This inspection took place on 26 and 29 June 2018 and was unannounced, which meant the registered provider was not aware the inspection would take place in advance.

White Rose House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

White Rose House provides nursing and personal care for up to 64 older people. The home has two floors, with the ground floor providing residential care and the first floor providing residential care for people living with dementia.

At the time of our inspection the home did not have a registered manager and instead a ‘turnaround manager’ was in day-to-day charge of the home and they had been in post from March 2018.

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 last inspection in May 2017, we found two breaches of the regulations relating to consent to care and good governance. We found the registered provider had not consistently applied the correct mental capacity assessment or obtained consent from the relevant individual where a person lacked capacity. Contemporaneous care notes were not kept for people nutritionally at risk or in receipt of pressure care and there was a lack of quality oversight due to minimal use of audit tools. The registered provider had not ensured all staff received an induction, ongoing support or the necessary training to be a skilled workforce.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of effective and well-led to at least good. At this inspection we still had concerns regarding assessments of people’s capacity which were not decision specific and people were assessed as having capacity when this should be assumed as stated in the Mental Capacity Act (2005). We found the oversight of the home had not been effective as there were still concerns regarding the use of topical creams. We found people had developed pressure areas and there were gaps in people’s repositioning records. The turnaround manager told us these pressure areas were either improving or were fully healed at the time of our inspection.

Communication in the home had not been effective and we found one person had been inappropriately assisted to move as a result of this.

People told us they were supported by staff to access healthcare services. However, we saw examples through records of complaints where access to healthcare had not been promptly supported.

Staff received training in a number of areas and ongoing support was provided through individual and group supervision. We found staff appraisals were not taking place, although a plan to address this was in place.

Staff were able to describe how they would identify abuse and report this. We looked at safeguarding records and found this information had been appropriately acted on.

People told us they were satisfied with the quality of food provided, although they wanted more choice in their afternoon meals. We observed the dining experience and found this was positive.

The activities provision within the home was a strength of the service with both regular and one-off events being held. Weekly trips were taking place, but we found these were limited to a small number of people who were more independent and required minimum support.

People were complimentary about the staff who provided their care. We found staff respected people’s dignity and privacy.

Care plans were person-centred with details about people, their life history and care pref

This inspection took place on 16 May 2017 and was unannounced. We carried out an inspection in March 2016, when we found the provider was not meeting all the regulations we inspected. We found the provider had not consistently applied the correct mental capacity assessment or obtained consent from the relevant individual where a person lacked capacity, contemporaneous care notes were not kept for people nutritionally at risk or in receipt of pressure care and there was a lack of quality oversight due to minimal use of audit tools and the provider had not ensured all staff received an induction, ongoing support or the necessary training to be a skilled workforce. We told the provider they needed to take action; we received an action plan telling us what they were going to do to ensure they were meeting the regulations. At this inspection we found the home had not fully met all the regulations.

White Rose House Care Home provides nursing and personal care for up to 64 older people. All the bedrooms have an en-suite facility. There is a coffee lounge, library, hairdressing salon as well as landscaped gardens. Car parking is also available.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). However, they were no longer in day to day control of the service. A new manager had been appointed in January 2017. 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 our last inspection a new manager and area director had been appointed. During our inspection we were able to see improvements had been made in this period of time. However, the management team need to review the records kept in the home as the home was not keeping contemporaneous care records and there was a lack of provider quality oversight. People had opportunity to comment on the quality of service and influence service delivery. Effective systems were in place which ensured people received safe, quality care. We saw complaints were appropriately managed.

We found medicines were well managed; although, the administration process and recording for the application of creams needed reviewing. People attended regular healthcare appointments. However, the process for people’s weight management needed strengthening.

Although the provider was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS), further work was needed to ensure, where needed, mental capacity assessments had been completed.

There were no activities available on a day to day basis. A new activity coordinator was due to start in mid-June 2017. A contingency was needed for the provision of activities when the activity coordinator was not available. People’s care plans contained sufficient and relevant information to provide consistent support; however, the management team needed to make sure all the care plans contained the most up to date information.

We found people were well cared for and supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. Staff received the training and support required to meet people’s needs. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understaffing of safeguarding and knew what to do to keep people safe. People’s mealtime experience was good and their nutritional needs were met. People’s equality, diversity and human rights were respected.

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The inspection of White Rose House took place on 14 March 2016 and was unannounced. The service was previously inspected in July 2015 and found to be requiring improvement in all areas. There were breaches in the Health and Social Care Act 2008 Regulations in regards to person centred care, dignity and respect and nutrition. The service had completed an action plan detailing how they were to address these issues and on this inspection we found some improvement had been made but there were also further areas of concern.

White Rose House provides nursing and personal care for up to 64 older people. On the day of inspection there were 53 people living in the home, 16 of whom were in receipt of nursing care.

There was no registered manager available on the day we inspected. However, there was a relief manager in post who had been in the home for three weeks. 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.

People told us they felt safe and the staff we spoke with were able to explain what may lead them to report a safeguarding concern. Risk assessments were not always reflective of a person’s needs which meant key aspects of minimising these risks to people in delivery of their care could be missed.

We found staffing levels were satisfactory in regards to meeting people’s needs and staff responded promptly to call bells. However, we did highlight to the registered provider the issue with the call bell defaulting to an emergency alarm immediately which put staff under additional pressure to respond quickly as they were unable to determine the urgency of a call. They said they would take immediate action to rectify this.

Medicines were stored appropriately and people received their medication safely and in line with their prescriptions. This included any PRN (as needed) medication where the home had specific protocols in place to identify when this might be needed.

New staff had not received an induction prior to the start of the relief manager but this had been subsequently arranged. We found that ongoing supervision and training had not been given to ensure staff were suitably skilled and competent.

The home had a number of Deprivation of Liberty Safeguards (DoLS) authorisations in place. We found errors in a number of mental capacity assessments which conflicted with other information in people’s care records which meant the service was not compliant with the requirements of the Mental Capacity Act 2005.

Recording was poor for nutritional intake and pressure care relief, especially on the residential unit as there were no specific pressure care records for staff to follow. Pressure care was recorded in people’s daily notes which meant it was harder for staff to determine what pressure care had been given and at what time.

We did see a much improved dining experience for people in both the communal areas and for those eating in their rooms from our previous inspection. Staff were caring in their approach with people, mindful of acknowledging them and respecting their privacy. It was evident that there had been consideration about how to support people with dignity.

The activities co-ordinator was a positive role model for the home and people spoke highly of their contribution. Care records were detailed but there was sometimes too much information which meant navigation around the file was difficult. This posed a significant risk as the service was using agency staff and they needed to be able to access key information quickly. Reviews were recorded separately to the care plan which again meant key information was not integrated and heightened the likelihood of this being missed.

People told us they liked living at the home and staff f

This visit was carried out by three inspectors.

We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, their relatives, staff members and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were some systems were in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. However, we found that audits of care records had not been carried out in the last five months.

We found many areas at the home were unclean and equipment was not always well maintained.

Staff rotas took people’s care needs into account. However, there were several times where the home had less staff members on shift that was required, particularly during nights, where there were many staff shortages that had not been covered.

We found some issues within care records we looked at and asked the provider to make a referral to the local safeguarding team for these issues.

Is the service effective?

People’s care records were not always assessed with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people’s care records were not always up to date and, at times, contained incorrect or inaccurate information.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People’s preferences, interests, aspirations and diverse needs had been recorded in some care records, but not others.

Is the service responsive?

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges with no interaction from staff members for a considerable length of time. People who lived at the home told us they would like more activities to partake in.

People, or relatives of people, knew how to complain if they were unhappy. We saw evidence that complaints were dealt with in a timely manner and responses sent to the complainant.

Is the service well-led?

The service had quality assurance systems in place and, where shortfalls were identified, actions were identified. We found some issues with the completion of audits, where audits had not been carried out on care records in the last five months. We also found many areas of the home were dirty, though this had not been identified during audits of the environment at the home. We spoke with the manager about this, who told us audits had not been carried out recently due to them being relatively new in post. The manager said they would ensure that audits were carried out regularly.

Staff told us they were clear about their roles and responsibilities. People who lived at the home and some staff we spoke with said they felt carers were ‘stretched’ and did not have a lot of time to carry out their duties.

We carried out this review as part of our routine schedule of planned reviews. However, we had also received concerns that people’s social needs were not been met and following the outcome of a recent incident, written communication between the district nurses had been identified as an area for improvement. These issues were included for review as part of this visit.

At the time of our visit there were 62 people living in the home. We talked with 13 people who used the service, two visitors, seven staff and the manager.

During our observation we found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people.

People’s social needs were assessed and care was planned to meet their needs.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment. This was because the provider worked in co-operation with others.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

At the time of our inspection there were 58 people living at the home; we talked with four people who used the service and five staff.

Comments from people who used the service about the care they received included:

"The staff look after you very well indeed.”

“I can go to bed and get up when I want. I am quite happy with my room and can go there when I wish. The staff are all lovely.”

On the day of our inspection we spoke with five people who used the service and a visitor. They told us the staff treated them with dignity and respect and encouraged them to maintain their independence. For example; we saw that staff knocked on bedroom doors before entering, and we saw one person was encouraged by the staff to use their walking stick to ensure they could mobilise independently.

People told us they were happy living at the home. One person said, "The staff are all very good and the manager is brilliant.”

In relation to activities one person told us, “There is always something going on and it is up to us if we want to join in.”

People told us they were given a choice of meal and their food preferences were taken into account. Comments included: “The food is lovely.” “There is always plenty to eat and always a variety.”

A visitor told us, if they had a concern they would go to the manager and they were confidence their concern would be sorted out.

The inspection of White Rose House took place on 7 July 2015 and was unannounced. We previously inspected the service on 23 June 2014 and found it to be non-compliant with regard to the care and welfare of people, safeguarding, cleanliness, staffing and assessing and monitoring the quality of service provision. The provider submitted an action plan to address these areas and this inspection checked whether improvements had been made. We found that the home had made some progress in these areas.

White Rose House care home provides nursing and personal care for up to 64 older people. On the day of inspection there were 55 people living in the home. The home is over three floors shared between nursing and personal care support.

People told us they felt safe living in White Rose House and we found that staff understood how to identify abuse and respond effectively to any concerns. Staffing levels were appropriate to the needs of the people in the service on the day of our inspection and we saw that medicines were administered, recorded and stored correctly in a locked room.

We saw that the service had comprehensive risk assessments but these were not always current and some were not written in a person-centred manner.

Staff had received an appropriate induction and subsequent regular supervision. Training was mostly up to date but we saw the service needed to offer further dementia awareness for staff.

The service was acting in accordance with the Mental Capacity Act 2005 Deprivation of Liberty Safeguards legislation and people were consulted and referred on for further health support when needed.

We found that records relating to people at nutritional risk were not always kept up to date and in some cases, were inaccurate. This meant that people were not being consistently monitored and concerns identified. Mealtimes also evidenced limited choice for people as meals were ready-plated and condiments added without question.

Staff were caring when dealing directly with people and sought to obtain their consent re their care needs where necessary. However, we found not all staff were respectful when talking to each other about people living in the home.

The home had just appointed an activities co-ordinator and so were commencing a new programme of events and we found they were timely in their response to complaints. However, we found that not all records were written in a person-centred manner.

We found the home to have a friendly atmosphere and staff and people living there spoke highly of the registered manager and other senior staff.

The service had 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.

We saw that audits of the quality of the service were limited and needed consideration such as analysis of falls and incidents. The registered manager provided us with a prompt action plan following our visit indicating areas they had actioned for improvement.

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