medicines.
The home was rated Requires Improvement overall. Safe remained Requires Improvement, and Well-led fell from Good to Requires Improvement. The other three areas were not inspected at this visit, so their previous ratings were used in the overall result.
People felt safe
People who could describe their care said they felt safe and well cared for. Relatives also told inspectors that their relatives were safely cared for.
“People we spoke with who were able to tell us about their care told us they felt safe and well-cared for in the home.” from the report
Relatives received communication
Relatives said staff kept them regularly informed about their relative. Visiting had been restricted during the pandemic.
“People's relatives told us their relatives were safely cared for in the home and they had regular communication about their relative from staff.” from the report
Medicine storage
Medicines were stored safely and storage temperatures were checked. Inspectors also observed a calm and appropriate medicine round.
“Medicines were stored safely, and storage temperature was monitored.” from the report
Healthcare links
The home used video consultations and made referrals to healthcare professionals when needed.
“Records showed referrals were made to other healthcare professionals when required.” from the report
People's feedback was analysed
The home collected feedback from people and identified actions for improvement.
“We saw feedback from people had been collated and analysed.” from the report
Incomplete risk planning
seriousImportant risks were not always assessed or covered by clear care plans. This included choking, seizures, falls, nutrition and constipation, leaving people at risk of harm.
“The failure to assess risks to the health and safety of service users and to do all that is reasonably practicable to mitigate those risks placed people at risk of harm.” from the report
Staffing and skills
seriousThere was no effective tool in use to calculate staffing needs. At times only two care staff were available for 20 people, and not all night staff were trained and checked as competent to give medicines.
“The failure to ensure enough suitably qualified, competent, skilled and experienced staff at all times was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Medicine administration
seriousSome creams and other external medicines were not given as prescribed. Guidance and monitoring for variable-dose medicine and some as-required medicines were also incomplete.
“The failure to ensure the safe and proper management of medicines was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Weak quality checks
seriousAudits did not identify or act on important care, staffing and medicine problems. Some action plans did not say who would act or when work would be completed.
“The provider had failed to operate an effective system to assess monitor improve and mitigate risks to the health, safety and welfare of people using the service.” from the report
Recruitment records
seriousTwo of three staff files checked did not contain a full employment history or explanations for gaps.
“We found two of the three staff recruitment files we reviewed did not contain a full employment history or an explanation of gaps in employment.” from the report
Visiting arrangements
needs fixingThe home had stopped most visits during lockdown and had not followed its own risk assessment process or done everything possible to enable visits under government guidance. CQC recommended that current visiting guidance be followed.
“We recommend the provider always implements current guidance on visiting.” from the report
- 01What action have you taken to ensure every person's risks from choking, seizures, falls, nutrition and constipation are assessed and clearly recorded?
- 02How do you now calculate the number and skills of staff needed on each shift, especially when people need two staff or may need urgent medicines?
- 03What checks now confirm that creams and other medicines are given as prescribed, and that variable-dose and as-required medicines are monitored properly?
- 04How have you improved audits so that problems are identified, allocated to a named person and completed by a clear date?
- 05What is your current visiting policy, and how do you make sure visits follow current guidance?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 24 April 2021 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 2020
Rated Good overall; inspectors found kind, effective care, but the Safe rating remained Requires Improvement because some risk records were out of date.
This was an unannounced inspection on 17 and 21 January 2020. Inspectors spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and management records.
People and relatives described the care as safe and staff as kind. Medicines were managed safely, staff were trained, people's health needs were supported, and food and activities were well regarded.
The main shortfall was that some risk assessments and care plans had not been updated after people's needs changed or after incidents. Some required recruitment checks were also incomplete. The home had started work to address these issues.
The home was rated Good overall. Effective, Caring, Responsive and Well-led were rated Good. Safe remained Requires Improvement. The previous overall rating was Requires Improvement, and the earlier breach of regulation had been resolved.
Kind and respectful care
People, relatives and inspectors described caring staff. Staff were observed supporting people patiently and respectfully.
“People and relatives told us the service provided safe care and staff were kind and caring.” from the report
Skilled staff
Staff completed required training and additional training for people's individual needs. People and relatives said staff had the skills and experience to provide care.
“People and their relatives told us they received care from staff with the skills and experience to meet their needs.” from the report
Food and nutrition
People spoke highly of the food. The chef catered for different textures, portion sizes, dietary needs and personal preferences.
“People and relatives all spoke highly of the food on offer.” from the report
Personal choices
People could make choices about food, activities, clothing, routines and where they spent their time. The home also acted on individual requests.
“The service had a 'let's make it happen' scheme, this initiative attempted to meet people's requests and wishes.” from the report
Out-of-date risk records
seriousSome risk assessments and care plans were not updated after incidents or changes in people's needs. This included risks linked to bed rails, leaving the home and falls.
“We found risk assessments had not always been updated to reflect people's changed needs or following an incident.” from the report
Incomplete recruitment checks
needs fixingApplicants had not always been asked for their full employment history. The home took action during the inspection by asking current staff to provide this information.
“Not all the required checks were in place to ensure people were protected from the employment of unsuitable staff.” from the report
Staffing levels not formally calculated
needs fixingSome people and relatives felt there were sometimes too few staff. No one said their needs were unmet, but the home did not yet have a dependency-based tool to calculate staffing levels.
“They told us they would implement this tool to check staffing levels were appropriate.” from the report
Cleaning on the first day
minorSome areas were not clean on the first day because the cleaner was absent and care staff cleaned when they had time. The home was clean on the second day.
“On the first day of our inspection we noted not all areas of the home were clean” from the report
- 01Have all risk assessments and care plans now been reviewed after incidents and changes in people's needs?
- 02How do you make sure full employment histories and any gaps are checked before staff start work?
- 03Have you introduced the tool for calculating staffing levels according to people's dependency needs?
- 04Who is the registered manager now, and how was continuity maintained while there was no registered manager?
- 05What progress has been made with making the environment more dementia friendly?
This was an inspection of the whole care home and all five CQC questions, including both the premises and the care provided. This explanation was written from the published report of 29 February 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.
Every inspection of White Lodge Care Home
5 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- April 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2020Goodup from Requires improvementSafe: Requires improvementWell-led: Good
- January 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2018Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Registered with the Care Quality Commission on 5 August 2014.
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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