The inspection took place on 07 March 2018 and was unannounced. Our last inspection was in April 2017 where we identified seven breaches of the legal requirements. These related to risk management, safeguarding, staffing, dignity and respect, person-centred care, governance and notifying CQC of important events. At this inspection, we found that the provider had taken action to meet the requirements of the regulations in these areas. There was a new registered manager in post and they had implemented improvements to staffing, risk management and care planning. We noted they were finding innovative ways to involve people in the running of the service, as well as improving levels of support and communication for staff.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Whitebourne 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.

Whitebourne accommodates up to 66 people in one purpose built building. Care is provided across two floors, each with their own communal areas. The service specialises in providing care to older people who are living with dementia. At the time of our inspection, there were 45 people living at the home.

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.

Risks were managed safely, in line with people’s needs. Detailed plans were drawn up to manage individual risks and staff were knowledgeable about them. Where incidents, such as falls, had occurred, staff took action to ensure people’s safety. Staff understood their roles in safeguarding people from abuse and where necessary had raised concerns appropriately. The provider worked alongside the safeguarding team where necessary and had been notifying CQC of important events.

People’s care was planned in a person-centred way. People were given regular opportunities to express wishes or preferences and these were responded to by staff. People’s care was planned in a way that reflected their needs and was regularly reviewed. Staff knew people well and routinely involved them in their care. People received care promptly and in a dignified manner. Staff were respectful of people’s privacy, as well as finding ways to encourage people to maintain independence. Staff sought people’s consent and where appropriate, applied the Mental Capacity Act 2005.

Staff felt supported by management. The registered manager delegated tasks appropriately which had caused a significant improvement in staff support and communication. Improvements were being identified and implemented as planned and these involved people, relatives and staff. The provider had improved the communication systems in place and was finding ways to reward staff for good practice. The provider had developed important links with the local community that had led to improvements in activities and staff training. Staff had received training to enable them to be confident in their roles and they received regular one to one supervision meetings with their line managers.

People’s medicines were managed and administered safely. Staff followed best practice in administering medicines and the provider had systems in place

This inspection took place on 24 April and 2 May 2017. Both visits were unannounced.

Whitebourne is a care home providing residential care for up to 66 people, some of whom are living with dementia. At the time of our inspection there were 63 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. Since the inspection management arrangements at the home have changed. At the last inspection in 2015 we did not identify any breaches of the regulations. Since then the service quality had deteriorated and the provider failed to have effective oversight in order to identify what was going wrong and to make improvements. Since this inspection the provider has increased their quality assurance checks and has implemented a new action plan to make the improvements needed. The local authority and the CCG have informed us that some improvements have been made and others are still in progress.

Some people were not being protected against potential risks because risk assessments and guidelines for staff were not in place for people who have behaviour that challenges the service. Mobility care plans lacked the detail required for people to be adequately supported and to enable staff to attempt to prevent falls. Some staff did not have a good understanding of what might constitute abuse. Where potential abuse had occurred due to the behaviour of a small number of people this had not been identified or reported appropriately.

There were not sufficient staff to meet people’s needs. People and staff members confirmed this. Staff did not have enough time to spend with people and staff told us they did not have time to update care plans so these were out of date. Due to a lack of staff people’s needs were not always being met and there was a high incidence of unwitnessed falls. We spoke to the provider about this. They accepted they did not have sufficient staff to meet people’s needs and agreed to increase the staffing, and to not accept any more referrals at this time.

Staff did not always work in accordance with the Mental Capacity Act 2005 (MCA). Staff were unable to describe the principles of the MCA and some people did not have their capacity assessed to consent to their care or other important decisions.

Staff had not always received the induction training needed to meet people’s needs. Staff had received on-going training.

People were not supported by staff who had regular supervisions (one to one meetings) with their line manager. The provider had a supervision and appraisal policy, which set out how many one-to-one meetings staff should have each year and included staff at all levels. This was not being followed. Since the inspection this has improved and staff are being supervised.

Staff were not always caring or treating people with dignity and respect. Although other individual staff did show compassion and care. People were not being assisted with personal care regularly.

People’s care was not always planned and plans lacked the detail required for staff to know what care to provide to people. Staff told us the care plans were out of date.

Care that was provided was not always person centred. People were unable to choose when they received care. Staff did not always know people very well.

People did not have a sufficient range of activities to stimulate and interest them especially for those who remained in their rooms and there was little if any activity at weekends.

The provider had systems in place to monitor the quality of the service and make improvements. However, these were not always effective. They did not identify that some people’s care was not p

Whitebourne provides accommodation and personal care for up to 66 older people, some of whom are living with dementia. There were 60 people living at the service at the time of our inspection.

The inspection took place on 20 May 2016 and was unannounced.

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 2008 and associated Regulations about how the service is run.

Staffing levels were sufficient to meet people’s needs, call bells were answered promptly and people did not have to wait for their care. However, staffing levels varied from day to day and the service did not use a staff tool to determine how many staff were required. We have made a recommendation regarding this.

There was an effective recruitment process that was followed which helped ensure that only suitable staff were employed.

People told us that they felt safe and relatives said they felt confident that their family members were well looked after. Staff received training in recognising the signs of abuse and were aware of how to report concerns. Risk assessments were completed to identify potential risks and these were regularly reviewed and updated.

Medicines were managed well and staff were aware of emergency protocols in place for people. People were supported to maintain good health and had regular access to a range of healthcare professionals.

People told us that the quality of food was good and a choice was always available. People were supported to maintain a healthy diet. Where people required support to eat this was provided in a dignified and unhurried way.

Staff received necessary training and support to enable them to do their jobs. There were monitoring tools in place to ensure that training, supervisions and appraisals were kept up to date.

People described staff as “Obliging, “Friendly” and “Kind”. We saw positive interactions between staff and people who took time to explain what was happening. Staff had a good understanding of people’s legal rights and took time gain consent from people.

Each person had an individualised plan of care which gave details of the person’s preferences and needs. Staff knew people well and approached them with kindness. People’s dignity and privacy was respected.

There were a range of activities for people to participate in both within the service and within the local community. People were encouraged to maintain their hobbies and interests.

People and their relatives spoke highly of the registered manager who they said was approachable. Feedback was sought from people regarding the quality of the service and action was taken to address any concerns raised. A complaints policy was in place and people told us they would feel comfortable in raising any concerns.

At the time of our inspection there were 65 people living in the home most of which had severe dementia. During our visit we observed staff talking to people with respect and compassion and assisting them in making choices.

People had up to date care plans and risk assessments that were regularly reviewed and that met their support needs.

We found that staff received annual safeguarding training and had a good understanding of their responsibilities regarding this.

We saw that the provider had an adequate number of skilled staff in order to provide individualised care. All staff received regular training and were well supported. We saw that staff had appropriate qualifications and experience in order to meet the care needs of the people.

The provider had systems in place to assess and monitor the quality of the service people received.

All of the people at Whitebourne had dementia and many were unable to tell us about their experiences. To help us to understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) tool.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they received and whether they had positive experiences. We spent time on each of the floors observing care and found that people had positive experiences.

Families spoken with during the inspection told us that where possible their relative had been asked to give their consent prior to any care or activities being undertaken. They also told us "staff always included them in discussions" about their relative's care.

People who could express a view told us they enjoyed the food, and that if they did not like what was on the menu, the chef would provide an alternative. Family members spoken with told us that their relative always enjoyed the food provided at the home.

People who could communicate with us in a meaningful way told us told us their rooms and the rest of the home was clean. Relatives spoken with told us the home was very clean. People who could express a view told us they had not had to make a complaint. Relatives spoken with told us that on occasions where they had minor concerns, staff dealt with them quickly and resolved the issues.

We did not speak with people during this inspection.

Some people spoken with told us they were happy with the home and the way it was run. They told us they could do what they liked within reason and found the staff to be nice.

Two people that we spoke with said they enjoyed the activities, especially exercises to music.

Some people that had been dressed by the night staff told us they always got up early as they didn’t need much sleep.

People that we spoke with confirmed with us that they felt safe and staff were kind to them.