This was an unannounced inspection that took place on 30 June and 3 July 2017.

The home provides care and support for five people with learning disabilities and is located in the Twickenham area.

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 and associated Regulations about how the service is run.

In May 2015, our inspection found that the service required improvement in the area safe regarding a small proportion of the medicine records which were incomplete for creams administered. All the other key questions were rated good with an overall good rating. At this inspection the service was rated overall good with good in all the key questions.

A relative and an advocate told us that they thought the service the home provided was good and people using the service told us and their body language indicated that they enjoyed living at the White House and felt it was their home. During our visit people chose the activities they wished to do such as drawing. People took part in activities as a group or individually depending on the nature of the activity and their preferences. The staff team provided the care and support people needed in an individual, person centred way including during group activities with people receiving the care and attention they needed to enhance their enjoyment.

The home’s atmosphere and environment was inclusive, warm and enabling towards people using the service and their visitors with a lot of laughter and smiling taking place during our visit. It was well maintained, furnished, reasonably clean and a safe environment for people to live and work in.

The records were well maintained, up to date, regularly reviewed and enabled staff to support people using the service appropriately.

The staff knew people using the service, their likes, dislikes and routines well including how they wished to be supported. They had appropriate skills and received training that was focussed on providing individualised care and support in a professional, friendly and supportive way. They also made themselves accessible to people using the service when required. Staff said they had access to good training and support.

People were provided with balanced diets that protected them from nutrition and hydration associated risks that also reflected their likes, dislikes and preferences. They were enabled to choose and help prepare meals if they wished to. People were also encouraged to discuss health needs with staff and had access to community based health professionals, when needed.

The home’s registered manager was approachable, responsive, encouraged feedback from people and monitored and assessed the quality of the service provided.

This was an unannounced inspection that took place on 15 May 2015.

The home provides care and support for five people with learning disabilities and is located in the Twickenham area.

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 and associated Regulations about how the service is run.

There was one improvement area. A small proportion of the medicine records were incomplete for creams administered. The other records we looked at were up to date and well kept.

We recommend that the service refers to current medicine administration and recording guidance.

People said the home provided a good service and they enjoyed living there. People chose the activities they wished to do. These were group and individual based. The staff team provided the care and support they needed to do them.

We saw that the home had an inclusive, warm and enabling atmosphere. People were enjoying themselves during our visit. The home was well maintained, furnished, clean and provided a safe environment for people to live and work in.

The records were comprehensive and kept up to date. The care plans contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties well.

The staff we spoke with was very knowledgeable about the people they worked with and field they worked in. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. They were trained and skilled in challenging behaviour and de-escalation techniques that they were required to use during our visit. They were well trained, knowledgeable, professional and accessible to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They were positive about the choice and quality of food available. People were encouraged to discuss health needs with staff and people had access to community based health professionals, as required. Staff knew when people were experiencing discomfort and made them comfortable.

The home’s manager was approachable, responsive, encouraged feedback from people and monitored and assessed the quality of the service provided.

The inspection was carried out by an inspector during one day. This helped answer one of our five questions;

Is the service effective?

During this inspection we did not review any information in relation to the questions 'Is the service safe', 'Is the service caring', 'Is the service responsive' and 'Is the service well led'? This was because this was a follow up inspection to check that two compliance actions made at the last inspection had been met.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

During our last inspection on the 11th April, 2014 we made two compliance actions regarding recording of assessment and care plan information. This was a follow up inspection to check that the compliance actions had been met. At this inspection we found that both compliance actions were met.

Our inspection team was made up of an inspector who answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit we saw that people were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust, staff understood how to safeguard the people they supported and had received training. Details of specific areas or circumstances under which people may be particularly vulnerable were written down in the care plans we saw.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications were to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly, therefore not putting people at unnecessary risk.

The staff rotas took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

The 2 case files we sampled contained health and care needs assessments, although a record of the assessment of a person who had moved in during the week of our inspection visit was not provided. There was comprehensive information provided by the previous placement that was on file. A sample of 2 care plans we looked at had not been recently updated and there was no written evidence that the home's care reviews were taking place. There were specialist dietary, mobility and equipment needs identified in care plans as required. One person said that they had been involved in writing their care plan and it met their current needs. Some of the care plans had been signed by people using the service. People told us "I'm doing gardening", "I'm helping with the meal we're having chicken pie" and "I've been working and shopping today".

The layout of the service enabled people to move around freely and safely and the premises met the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people’s needs and keeping their care plans up to date.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People commented, “I like it here and the staff” and "Everyone is very nice".

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed and there were regular house meetings where people could put forward their views, suggestions and opinions.

People’s preferences, interests, aspirations and diverse needs had not always been updated in their care plans, although activities were recorded in their daily note books. Because of this care and support could not always be provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. During our visit people were coming from and going to a number of different activities either individually or as a group. The home had access to transport, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. People said that they had never needed to make a complaint as any problems were generally sorted out on the spot or during house meetings . We looked at how complaints were investigated and this was satisfactory. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

There was a new management structure in place that was pro-active, listened to people's needs and opinions and acted upon them. They were introducing a number of new initiatives and had employed consultants to introduce practice improvements in areas they felt required it. The service worked well with other agencies and services as reflected in the information provided by the placement that the person who had just moved in, came from.

The registered manager was away from work and suitable covering interim measures were in place. Appropriate notifications to the Care Quality Commission had been made.

People who use the service told us that staff treated them with dignity and respect. This included being enabled and encouraged to make their own decisions and choices, including care, treatment and deciding which activities they would like to do. "I'm going to have a cup of tea". "I'm drawing a swimming pool picture". "I've made this birthday card especially for your birthday".

They felt safe and protected by the service and enjoyed where they lived.

They also said the food was good. "I choose from the menu pictures". "We're having chicken pie tonight".

We saw staff were friendly, supportive, knew their jobs and there were enough of them to meet people's needs. They treated people with dignity, respect and equally.

The support plans and other records we saw were up to date and enabled people to do activities they wanted to and develop their life skills.

There were suitable safeguarding policies and procedures and staff had received training.

There were also an accessible complaints procedure with clear recording processes that fedback to people and recorded outcomes.

We saw staff supported people with their concerns or if they were upset in a calm, appropriate manner.

We spoke with one person using the service, four staff members and the manager during this unannounced inspection visit. We also observed the support being provided for three people using the service who were unable to tell us about their experience.

One person told us that they liked living at the White House and showed us their room which contained many personal possessions which they were clearly proud of. We saw that staff supported this person to pursue their interests including attending events and buying magazines.

We saw that staff interacted positively with individuals throughout our visit treating them in a kind and dignified manner. The atmosphere of the home was relaxed and homely. The staff we spoke to were knowledgeable around people's needs including their likes and dislikes.

The people who live at the home told us that there were happy there. They appeared relaxed and comfortable. They told us that they liked the staff. We saw that the staff treated people with respect and kindness.