The Whitehouse Residential Home is a ‘care home’. 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 Whitehouse can accommodate up to 33 people that require accommodation and personal care. The home comprises of two buildings, one of which accommodates people living with dementia. At the time of our inspection there were 28 people using the service.

There was a registered manager in place. 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.

At our last inspection in April 2016 we rated the service 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 on-going 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.

People living in the service told us they felt safe. There were enough staff available to care for people safely and we observed staff provide care to people in a timely way. We saw staff were kind and caring. They promoted and respected people’s cultural and spiritual needs.

We saw the service used effective recruitment procedures which helped to keep people safe. Staff also completed a thorough induction and received regular training to support them in their roles. Staff said they had been provided with safeguarding vulnerable adults training so they had an understanding of their responsibilities to protect people from harm.

There were effective procedures in place for the safe management and administration of medicines. Staff competency was checked to ensure people received their medicines safely.

People’s care was reviewed to ensure they received the correct level of care and support. People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People’s healthcare needs were met. They had access to community based healthcare professionals, such as GPs, and they received medical attention when needed.

People, their relatives and the staff all spoke highly of the registered manager. Staff told us the registered manager was always available if they needed support. The registered manager completed regular audits of the service to make sure action was taken and lessons learned when things went wrong. This meant systems were in place to support the continuous improvement of the service.

Further information is in the detailed findings below.

The Whitehouse Residential Home accommodates up to 32 older people that require accommodation and personal care. The home comprises of two buildings, one of which accommodates people living with dementia. At the time of our inspection there were 19 people using the service.

The service was last inspected on 14 and 17 July, and 10 August 2015 and was found to be in

breach of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the provider sent us an action plan identifying actions to be taken and timescales for completion, in order for them to become compliant.

This inspection took place on 20 April 2016 and was unannounced, which meant we did not notify anyone at the service that we would be attending and included checks to confirm the service had followed their action plan and met legal requirements. On this inspection we checked and found improvements had been made with the breaches of regulation identified at the last inspection. The registered provider must now evidence that these improvements can be sustained to ensure the service remains well led. Systems and processes that have been introduced must remain consistent and robust to continue to effectively monitor the service and mitigate risks to people.

It is a condition of registration with the Care Quality Commission that there is a registered manager in place. 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.

A new home manager was appointed at The Whitehouse Residential Home two weeks ago. They informed us they were submitting an application to register as manager.

People spoken with said they felt safe living at The Whitehouse Residential Home and they could talk to staff if they had any worries.

There were systems in place to make sure people were protected from abuse and avoidable harm.

We found systems were in place to make sure people received their medicines safely.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home.

A varied and nutritious diet was provided to people that took into account dietary needs and preferences. People we spoke with told us they enjoyed all of the meals provided at the home.

People’s physical and mental health needs were monitored. There was evidence of involvement from professionals such as doctors, the mental health team, dentists and district nurses in people’s support plans.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. Staff supervision and appraisal meetings took place on a regular basis to ensure staff were fully supported.

We observed people’s needs were met by staff that understood how care and support should be delivered. People were treated with dignity and respect.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

The inspection took place on 14 and 17 July and 10 August 2015. The visits on 14 and 17 July 2015 were unannounced, which meant we did not notify anyone at the service that we would be attending. On 10 August 2015, we agreed the visit date with the registered manager so that we could ensure it was at a time when they would be available.

The service was last inspected on 3 and 4 July 2014 and was found to be in breach of two of the regulations we inspected at that time. These related to safeguarding people from abuse and assessing and monitoring the quality of service provision. The provider sent a report of the actions they would take to meet the legal requirements of these regulations which stated they would be compliant by October 2014. We checked whether these had been met as part of this new approach comprehensive inspection.

The Whitehouse Residential Home accommodates up to 32 older people that require personal care. The home comprises of two buildings, one of which accommodates people who may be living with dementia. 11 people resided on the unit for people with dementia at the time of our inspection and there were a total of 23 people using the service.

There was a registered manager in post 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 2008 and associated Regulations about how the service is run.

Although people told us they felt safe, the service did not operate safely. Medicines were not appropriately managed which led to a risk of people not receiving their required treatment in a safe manner. We saw that practices relating to medication were not undertaken in line with the service’s own policies.

Staff told us they found the current staffing levels in place to be dangerous and unsafe, particularly at night. No dependency assessment was undertaken to establish the staffing levels required to meet people’s needs. For example, we found at least five people required the support of two staff members with some of their care needs. This included the use of equipment, such as hoists, which required two staff members to operate safety. These needs could not be safely managed with the current staffing arrangements in place.

Safeguarding polices were in place and staff received training in safeguarding. We saw that although some incidents of potential abuse were reported and logged by staff, they were not being referred or communicated to the local authority safeguarding team. This led to us forwarding details of these to the local authority following a discussion with them after our inspection. Incidents were not robustly analysed and there was a lack of evidence to show that actions had been taken to effectively minimise risk and prevent recurrence.

We saw evidence of updates to people’s care plans and risk assessments but these were not always meaningful as they did not always correspond with our observations and what staff told us. People’s views about activities at the home were mixed, with some people commenting they would prefer more activities. We saw few activities take place during our inspection.

The principles of the Mental Capacity Act 2005 were not always followed to show how people were assessed as lacking capacity. We saw some restrictive practices in place and found Deprivation of Liberty Safeguards had not been considered and applied for where there was a possibility they may be required, so that people were not deprived of their liberty without lawful authority.

Recruitment procedures were not sufficiently robust to ensure that staff were assessed as suitable to work at the service.

We saw instances where staff were undertaking care provision that they had not received appropriate training in. Staff told us they felt supported and said they had regular supervisions and appraisals. We found that these had not always identified individual training needs.

People and relatives we spoke with all commented positively about the staff and felt they were caring. We saw instances of caring interactions between staff and people. We observed staff offer reassurance to people when they were providing support. However, we observed some situations where people did not have their privacy and dignity maintained, and where people were not consulted about their preferences.

We saw feedback surveys from last year and saw the results of these had been analysed and actioned with areas for improvement. There was a complaints procedure in place at the service.

Regular team meetings took place with staff. Staff comments varied about how well they felt supported by management. We saw that quality monitoring of the service by the registered provider was not documented and audits undertaken by the registered and deputy manager had failed to identify shortfalls in a number of areas.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.