The inspection was carried out on 26 January 2017, and was an unannounced inspection.

The White House is a residential home registered to provide care and support for up to 38 older people including those living 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. There were currently 22 people living in the service when we inspected.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our previous inspection on 07 April 2015, we recommended that the provider sought advice and looked at published research and guidance about providing diverse meaningful activities for the elderly in accordance with their individual needs and choices. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

People were encouraged to take part in activities. Activities met people’s needs and the home was responsive to people’s activity needs.

During this inspection, we found that the registered manager failed to notify the commission about important events happening in the service. We have made a recommendation about this.

One to one staff supervision had not been consistent. There were gaps in supervisions which showed that staff had not sometimes had supervision for a year or more. Yearly appraisals had not been consistently carried out. We have made a recommendation about this.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as mobility and skin integrity. However, there were no comprehensive falls risk assessment in place and the registered manager had not been following their own policy on falls. We have made a recommendation about this.

The environment in the home was not totally dementia friendly which should have a positive impact on people living with dementia. We have made a recommendation about this.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

People had access to nutritious food that met their needs. We observed that people had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives.

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People knew how to make a complaint and these were ma

The inspection took place on 07 April 2015 and it was unannounced. The White House is a residential home providing care and support for older people including those with dementia. At the time of our inspection, 21people lived at the home.

At our last inspection on 13 May 2014, we found people were not always protected from abuse because the provider had not made appropriate arrangements to protect people or ensure staff were adequately trained and supervised. The provider did not have an effective system in place to regularly assess and monitor the quality of service that people received. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We set compliance actions and the provider wrote to us telling us how they would become compliant with the regulations by 01 October 2014. At this inspection we found the provider had completed all the actions they told us they would take to improve the service provided.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Although people and relatives felt the home was responsive to their needs, people were not happy about activities. One person said, “There’s nothing to do with the Lord here. Its ages since I went to church”. Activities were sporadic, as they were facilitated by the carers who had other tasks to complete. We have made a recommendation about this.

The environment was safe and adaptations were made to make it suitable for older people, such as a passenger lift and wet rooms with easy access. Bedroom doors had people’s names on them however the doors to people’s bedrooms all looked the same, which might make it difficult for people with dementia to easily find their way around the home.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies, such as the local authority safeguarding team in a timely manner. All of the people who were able to converse with us said that they felt safe in the home; and if they had any concerns they were confident these would be quickly addressed by the registered manager and staff.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. We found risk assessments on various areas of care such as falls, mobility, bed rails and diabetes. These risk assessments had been reviewed. Accident records were kept and audited monthly to look for trends. This enabled the staff to take immediate action to minimise or prevent accidents.

There were enough staff in all areas of the home at all times, to support people and meet their needs. Everyone we spoke with considered there were enough staff on duty. The home used safe systems of recruiting new staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home.

People had their medicines managed safely and received their medicines as prescribed. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, occupational therapists and social workers.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that each decision was taken in accordance with the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and associated Codes of Practice. The Act, Safeguards and Codes of Practice were in place to protect people by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

People were provided with sufficient quantities to eat and drink and their nutritional needs were met. People said the food was good. The menu provided people with well-balanced diet. People had a choice of hot foods each day; and a choice of two main meals and desserts at lunch times

People were encouraged to lead the life style of their choice and staff supported them to meet their diverse needs and their privacy and dignity was respected. People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people told us their healthcare needs were well managed.

Staff interacted with people in a caring, respectful and professional manner. Staff were skilled at responding to people’s requests promptly and had a detailed understanding of people’s individual care and support needs.

There was an open culture and the registered manager and staff provided people with opportunities to express their views. There were systems in place to manage concerns and complaints. People understood how to make a complaint and were confident that actions would be taken to address their concerns.

The provider had effective quality assurance systems in place to identify areas for improvement and had taken appropriate action to address any identified concerns. Audits completed by the registered manager and deputy manager had resulted in improvements in the home.

Records were managed well to promote effective care. The records were clearly written, up to date and informative.

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 2005. 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 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

Medicines were safely administered and appropriate arrangements were in place regarding recording and obtaining medicines.

We used a number of different methods to help us understand the experiences of people who used the service. Some people who used the service had dementia. This meant that they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the service. The atmosphere in the home was calm and relaxed. All the interactions we saw between staff, management and people who lived in the home were friendly, supportive and respectful.

People who lived in the home told us they were satisfied with the service. They said, "I like living here, they look after us all very well." "I can choose what I want to do; I prefer to sit here in the dining room most of the time" and "I have no complaints at all, everyone is very friendly."

People were provided with appropriate care and support that met their needs and promoted their wellbeing. The meals were well received by the people who lived in the home and a good choice was available.

People mostly received the medication they needed at the time they needed it however, we did find some discrepancies which the manager told us would be addressed.

Robust recruitment procedures ensured that people were protected through the appointment of appropriate staff.

Audits were in place to monitor the quality of the service and people knew who to talk to if they had any concerns about the service.

We spoke with three people living at the home, a member of staff and the registered manager. We observed the care of other people at the home who were less able to communicate with us.

The people we spoke with said they were very happy living at the home. One person had recently moved in and said that she was still settling in but commented “I’ve had my ups and downs but the girls are very good”. This person also told us that the food was “very good, I tell them if I don’t like it and they get me something else”.

Another person commented “the staff are very kind, they let you do what you want”, and “I can’t think of anything they could do better”.

People told us that they like their rooms, that staff kept them clean and tidy and that the staff took care of their laundry.

People said that the activities at the home suited them and they could take part in what they wanted to.

We spoke with three people who live at the home and we observed the care and interactions of others who were less able to communicate. People were generally very happy living at the home and they said they liked the staff. People said the food was very good and they enjoyed coming to the lounge to chat with others and the staff. People commented “The staff are very good, they are a good bunch” and “the food’s lovely” and “I like a bath once a week and that’s what I get”.

Staff were observed interacting with all the people in the lounge and people were smiling, chatting and singing. Two people remained in their rooms during our visit as they were frail and unwell; staff were seen checking on them throughout our visit.