Located in the small village of Bisham, just across the River Thames outside Marlow, White Lodge Care Home provides accommodation and personal care for older adults. White Lodge Care Home is a period country house and has 21 bedrooms, located across three floors. The home is family-owned and managed. The location is registered to accommodate up to 23 people. There is a large garden at the rear, which provides some fruit and vegetables used in meals at the service.

At the time of the inspection, there was 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.

Since transitional registration under the Health and Social Care Act 2008 in January 2011, White Lodge Care Home has not always maintained compliance with the relevant regulations at each inspection by CQC. The most recent inspection was an unannounced comprehensive planned visit in September 2015. This inspection checked our 16 key lines of enquiry. Key questions safe and effective were rated ‘requires improvement’. Overall the location was rated ‘requires improvement’. Breaches of Regulation 18 (staffing) and 19 (fit and proper persons) were found and we issued two requirements. An action plan was received by us in September 2015. A previous inspection in 2013 and two previous inspections in 2012 were compliant with the outcomes we inspected.

This visit was the second comprehensive inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the second rating under the Care Act 2014. We found the breaches of Regulation 18 and 19 from our September 2015 were compliant. The rating has improved to ‘good’ overall. Key question safe remains at ‘requires improvement’, as further work is required with regards to medicines management and the prevention and control of Legionella. We have made some recommendations throughout our report.

People were safeguarded from abuse and neglect. There was a robust system in place to ensure that people’s safety was maintained.

Risks for people were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

The building and premises risks were assessed and managed to ensure people, staff and visitor safety at all times. The service did not have a Legionella risk assessment at the time of the inspection, but obtained one shortly afterwards. There are actions required by the provider arising from the findings of the risk assessment.

Enough staff were deployed to support people. Care workers we spoke with were satisfied that there was sufficient staff and that they did not place people at risk when they were busy. Our observations showed that the service was busy at times, but overall calm and relaxed and staff were dedicated to the people they supported.

Medicines were not always safely managed. We examined the handling of people’s medicines during our inspection and found that people were at risk of medicines incidents.

Staff were knowledgeable and competent. They received improved levels of training, supervision and performance appraisal.

The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decision meant the service complied with the MCA Codes of Practice. There was clear information at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations.

We found the service was caring. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. Many of the people who used the service had lived there for long periods of tim

We found before care, treatment and support was delivered people’s consent were sought. Staff members were able to demonstrate the procedure for obtaining consent and people we spoke with confirmed this was their experience.

Initial assessments were undertaken to ensure people’s needs and preferences were clearly identified. Care plans were developed to inform staff members on how to deliver care according to needs identified and risk assessments were conducted to manage identified risks. One relative said: “They know all of X’s idiosyncrasies and if I want to know anything about X they look it up in the care plan.”

People were provided with nutritious meals and drinks. Care plans guided staff members on how to support people to have a nutritious balanced meal. This was to ensure people were not at risk of poor nutrition and dehydration.

On the day of our inspection the lift engineer was in attendance servicing the lifts. We looked at record of checks carried out by the engineer and saw no issues were found and the equipment was in working order. This showed equipment was properly maintained and suitable for its purpose.

There were enough qualified, skilled and experienced staff to meet people’s needs. One staff member told us they had enough time to carry out support to people and thought the shifts were well managed. This was supported by one relative who told us: “There is not much of a turnover in staff, there is very good continuity of care.”

We spoke with five people. People told us they were happy with the care provided. One person said they were "happy living at the home". One relative told us the care was "fantastic".

The home had systems in place to ensure the equipment was maintained and fit for purpose.

Appropriate recruitment checks were carried out before new staff commenced work.

People told us they would raise concerns with the home's manager if needed. People’s complaints were investigated and resolved, where possible, to their satisfaction.

People said they were well cared for and the staff “were very kind and caring”.

People told us that staff respected their privacy and dignity while carrying out personal care.

People said they were happy living at the home and felt able to raise concerns with the home’s managers.

White Lodge Care Home is located near Marlow. It provides accommodation and personal care for up to 23 people. At the time of the inspection 21 people were living at the service. The Provider is heavily involved with the running of the home. There was a very homely welcoming feel to the establishment. The service offered a range of activities during the week, including quizzes, crafts, hairdressing.

White Lodge has 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.

The inspection was undertaken over two days and was unannounced. At the previous inspection undertaken on 02 October 2013 the service was found to be compliant in all standards checked.

People told us they felt safe and content living at White Lodge, comments included “I definitely feel safe”, “It’s a happy place”; and “It’s so nice, so good you feel contented and safe.” This was echoed by family who visited the home, comments included “ I love it , I would move in tomorrow”, and “I cannot fault it”, “The staff always keep in touch.”

We found no concerns regarding staffing levels, and observed quick responses to call bells; this corresponded with what people using the service and their families told us. Comments included “They (staff) always respond very quickly”, “They (staff) are very prompt in their actions.” Staff were attentive, caring and aware of people’s preferences, likes and dislikes and how best to support them, they were also knowledgeable about their roles and responsibilities. Staff were aware of how to minimise risks to individuals and how to raise concerns when needed. Safeguarding information was available to staff and people who visited the service.

Healthcare professionals were very complimentary of the service. They felt staff were knowledgeable about the people they were supporting and identified issues quickly so appropriate action could be taken to prevent a deterioration in health or wellbeing.

Risk assessments were comprehensive and reviewed at regular intervals. Medicines were managed in safe way. We found people were complimentary of the food provided. Many vegetables and fruit cooked were grown on site and so were freshly prepared.

The service worked in line with the Mental Capacity Act 2005; however there was some misunderstanding around the use of assessments for people who were already deemed to have capacity.

We found that some pre-employment checks were completed for new staff, these included employment history, references, and Disclosure and Baring Service checks (DBS). A DBS is a criminal record check. Staff did not have a pre-employment health checks. This is a requirement for people who carry out a regulated activity. Staff received training appropriate to their roles, however refresher training was not offered consistently and regularly. There was not a robust system in place to monitor when staff needed refresher training. The service used a system to record training, but this was not routinely kept up to date.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to the regulations 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 this report.