We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The White House Maidstone Road, Chatham, ME4 6HY Tel: Date of Inspection: 13 May 2014 Date of Publication: August 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Safeguarding people who use services from abuse Cleanliness and infection control Supporting workers Assessing and monitoring the quality of service provision Records Met this standard Met this standard Action needed Action needed Action needed Action needed Action needed Inspection Report The White House August

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Mrs Lynn Nicolaou & Mr Christos Adamou Nicolaou Mr Christos Adamou Nicolaou The White House is a residential home providing care and support for older people including those with dementia. The home has single and a limited number of double rooms. There are some rooms available with en-suit facilities. It is close the Chatham and has good bus links with the town, and has off road parking. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report The White House August

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 What we have told the provider to do 6 More information about the provider 6 Our judgements for each standard inspected: Respecting and involving people who use services 7 Care and welfare of people who use services 9 Safeguarding people who use services from abuse 11 Cleanliness and infection control 13 Supporting workers 15 Assessing and monitoring the quality of service provision 17 Records 19 Information primarily for the provider: Action we have told the provider to take 21 About CQC Inspections 23 How we define our judgements 24 Glossary of terms we use in this report 26 Contact us 28 Inspection Report The White House August

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 13 May 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff and reviewed information given to us by the provider. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. What people told us and what we found Two inspectors visited the home, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and a visiting relative, the staff and from looking at records. We also used a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care which helped us understand the experience of people who could not talk with us. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; -Is the service safe? CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke to four staff about their understanding DoLS, however, it was apparent that staff did not fully understand what DoLS was and their responsibility regarding the Mental Capacity Act We saw that not all staff had been trained in DoLS, Mental Capacity Act 2005 and safeguarding of vulnerable adults. We were told these trainings had been booked. Although one member of staff believed one best interest meeting had been held, we found that people's mental capacity had not been assessed and no best interest meetings had been held according to legal requirements. We found risk assessments on the files viewed but these were not comprehensive. The instructions for staff to minimise risk was seen in the plan of care. Although there was no review dates Inspection Report The White House August

5 on care plans, they were reviewed monthly. - Is the service effective? People's health and care needs were assessed, and families were involved in writing their relatives care plans. Care plans had been reviewed regularly however information in people's plans was not always up to date. Care plans were therefore not able to support staff consistently to meet people's needs. Staff we spoke with confirmed that people's visitors were able to see relatives in private and that visiting times were flexible. There was a key worker system at the home. Staff were personally responsible for individual people who lived in the home. They liaised with people's families keeping them informed of people's wellbeing. - Is the service caring? We found that people who lived in The White House Residential Home were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. However, we did find that staff gave more time to people who were able to communicate. We saw that staff helped people with their care and support, at mealtimes and during activities with patience and kindness. One person who lived at the home said "Love helping staff here, staff do a wonderful job, can't find fault with them, always helpful". - Is the service responsive? People had access to daily activities that included quizzes, singing, exercises and reminiscence. We saw evidence during our visit that the home involved other health professionals when people became unwell; they also informed the respective families. Staff had adapted the provision of care to people's changing in needs. However, we found that care plans did not reflect the changes in care in a timely way. - Is the service well-led? People and their relatives or representatives were consulted about how the service was run, annual survey questionnaires were sent and analysed. Staff told us they were able and encouraged to express their views and concerns they may have and were listened to. We found that policies and procedures were out of date and not easily available to staff. They did not all reflect changes in legislation; we were told that the policies and procedures were being reviewed. However, many were up to six years out of date and they did not address every aspect of the service. This meant that staff did not have access to accurate up to date information when needed. The manager/provider operated a system of quality assurance and completed an audit to identify how to improve the service. However, the audits failed to show that staff had not received regular supervision or that staff had not undertaken the required training and updates. This meant that the system was not robust and failed to identify areas where improvement was necessary Inspection Report The White House August

6 You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 04 September 2014, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report The White House August

7 Our judgements for each standard inspected Respecting and involving people who use services Met this standard People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Reasons for our judgement People's privacy, dignity and independence were respected. We observed care and support throughout our visit, spoke to people who lived in the home and staff about how people's care was provided to protect people's privacy and dignity. We also used a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care which helped us understand the experience of people who could not talk with us. We saw that people had been encouraged to bring in their own items to personalise their rooms. We found that many of the people in the home had dementia, and were unable to make important decisions for themselves. Most people were unable to make decisions about their care and treatment, and had a next of kin or representative to speak on their behalf. We observed that staff spoke kindly to people and treated them with respect. They were addressed by their name of choice, and this showed respect for their individuality. We spoke with three members of staff about how they had protected people's privacy, dignity and independence. Each staff member was able to explain how they had done this and gave examples of the care needs of people who lived in the home. For example a staff member said, "I always keep people covered as much as possible when assisting them to wash and I make sure the door is closed. I make sure I encourage the person to do what they can do for themselves and ask them to choose what they want to wear". We noticed that the staff asked people for permission before they carried out any care practices, such as asking if they could help them to the toilet, or helping them to take a drink. As some people were unable to converse clearly with us due to their dementia, we spent time observing people using SOFI. This enabled us to determine the way staff interacted with the people who lived in the home. We saw that staff asked people with dementia about what they wanted to do or where they wanted to go, involved the person as much as possible. For example, we saw staff supported people to drink hot drinks, engage in Inspection Report The White House August

8 crossword puzzles, and chat. We observed that staff supported people to leave their room to use the toilet and saw people discreetly being asked if they needed the toilet and help was offered. Staff respected people's wishes if they said they did not want to use the toilet. Staff were seen to ask people before they assisted them with their care and support. Staff were generally attentive and helped people who needed assistance. The provider may wish to note we found that staff had more time for people who could communicate more easily. We saw an example where a person's body language clearly showed they were looking to interact with staff several times but the staff walked past and did not respond; the person gave up and went to sleep. This meant that some staff had not accommodated people who could not communicate as much as they accommodated those that were able to communicate, hence not fully meeting their communication needs. A visitor to the home told us that they visited regularly, they told us, "people here seem to be well looked after, the staff are very kind and are always helpful". Inspection Report The White House August

9 Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at four care plans for people who lived at The White House Residential Home. We did not find a comprehensive assessment of need, however we found that people's needs were identified in the person care plan. The care plans reflected individual care needs and instructed staff how care and support was to be provided to individuals. We were told that all care plans were reviewed on a monthly basis or sooner if required. We saw reviews had taken place and staff spoken with confirmed that any changes were communicated. The deputy manager explained that significant changes in people's wellbeing was communicated to people's families or representatives straight away and a summary of the previous months care was made available to people's relatives each month. This showed that people and their families/representatives were involved in people care and kept informed of changes. Care plans were developed according to people's needs and included, medical needs, nutrition, continence, personal care, mobility, and social needs. Each file included people's wishes regarding how they wished to be known. We found that risk assessments included people's mental health and cognition, falls, bathing, medication and moving and handling. Where risks had been identified the management strategy instructed staff about how to reduce the risk. We found risk assessments on the files viewed but these were not comprehensive. Risk assessments were reviewed regularly, and staff spoken with were aware of peoples risks. This meant people's assessed needs included possible risks and staff had the information to protect their welfare and safety. We saw that people who used the service were weighed regularly and that weight fluctuations were noted and acted upon. We found that food and fluid intake were appropriately logged and that special diet requirements were respected. This meant that the manager/provider made reasonable adjustments in service provision to meet people's Inspection Report The White House August

10 individual needs. We observed people and staff who participated in crossword puzzles, chatting, and music was playing on the CD player. During the afternoon a dog from PAT A Dog scheme visited, the dog and his owner were regular visitors to the home. It was apparent that the people who lived in the home knew the dog well and enjoyed the visit. One person who lived at the home said that they wished there was more happening during the day as they get bored. Another person who lived at the home said "Not many activities" "We are lazy we sit and drink tea". We asked the staff if there was a programme of activities they said there was but this was not displayed. Inspection Report The White House August

11 Safeguarding people who use services from abuse Action needed People should be protected from abuse and staff should respect their human rights Our judgement The provider was not meeting this standard. People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There was a safeguarding adult protection policy in place. We noted that this had not been reviewed. There was no up to date copy of the local authority safeguarding protocols which detailed what actions to be taken by the manager/provider to help keep vulnerable adults safe. This meant that the manager/provider had not ensured staff had the up to date procedures involved in raising concerns about the possible abuse or neglect of vulnerable adults. We spoke with four staff about their knowledge and understanding of how to keep vulnerable adults safe. The staff spoken with had different views on what constituted abuse and who they should contact if they had any concerns about people who used the service being abused. For example, we gave staff a scenario, 'You hear another staff member shouting at a person who lives in the home', they were asked if this was abuse and what would they do? One staff member said, "I would talk to the member of staff, I would not report it". Another staff member said, "If I heard people shouting at residents then I would tell them not to shout, it is not fair to shout it is abuse". This showed that some staff were not aware of safeguarding adult reporting protocol. Staff spoken with told us they had undertaken safeguarding training recently, however not all the staff had fully understood the training they had received. This meant that staff were not fully aware of how to identify the possibility of abuse and respond appropriately. The manager/provider had a whistle blowing policy, however staff questioned did not fully understand what the policy meant, two staff thought it meant that if you saw something that could be considered abuse and they were not happy to speak to management they could notify the social services. They did not realise for example that the policy offered Inspection Report The White House August

12 them protection from discrimination and victimisation if they reported on another member of staff at the home. This meant that although staff had been made aware of their responsibility to report abuse they did not understand the protection that the whistleblowing policy offered them. Three staff out of four did not know what was meant by the term Deprivation of Liberty Safeguards (DoLS) and confirmed they had not received training regarding the Mental Capacity Act The manager/provider confirmed this and told us that the training had been booked. One member of staff was aware and had had training externally. Staff we spoke with were not aware of the systems in place to assess people's mental capacity regarding particular decisions and hold meetings with representatives when necessary. One staff member thought one person may have had a best interest meeting but were not sure of the outcome. This meant that staff may not be providing care according to the requirements of the Mental Capacity Act Inspection Report The White House August

13 Cleanliness and infection control Action needed People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was not meeting this standard. People were not fully protected from the risk of infection because appropriate guidance had not been followed. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement People were not wholly protected from the risk of infection because appropriate guidance had not been followed. We observed the use of personal protective equipment such as gloves and aprons during our visit. We saw that the laundry room, corridors, lounges and communal areas were visibly clean. The home had two people who were employed to cover the home over seven days a week to keep the home clean. We viewed a cleaning schedule for the home and were told that some carpets such as the lounge carpet are cleaned at night by arrangement with the domestic staff. The cleaner explained what cleaning they do on a daily basis and cleaning that is less often. The schedule did not detail how often cleaning was to be undertaken, for example daily, weekly or monthly. This meant that steps had not been taken to make sure cleaning takes place in a timely way to reduce the risk of infection to the people who lived in the home. We spoke to the staff member doing the cleaning and two care staff about what they would do if there had been a spillage of bodily fluids. The staff all said that they would attend to this straight away to prevent spread of infection. They were able to describe the cleaning materials and equipment they would use. This meant staff did understand the need to keep the home clean to prevent infection. The policies and procedures they had in place were written in 2009 and had not been up dated to reflect the changes in legislation. They did not have an infection control champion/lead but the manager/provider said that they would take on that role in future. This meant that staff did not have all the information they needed and there was no infection control monitoring to keep people safe. The home did not have a copy of the Health and Social Care Act 2008, Code of Practice on the prevention and control of infections and related guidance to ensure that the Inspection Report The White House August

14 required standards were maintained. This meant that the provider had not followed stipulated guidelines on infection control. We looked at the dining area, lounge, laundry room bathrooms and people's bedrooms. We found a very unpleasant smell in one bedroom, we also found that the dining room carpet was very stained, this was discussed with the provider. The manager/provider explained that these carpets were cleaned frequently and had plans to approach the family to replace the flooring to something more appropriate in the bedroom affected by unpleasant smell. This meant that the manager/provider was aware that the carpet odour and stains require attention to protect people from infection. Staff had not all received training in infection control and there was no evidence that areas of infection control were audited. This meant that the home was not fully compliant with the Department of Health's Code of Practice on the Prevention and Control of Infections and related guidance. Inspection Report The White House August

15 Supporting workers Action needed Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was not meeting this standard. People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We spoke with four members of staff who told us they received training opportunities and we saw training certificates in six staff files. The training certificates showed that staff had completed training in a range of areas that were required in their job role such as Manual Handling, Safeguarding, Medication, Infection Control, Health and Safety, Fire, Nutrition, Food Hygiene and First Aid. However, we found that the certificates on three staff files showed that some trainings were out of date and had not been refreshed in a timely way. This meant that not all staff had the updated required skills to care for people who lived in the home. We viewed the training matrix when we visited the home and three staff spoken with confirmed that they had not undertaken some courses. For example, Challenging Behaviour, Mental Capacity Act, Deprivation of Liberty Safeguards, Continence and Dementia. This meant staff had not received training necessary to ensure staff had the skill and knowledge to care for the individual needs of people who lived at the home. The staff we spoke with told us they had not received a formal two way recorded supervision on a regular basis. Two staff members remembered just one supervision session in the last year. They did however confirm that they had an annual appraisal to discuss their work and performance once a year.the manager/provider said that they often had conversations with their staff but these were not recorded. This meant that the manager/provider did not have suitable arrangements in place to ensure staff were supervised appropriately. We spoke with four members of staff who commented that they found the manager/provider and deputy manager approachable. One said "The management is supportive if we have any problems at work or at home". A senior member of staff said, "There is always someone on call to speak to if something happens or we are not sure Inspection Report The White House August

16 what to do" This meant that staff were able to access support as required. Inspection Report The White House August

17 Assessing and monitoring the quality of service provision Action needed The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was not meeting this standard. The provider did not wholly have an effective system in place to regularly assess and monitor the quality of service that people received. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement The provider did not wholly have an effective system in place to regularly assess and monitor the quality of service that people received. We looked at records and spoke with the manager/provider about how they had monitored Health and Safety and quality in the home. People we spoke with told us that there was an open door policy at the service and they could speak to the manager/provider at any time about comments or concerns they had. One person said, "The owners are very approachable. We can speak to them at any time". The manager/provider explained that although they had not held resident family meetings, they speak to families often when they come to visit and contact them if there are any issues. This showed that the management of the home was open to the views of staff, residents and relatives. The manager/provider explained that they had sent out a survey to people's families and health professionals who visited in the home regularly. We saw the results of that survey and had commented on that at our last scheduled inspection in October At that time we judged that the home had asked for people's views to monitor and improve the service offered. We found that regular staff meetings had not taken place every two months as they had been before. Staff meetings were previously held to make sure that staff were kept up to date with any changes and had opportunities to raise any concerns or make suggestions. There were no records of staff meetings happening since our last visit. This meant staff no longer had the opportunity to discuss any issues in open forum, infection control and peoples care and welfare needs. We spoke to the manager/provider who told us there had been no complaints recently. We Inspection Report The White House August

18 did not see a complaints file. The manager/provider said that normally comments made about aspects of the service had been dealt with straight away. Records showed that the manager/provider had audited the quality of the service provided. She ensured that regular care plan audits had taken place along with other audits including health and safety, medication and fire system. The manager/provider told us that they had undertaken a visual check of the rooms every week. However, the audit system did not cover all the areas, which had resulted for example in staff training not being up to date, policies and procedures being out of date and staff receiving regular supervision. This meant that although there was an audit system in place it was not robust and had not improved the quality of the service. There were effective risk management systems in the home. These included regular safety checks of installations and equipment. A fire safety risk assessment had been carried out and recorded and regular checks were made of the fire safety system. We found that up to date safety certificates were in place for gas and electrical installations and equipment. This meant that people were protected from risk of harm and the manager/provider had taken steps to ensure that the service operated in a safe environment. Inspection Report The White House August

19 Records Action needed People's personal records, including medical records, should be accurate and kept safe and confidential Our judgement The provider was not meeting this standard. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We found not all the plans of care had been up dated when there had been a significant change in people's care needs. For example, one person's care needs had changed. The person was no longer mobile and they needed to be cared for in bed. The district nurse was visited regularly and staff made sure the person was turned every two hours. The plan of care did not reflect this change to the person's health and care needs. This meant staff did not have up to date and accurate information on how to meet the person's care needs. When we looked at the daily records we found that staff did not comprehensively record what had happened to individuals each day. Staff relied on code numbers to indicate what care had been provided some of which related to individual care plans. However, we saw that when there were changes in people's care needs, the plan was not up dated, therefore the numbers may not cross reference to the care being provided. This meant that the information recorded was not accurate. By using numbers to record the basic care that had been provided, we found it did not give the detail required, for example we saw codes where 1 was for visitors/activities, 2 for continence care/toilet, 3 for diet nutrition and weight, 4 was for accidents/falls, 10 was for personal care, 11 physical health and wellbeing. We saw further care codes and one of these for example stated bath/shower. Unless staff stated in writing whether a person had a bath or a shower we did not know what care had been provided. We were also not made aware of how much the person was able to do for themselves. This meant daily records were not detailed and could be misleading. The manager/provider told us that the homes policies and procedures were being updated. We saw this file and found policies and procedures were of various ages and most were in need of updating. For example the infection control policy was five years old it was out of date and had not been updated in line with legislation that changed in Inspection Report The White House August

20 We found that people's personal records were stored in locked cupboards in staff or management offices. This ensured that people's confidential personal information was protected. Inspection Report The White House August

21 This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010 Safeguarding people who use services from abuse How the regulation was not being met: The provider had not made appropriate arrangement to ensure staff had the required training and knowledge to understand all of what constituted abuse and how this should be reported. Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010 Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control How the regulation was not being met: The provider had not made sure that people who lived at the home were protected from infection because the provider had not followed stipulated guidelines on infection control.. Regulation 12(a)(b)(c) Regulated activity Accommodation for persons who require Regulation Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Inspection Report The White House August

22 This section is primarily information for the provider nursing or personal care Supporting workers How the regulation was not being met: The provider had not made sure that staff employed at the home had appropriate training and supervision in order to provide appropriate care to the people who lived in the home. Regulation23(1)(a) Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision How the regulation was not being met: The provider had not made sure that there were robust systems in place to identify, assess and manage the quality of the service that people received. Regulation 10. (1)(a)(b) Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010 Records How the regulation was not being met: The provider must make sure that people are protected against the risks of unsafe or inappropriate care and treatment by keeping accurate, up to date records. Regulation 20 (1) (a). This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us by 04 September CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report The White House August

23 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report The White House August

24 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report The White House August

25 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report The White House August

26 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report The White House August

27 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report The White House August

28 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report The White House August

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