White House Home Care Services Limited received an overall rating of Requires Improvement for the third consecutive inspection, with continuing regulatory breaches in recruitment (Regulation 19), person-centred care planning (Regulation 9), and good governance (Regulation 17). The service demonstrated genuine strength in its caring approach, with staff consistently praised by people and relatives, but systemic failures in oversight, record-keeping, supervision, and care plan completeness remained unresolved.
Concerns (9)
criticalStaffing levels: “The provider and registered manager had not requested any references or completed a DBS check for them. There was no evidence they had checked they had the qualifications, competence, skills or experience”
criticalGovernance: “Systems and processes were not established or operated effectively to assess, monitor and improve the quality and safety of the service.”
criticalCare planning: “there was no information about how one person's health condition meant some days they required more support than others and how their health condition affected them”
criticalRecord keeping: “a relative and staff informed us one person's care plan had been missing from their home for approximately one year”
moderateSupervision / appraisal: “The registered manager did not provide and document a record of staff supervision...two staff told us they did not feel supported.”
moderateConsent / capacity: “there was no written documentation for people to sign consent to their care records...no system to document how consent would be obtained where people may lack capacity”
moderateIncident learning: “Two people had falls recorded in the accident and incident folder. However, falls risk assessments had failed to be implemented following this.”
moderateLeadership: “Some staff felt they were not approachable...A member of staff said, 'I just don't think we are looked after properly.'”
moderatePerson-centred care: “there was also no information about people's current circumstances or life history, which is important so staff can have meaningful conversations”
Strengths
· Staff were consistently described as kind, caring and compassionate by people and relatives, with comments such as 'exceptional' and 'superb'.
· People received their medicines safely and staff supported them to manage medications with appropriate MAR records.
· Staff had good awareness of safeguarding and how to recognise and report concerns.
· Staff promoted people's independence and respected their privacy and dignity.
· Staffing levels were sufficient to meet current needs and agency cover was arranged for absences.
Quality-Statement breakdown (15)
safe: Recruitment proceduresRequires improvement
safe: Medicines managementGood
safe: SafeguardingGood
safe: Staffing levelsGood
effective: Staff supervision and appraisalRequires improvement
effective: Consent and Mental Capacity ActRequires improvement
effective: Staff training and skillsGood
effective: Nutrition and healthcare supportGood
caring: Dignity, respect and privacyGood
caring: Promoting independenceGood
responsive: Person-centred care planningRequires improvement
responsive: Complaints handlingGood
well-led: Quality assurance and auditingRequires improvement
well-led: Incident learning and improvementRequires improvement
well-led: Leadership and staff supportRequires improvement
White House Home Care Services Limited was rated Requires Improvement overall following inspection on 19–24 July 2017, with breaches of Regulations 9, 17 and 19 identified relating to inadequate care planning, ineffective quality monitoring and unsafe recruitment practices. The service demonstrated genuine strengths in its caring culture, safeguarding awareness and staff support, but must address systemic gaps in documentation and governance to achieve compliance.
Concerns (7)
criticalStaffing levels: “Out of the six staff files we looked at, three people did not have references and two people had one reference, one of which was returned after their start date.”
criticalRecord keeping: “Disclosure and barring service (DBS) checks had been completed...However, two of these had been returned after the start date and there was no record that a holding check had been completed.”
criticalCare planning: “The assessments and task sheets were very basic and did not provide full information about people's needs nor full guidance for staff in how to support people in line with their preferences.”
criticalGovernance: “Several medicines administration record audits had failed to identify inconsistencies in the use codes used by staff or relatives when people had their medicines omitted.”
criticalIncident learning: “Not having a quality monitoring system that was effective in highlighting shortfalls, so they could be addressed in a timely way, was a breach of regulation 17 (good governance).”
moderatePerson-centred care: “One person's task sheet indicated staff were to 'make a meal'...'encourage [name] to assist with food preparation'. None of the tasks described how they were to be completed or what the person's preferences were.”
minorMedication management: “There was a minor issue with confusion over codes when medicines were omitted. This was mentioned to the registered manager to address.”
Strengths
· People told us staff were professional, friendly and listened to them; staff respected privacy and dignity and delivered personal care in ways people preferred.
· Staff knew how to safeguard people from the risk of harm and abuse and knew how to report concerns to appropriate authorities.
· An electronic monitoring system was in place to log staff arrival and departure times, helping to minimise missed calls.
· Staff monitored people's health and nutritional needs and contacted health professionals on people's behalf when required.
· Staff had access to training, supervision and support and described management as open, supportive and approachable.
White House Home Care Services Limited achieved a Good rating across all five key questions at this inspection, having improved from Requires Improvement at the previous inspection and remedied all prior regulatory breaches. Minor issues remained around the absence of a formal supervision and spot-check schedule, unsigned MAR entries, and a missing medicines risk assessment, but none constituted a breach of regulation.
Concerns (4)
minorSupervision / appraisal: “we found there was no supervision or spot check schedule to ensure these were carried out at regular intervals.”
minorMedication management: “Where the service had produced their own MARs some information about people's medicines had not been signed by staff to show it was correct and accurate.”
minorMedication management: “One person was receiving blood thinning medicine. There was no risk assessment in place to guide staff on how to manage the possible side effects of this medicine.”
minorCare planning: “it was not obvious from people's care records when and who had been involved with the review and if they had agreed to the care plan.”
Strengths
· Thorough recruitment checks including DBS, references and employment gap exploration ensured only suitable staff were employed.
· People were regularly supported by the same care worker, providing continuity of care appreciated by service users.
· Staff received safeguarding training and were aware of signs of abuse and their reporting responsibilities.
· Risks to people's safety were assessed and preventative measures put in place, including environmental and equipment-related risks.
· Staff completed a variety of training including e-learning and face-to-face practical subjects such as moving and handling.
White House Home Care Services Limited was rated Requires Improvement overall at its first inspection, with breaches of Regulation 16 (failure to notify CQC of deaths) and Regulation 17 (absence of quality assurance audits and governance systems). Caring and responsive practice by frontline staff was a notable strength, but gaps in staff training, recruitment records, supervision documentation and business continuity planning required urgent remediation.
Concerns (6)
criticalGovernance: “We found no systems in place to monitor and improve the quality of the service and no evidence of audits to drive continual improvement.”
criticalIncident learning: “They had provided some end of life care to several people who had passed away and confirmed they had not submitted any statutory notifications to CQC.”
moderateStaff training: “We found there was a lack of training in specific areas such as first aid, infection control and food safety.”
moderateSupervision / appraisal: “We were unable to see any supervision records held with staff at the service in the last year.”
moderateRecord keeping: “We saw no evidence of references in any of the staff files we checked, which did not follow the registered provider's recruitment and selection policy.”
moderateInfection control: “None of the staff had received infection control training to assist in maintaining good infection prevention and control.”
Strengths
· People told us calls were made on time and staff communicated proactively about any delays.
· Staff had completed safeguarding training and understood signs of abuse and how to report concerns.
· Personalised risk assessments were in place for each person and regularly reviewed.
· Medicines Administration Records were completed accurately with no gaps in recording.
· People were treated with dignity and respect; positive, caring relationships observed between staff and people.
caring: Communication and information
Good
responsive: Assessment and care planningRequires improvement
responsive: Complaints handlingGood
well-led: Quality monitoring and governanceRequires improvement