About the service:

The Whitehouse is a care home registered to provide care and accommodation for 14 older persons. There were 11 people living at the service on the day of our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

• Our own observations supported this and we saw friendly relationships had developed between people and staff. One person told us, “They can’t do enough for me, they are so kind”.

• People enjoyed an independent lifestyle and told us their needs were met. The enjoyed the food, drink and activities that took place daily. One person told us, “There’s plenty going on”. Another person said, “I’m always happy with the food”.

• People felt the service was homely and welcoming to both them and their visitors. One person told us, “My son visits me and he always gets a cup of tea”.

• Staff had received essential training and it was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “We get regular training and we know the residents really well”.

• The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes.

• People told us they thought the service was well managed and they enjoyed living there. One person told us, “I can’t fault it here, I’m happy”.

• Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff.

Rating at last inspection: Good (report published 17 August 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

We inspected The Whitehouse on the 13 July 2016. We previously carried out a comprehensive inspection at The Whitehouse on 24 November 2015. We found areas of practice that needed improvement. This was because we identified issues in respect to emergency planning, the supervision of staff, systems for people to provide feedback, the effectiveness of management arrangements, submission of formal notifications and quality monitoring. The service received and overall rating of ‘requires improvement’ from the comprehensive inspection on 24 November 2015.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found improvements had been made in many of the required areas. However, further improvements were needed in relation to quality monitoring and policy and procedural documentation.

The overall rating for The Whitehouse has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been made and sustained.

The Whitehouse is registered to accommodate up to 14 people who require support with their personal care. They specialise in supporting older people. Accommodation was arranged over three floors. On the day of our inspection, there were 10 people living at the service.

At the previous inspection, policies and procedures available for staff to use were not up to date. At this inspection, we saw that several of the policies and procedures had been updated. However, we still saw documentation that was out of date and was based on previous regulations.

We saw audit activity which included health and safety, medicine management and infection control. The results of which were analysed in order to determine trends and introduce preventative measures. However, the audit of medication had not been repeated since our previous inspection. We saw that the recording of temperatures of the medication fridge had not taken place since March 2016 and that the thermometer used to measure the temperature had broken. Increased levels of medication auditing would have highlighted this issue formally and contingency measures would have been implemented sooner.

We have identified the issues above, as areas of practice that need improvement.

A registered manager was in post. 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. However, the registered manager did not have day to day responsibility for the home and was based full time at another service within the group run by the provider. Day to day management for The Whitehouse was provided by a full time manager and deputy manager.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe, I really do”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been administered appropriately.

People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happeni

This inspection took place on the 24 November 2015. The Whitehouse was last inspected on 7 November 2013, where concerns around record keeping were identified. The Whitehouse is registered to accommodate up to 14 people who require support with their personal care. They specialise in supporting older people. Accommodation was arranged over three floors. On the day of our inspection, there were 10 people living at the service.

There was a registered manager in post. 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.

There were systems in place to evacuate people and deal with emergencies. However, the service had no formalised individual evacuation plans for people, or robust business continuity procedures to follow. This placed people at risk should an emergency take place.

Staff told us they felt supported and had informal development plans to enhance their skills and knowledge. However, we were informed by staff and the registered manager that regular formal supervision meetings had not been taking place for care staff.

The provider undertook some quality assurance audits to ensure a good level of quality was maintained. However, despite having systems in place for the recording of incidents and accidents, they were not monitored and analysed over time to identify emerging trends and themes, or to identify how improvements to the service could be made. Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow.

People were not actively involved in developing the service. Other than the complaints process, there were no formal systems of feedback available for people, their friends or relatives to comment on the service and suggest areas that could be improved.

Statutory notifications had not been submitted to CQC by the provider. A notification is information about important events which the provider is required to tell us about by law. Notifications in relation to these relevant events had not been sent to the CQC.

The registered manager was responsible for managing two homes in the group and split their time between both. This arrangement of the registered manager having oversight of both homes was not robust, and had resulted in a reduction in quality and effectiveness of day to day practices at the service.

We have identified the issues above, as areas of practice that require improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Yes, we’re all safe here, they are very good”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including diabetes management and the care of people living with dementia.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is excellent and the staff are very friendly and hardworking”. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included bingo, quizzes, musical events, arts and crafts and themed events, such as fish and chip meals being delivered. People were encouraged to stay in touch with their families and receive visitors.

People told us they felt well looked after and supported and stated that staff were friendly and helpful. We observed friendly and genuine relationships had developed between people and staff. One person told us, “The care is wonderful”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People knew how to make a complaint. They said they felt listened to and any concerns or issues they raised were addressed. Risks associated with the safety of the environment and equipment were identified and managed appropriately.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, where managers were always available to discuss suggestions and address problems or concerns. One member of staff said, “I feel completely confident in my manager and that they would support me. We are a good team, we support each other. If there was something I was struggling with, all my colleagues would help me”.

This inspection was a follow up inspection to the Whitehouse as we found it to be none non-compliant with outcomes 09 (Medication) and 21 (Records) at the last inspection.

We looked a large sample of records, including peoples care plans, accidents and incident logs, Medication charts, staff training records and documents relating to quality of service at the Whitehouse.

We found that the people who used the service were protected from the risk associated with the unsafe management of medicines. The six care plans and 11 MAR (Medication Administration Chart) charts and pharmacy logs we viewed demonstrated that medication was ordered, administered, regularly reviewed and stored in an appropriate manner. We viewed medication training documents that suggested that staff responsible for the administration of medication had received the relevant training to do so.

We looked a large sample of records and found non-compliance with outcome 21, Records. Although we recognised a great deal of hard work and many improvements to the service since the last inspection, there were areas that required further improvement to demonstrate compliance. We saw evidence that the service had implemented many changes to the service documentation, care delivered and the fabric of the building and its surroundings since the last inspection.

People’s privacy, dignity and independence were respected. People told us “The food is good" and "I know I can have a choice of food”. Another person said “I like to do crosswords to pass the time”.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Staff told us that they knew people well and were aware of their needs. One care worker we spoke with told us “most of the residents can communicate their needs and I feel confident they do. I know about their husbands and families and remind them about their loved ones when they forget”. People were registered with a GP and had access to a range of healthcare professionals.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The home had not followed published guidance in relation to the administration of medicines in social care. Some medicines were out of date, errors had not been investigated and records had not been accurately completed.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People were not protected from the risks of unsafe or inappropriate care and treatment because the provider had not ensured accurate and appropriate records were maintained.