The Care Quality Commission (CQC) has rated The White House care home in Chatham as inadequate for a third time and it remains it special measures to protect people following an inspection in December.
The White House is a residential care home for older people, people living with dementia and people living with a physical disability. There were 18 people living at the service at the time of the inspection.
CQC carried out the inspection after receiving notification of an incident where someone sustained a significant injury. This raised concerns about how the service managed skin integrity and whether staff were following guidance from healthcare professionals.
Inspectors found care had seriously deteriorated and the service was in breach of seven regulations. These breaches related to safe care and treatment, medicines management, protecting people from abuse and neglect, safe staffing, the unsafe environment, people being unlawfully restricted, and how the service was managed.
CQC has again rated The White House as inadequate for being safe and well-led.
In response to the findings, CQC imposed urgent conditions on the home to restrict them from taking on new residents without prior agreement from CQC.
The White House also remains in special measures which involves close monitoring to ensure people are safe while they make improvements. Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn’t happen.
CQC has also begun the process of taking regulatory action to address the concerns which The White House has the right to appeal.
Amy Jupp, CQC deputy director of operations in the south, said:
“Our inspection of The White House found serious failures in leadership and management of the service that put people at avoidable risk of harm. Leaders were aware of significant shortfalls in care quality, management and monitoring for months but failed to act, which had a detrimental impact on people’s safety.
“Safeguarding systems were ineffective. We saw unexplained bruising and injuries to people who couldn’t verbally communicate, yet these weren’t consistently investigated or reported. A hot drink had been thrown on one person, but this wasn’t raised as a safeguarding concern. Managers were also unable to explain why safeguarding issues raised by health professionals hadn’t been investigated.
“Leaders provided inadequate staff training, guidance and supervision which put people at serious risk. Staff didn’t put appropriate skin assessments in place for individuals at risk of pressure sores, and repositioning was inconsistent and unsupported by guidance, increasing the risk of severe pain or hospital treatment.
“The environment was unsafe and undignified. Five people had no hot water in their ensuites, some had poor lighting that increased fall risks, and there was a strong smell of urine in several areas. We observed people left wet or soiled for prolonged periods despite staff awareness.
“It is unacceptable that leaders allowed such poor care to continue. CQC has told leaders at The White House where they must make immediate and significant improvements and is monitoring them closely to keep people safe while this happens.”
Inspectors found:
- Leaders had not investigated unexplained bruising and injuries to people who couldn't verbally communicate how this happened and didn't always report these to the local safeguarding team.
- Staff lacked knowledge about people's complex needs and risks. One member of staff who'd completed their induction and was actively providing care told inspectors they had no idea who had the most complex care needs.
- People were at significant risk of dehydration as nobody averaged more than 620ml of drink a day, despite NHS guidance recommending 1,500-2,000ml per day.
- The chef was unable to explain which food consistencies were required for individuals and had not received training on this, placing people at risk of choking. In addition, leaders were also unaware of who was at risk of choking.
- Staff didn't always ensure people received their medicines safely. When inspectors checked medicine counts, they weren't always correct, meaning some people hadn't received their medicine.
- Staff used handheld devices to update care records, but four care staff had to share two devices, meaning there were delays in recording care.
- Staff were required to access dangerous, steep stairs down to the cellar where people's food was stored, despite there being empty rooms in the large home.
- Regular agency staff hadn't received dementia training according to their profiles, despite the majority of people living at the service having dementia.
However, inspectors also found:
- Some maintenance areas had improved since the last inspection, with regular health and safety checks undertaken by the maintenance team for moving and handling equipment.