The White House Nursing Home is a 'care home' which provides accommodation and nursing or personal care for a maximum of 36 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates people in one adapted building over two floors and on the date of this inspection there were 26 people living at the home, some who of whom were living with dementia.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good. We saw evidence to show the service was meeting all of the fundamental standards.

There was a registered manager in post who had been registered with the Care Quality Commission (CQC) since September 2014. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

The registered manager was aware of their responsibilities and submitted notifications to the Commission appropriately. The registered manager worked with the provider to ensure there was a strong strategic lead to provide personalised care to people. There was a robust governance framework in place. Audits and checks were carried out by the registered manager and provider. Any issues identified were acted upon and any identified risks were mitigated. There was a complaints policy in place and we saw evidence of investigations and actions taken from these. The provider also carried out feedback surveys annually with people, relatives and staff to help improve the care provided.

People told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were safely recruited and provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. The staffing levels at the home matched the assessed needs of people but due to the changing needs of people this needed to be reviewed.

The premises were safe and there were regular checks of the environment, equipment and utilities. There were infection control policies in place and we observed staff following these. Medicines were safely managed and there were medication policies and procedures in place. There was a business continuity plan in place for use in emergency situations. These were also reflected in people's care plans with personal emergency evacuation plans (PEEPs) to support the safe evacuation of people in an emergency. At the time of our inspection the lift was under repair and the registered manager had updated all risk assessments and PEEPs to reflect the changed in circumstances in the home.

People’s care plans were personalised and care provided to them was accurately recorded. Risks to people were assessed and mitigated. People’s care plans were reviewed regularly and people and their relatives were involved in care planning. We saw referrals to other agencies, for example the dietician and

At the last inspection on 19, 20 and 21 April 2016 we found a breach of regulation. Following the inspection the provider wrote to us to say what they would do to meet legal requirements in relation to medicines.

We undertook this unannounced focused inspection on 15 December 2016 to check that they had met legal requirements and to confirm that they had followed their action plan and made improvements to the service. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The White House on our website at www.cqc.org.uk.

The White House is a care home which provides nursing and personal care for up to 33 people, some of whom may be living with dementia. There were 27 people living there at the time of our inspection.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

At our focused inspection on 15 December 2016 we found medicines were managed safely. The provider had followed their plan and legal requirements had been met.

The inspection took place on 19, 21 and 26 April 2016. The first visit on 19 April 2016 was unannounced. The second and third visits on 21 and 26 April 2016 were announced. We last inspected the service in February 2015 and found the service met the regulations we inspected.

The White House is a care home which provides nursing and personal care for up to 33 people, some of whom may be living with dementia. There were 27 people living there at the time of our inspection.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records and procedures to support and evidence the safe administration of medicines. Appropriate codes for the non-administration of medicines were not always used, prescribed creams were not always recorded as administered, there was no specific guidance around ‘when required’ medicines, and records relating to ‘when required’ medicines were not always accurate.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe. One person said, “I’m safe because I’m well looked after here.” One relative told us, “I feel [family member] is safe here which is a great help.”

The provider made sure only suitable staff were employed. Thorough background checks were carried out before staff started to work with people who used the service.

Staff we spoke with said they had completed safeguarding training and could describe different types of abuse and signs to be alert to. Staff told us they would report any safeguarding concerns immediately.

Risks to people’s health and safety were assessed and reviewed regularly. Measures to reduce the risks identified were clearly set out in people’s care records. Accidents and incidents were recorded accurately and analysed by the registered manager.

The service was clean, well maintained and felt homely.

People told us they liked the food which was well presented and looked appetising. There were enough staff to support people to eat. People who required specialist diets were catered for. People had access to hot and cold drinks and snacks throughout the day.

The service was working within the principles of the Mental Capacity Act 2005. Deprivation of Liberty Safeguards (DoLS) applications had been made appropriately and contained details of people’s individual needs.

The design of the service supported people living with dementia, such as brightly painted doors, old photographs of the local area on display and gardening and household items on the walls.

People were happy with the care and support they received, and told us staff were caring and professional. One person said, “Staff really are caring.” A relative told us, “I can’t fault the care here. The staff are amazing.”

Care records were personalised to each individual and were reviewed regularly. Staff knew people’s needs and preferences well.

People and their relatives told us the service was well run. In a recent satisfaction survey 100% of relatives who responded said the registered manager was approachable. There was an effective quality assurance system in place to monitor the quality and safety of the service. People, their relatives and staff had regular opportunities to provide feedback on the service.

The inspection took place on 9 and 16 February 2015. The first visit was unannounced, which meant the provider did not know we would be visiting. The second visit was announced. We last inspected this service on 1 October 2014 and we found the home was meeting the regulations we inspected.

The White House Nursing Home provides personal and nursing care for up to thirty six people, some of whom are living with dementia. At the time of our inspection there were 19 people living at the home. The home transferred to the current provider in September 2014.

The home had a registered manager. 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 2008 and associated Regulations about how the service is run.

Prior to this inspection we received information of concern about the quality of care being provided. Particularly staff not being provided with relevant training, lack of stimulation for people, people sitting in hoist slings all day and people’s toileting needs not being met. Staff were provided with the training they needed to deliver appropriate care. One staff member said training was, “Every fortnight.” We saw on a number of occasions people had been left unsupervised in lounges, without interaction and stimulation from staff. We also observed during our SOFI observation that people did not receive regular interaction from staff. We saw some people were sitting in hoist slings when they were in the communal lounge. Both nurses we spoke with told us this was better for the people’s wellbeing and safety.

People and family members told us the home was safe and were happy with the staff delivering the care. People commented, “Very safe, no concerns whatsoever”, “I do feel safe”, and, “Yes, definitely safe.” One family member said, “Very good staff, I don’t see any neglect about.” People gave us positive views about the environment within the home. They said, “My room is good. I chose the pictures on the wall and I chose the wallpaper.” One family member said the condition of the home was, “Quite good.” Family members told us they had been involved in making decisions about changes to the home. We found the home was clean with no unpleasant odours.

People told us the staff were caring and treated them well. They said, “[Staff] treat you like their family”, “Staff are nice”, “Very good”, “Brilliant, fantastic”, “I am so content here. [My relative] chose well. This one hit the jackpot.” Family members also confirmed their relative’s received good care.

People, family members and staff told us the current staffing levels had a detrimental impact on people’s care. However, the registered manager was aware of this and had recruited additional staff who were due to start their employment imminently. People told us, “Not enough staff, some are overworked”, “Yes enough staff, could do with more for the dining room”, and, “Girls are alright, they can manage. There are times when the girls are overloaded.” There were systems in place to ensure new staff were suitable to work with vulnerable people. This included disclosure and barring service (DBS) checks and requesting references.

Medicines administration records (MARs) had usually been completed accurately. Where we identified gaps in people’s MARs, the provider had been pro-active identifying and investigating these gaps. We saw accurate records were kept for the receipt and disposal of medicines. Medicines were stored safely. Only qualified and competent nurses administered people’s medicines.

Staff had a good understanding of safeguarding adults and whistle blowing. They told us they knew how to report any concerns they had. They also said they would not hesitate to raise concerns they had. One staff member said, “I would feel confident to raise concerns. John [registered manager] would take action.” Staff said previous concerns had been dealt with “really well” and had been “taken through the right channels.” Previous safeguarding concerns had been dealt with in line with the provider’s agreed procedures.

The provider undertook standard assessments to help protect people from a range of potential risks. Separate risk assessments were carried out where staff had identified risks that were specific to the person.

The provider undertook regular health and safety checks and these were up to date. This included checks on gas safety, lifts, electrical safety, electrical appliances, equipment, safety checks of people’s bedrooms and fire safety. The home had emergency evacuation plans in place which were reviewed monthly.

Staff told us they had regular one to one supervision every three months and an annual appraisal. They told these included a discussion about their training and development.

Staff were following the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). Where required, applications had been submitted to the local authority for approval. Staff had a good understanding of their responsibilities under the MCA and knew when MCA applied to a person. People told us they were asked for permission before receiving any care. They said, “I do what I want. Staff don’t demand”, “Sometimes have to wait but not for long. Staff are reliable and will come back”, and, “Staff ask me what would I like.” We found on two occasions family members had signed documents on behalf of their relative rather than the person receiving the care. We saw no evidence from viewing care records that these people were unable to sign documents.

People were happy with the meals they were given. One person said, “Tremendous, best chef in the world.” Another person said, “[The] chef is very capable.” We observed some people did not always receive the support they needed to meet their nutritional needs in a timely manner. For example, one person did not receive support with eating and drinking in line with their agreed care plan. However, when people did receive assistance we saw staff were kind and considerate towards them. The home had received positive feedback following an external audit for improvement in screening people for poor nutrition.

People said they were supported to meet their health care needs. One person said, “Staff call the doctor quickly.” People had access to a range of health professionals including the community nurse, the optician and the chiropodist. Staff said they supported people to attend routine health appointments.

Improvements were being made to adapt the environment to suit the needs of people living with dementia. These included displaying reminiscence and sensory materials on corridor walls, décor, signage and personalised information displayed outside people’s rooms.

People said they were treated with dignity and respect. One person said, “[Dignity and respect] always, at all times”, and, “[Staff] treat you like a human being.” Staff described how they delivered care in order to maintain a person’s dignity. This included closing bedroom doors, knocking on doors before entering people’s bedrooms, always wearing gloves when supporting people, talking to people and explaining what they were doing and seeking consent before delivering care.

People told us staff were responsive to their individual needs. One person said, “No matter what I ask for or ask them [staff] to do, they never refuse. They say it’s your care home, we work for you.”

Staff had access to written information about people’s preferences including their likes and dislikes. One family member said, “We went through likes and dislikes. They wanted to get a feel for [my relative] and what [my relative] was about. They are still learning about [my relative] and tweaking.” Staff had developed life histories for each person which included details of people’s families, where they were born, their previous employment, holidays, interests and preferences in relation to their care. People had their needs assessed when they were admitted into the home. This was a comprehensive assessment that was used to develop personalised care plans. Care plans were reviewed regularly. However, the record of the review was brief and did not provide a meaningful update of the continuing relevance of the support plan to the person.

People had opportunities to take part in activities when these were arranged. These included playing “old-time music”, musical instruments, entertainers, ‘Pets as Therapy’ (PAT) animals such as dogs and miniature horses, movies, bingo and raffles. One person said, “It keeps us going.” One family member said, “[Activity co-ordinators name] does a really good job interacting.” They also said people “seem very involved.”

People and family members we spoke with said they had no complaints about the care provided at the home. One person said they had, “No complaints but they [staff] would act on it straightaway.” Another person said, “I would talk to staff, they would help.” Another person said there was “nothing wrong.” We saw there had been no complaints made about the service.

People and family members had opportunities to give their views about the service including regular ‘Relative’s and friend’s’ meetings and completing questionnaires. The feedback from previous consultation was displayed in the home’s reception area.

The home had a registered manager. People and staff said the registered manger was approachable. One person said there was, “No problem with John [registered manager]. You can see him anytime you want.” Another person said, “The manager is very good, I can talk to him.” Another person said, “The manager is very nice, very friendly. He likes to hear what is going on. If something isn’t right, he puts it right in a nice sort of way.”

Staff told us, and records confirmed regular staff meetings were held and they were able to make suggestions during these meetings.

People and staff said the home had a good atmosphere. One person said, “I really love it here, everybody gets treated the same.” Another person said there was “no nastiness at all.” Another person said, “Homely. Happy go lucky, everybody speaks to everybody.” One staff member said, “I love it, very relaxed. I like working here”, and, “Lovely atmosphere, very homely.” Another staff member said the atmosphere was “pretty good.” Another staff member said the home had a “nice” atmosphere. They said it was, “Small, friendly and close with families.”

We saw on entering the home, information about the home’s approach to ‘Dignity in Care’ was displayed prominently in the reception area.

The provider undertook a range of regular audits as part of its quality assurance programme. This included checks of care plans, staff files, the kitchen, infection control, ‘pressure sores’, medicines and a health and safety audit. These had all been successful in identifying areas for improvement.

The provider’s regional manager also carried out a regular three monthly monitoring visit and the registered manager carried out unannounced ‘out of hours’ visits. The provider and the registered manager had a clear aims for the future direction of the home. These were documented in the homes ‘Strategic Marketing Plan’ and ‘Home Development Plan.’