This inspection was unannounced and took place on the 18 and 20 April 2018.

Whitefield house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

Whitefield House is a large detached house which provides accommodation for up to 37 older people in single en suite rooms, some of which opened up onto the secure garden area. At the time of this inspection there were 37 people living in the home.

We last carried out a comprehensive inspection of this service on 5 October 2016. At that inspection we found the service was not in breach of any regulations but improvements needed to be made in the way some medicines were managed and improvements needed to be made to the quality assurance processes in place in the home to show the action taken to address audit findings.

During this inspection we found the required improvements had been made.

Medicines were managed safely and people received their medicines as prescribed.

There was a robust system of quality assurance in place. Weekly and monthly checks and audits were carried out by the registered manager and other managers of the service. These were used to assess, monitor and review the service. Managers also spent time observing the care provided and completed unannounced visits to the home at weekends and night times.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

Individual and environmental risk assessments were person centred and gave staff guidance on how to minimise and manage identified risks. The service had policies to guide staff on health and safety and infection control. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

Safe systems of recruitment were in place. There were sufficient staff to meet people’s needs and staff received the training, support and supervisions they needed to carry out their roles effectively. People who used the service told us, “Staff are very well trained; you know that by the way they treat you.”

People had their nutritional needs met and were very positive about the food provided.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care records were detailed and person centred. They were written in respectful ways, described people in positively and included information on how to promote peoples independence, including things the person liked to do for themselves. They contained information based on people’s needs and wishes and were sufficiently detailed to guide staff in how to provide the support people required.

The providers were committed to providing people with high quality of accommodation. Whitefield House was undergoing a programme of refurbishment and was being decorated and furnished to a very high standard.

We found the atmosphere in the home was friendly, homely and easy-going. Staff showed empathy for and kindness towards people who used the service. Interactions were relaxed and there was lots of humour and laughter. People who used the service and staff appeared to genuinely enjoy each other’s company.

People enjoyed the activities on offer at the home and in the wider community. The registered manager and staff we spoke with placed great importance on preventing people from becoming socially isolated and also in promoting people’s well-being.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) t

This was an unannounced inspection which took place on 5 October 2016. The service had previously been inspected in September 2013 when it was found to be meeting all the regulations we reviewed at that time.

Whitefield House is a large detached house which provides accommodation for up to 37 older people in single en suite rooms, some of which opened up onto the secure garden area. At the time of this inspection there were 36 people living in the home.

There was a registered manager in place at Whitefield House. 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.

Staff had received training in safeguarding adults. During the inspection we observed staff respond appropriately to concerns raised by a person who used the service. Staff told us they would have no hesitation in reporting poor practice and were confident they would be listened to by senior staff.

There were sufficient numbers of staff available to meet people’s needs in a timely manner. During the inspection we observed staff took time to sit and chat with people. People who used the service told us staff were always kind, caring and respectful of their dignity and privacy; this was confirmed by our observations during the inspection. Our discussions with staff showed they had a good understanding of people’s needs and were committed to providing high quality care. We saw that people were supported to maintain their independence as much as possible.

Recruitment procedures in the service needed to be improved in order to fully protect people who lived in Whitefield House from the risk of unsuitable staff. This was because additional checks had not been completed for those applicants who had previously worked with vulnerable adults or children. The registered manager told us the recruitment processes would be changed with immediate effect.

Although medicines were generally safely managed, improvements needed to be made to the way the covert administration of medicines was recorded. People are sometimes given medicines covertly, i.e. without their knowledge in food and drink, with the agreement of professionals in their best interests to help ensure they receive their medicines as prescribed.

People's care records contained enough information to guide staff on the care and support required. The care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. We saw that plans were in place to help reduce or eliminate the identified risks. Risk assessments had been regularly reviewed to ensure they fully reflected people’s needs.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the premises and the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

Systems were in place to help ensure people’s health and nutritional needs were met. People who used the service told us the quality of the food was good. We observed that, where necessary, staff offered people gentle support and encouragement to eat.

We saw that a programme of regular activities was provided to

We spoke with four people who used the service, four staff members, a relative and the registered manager during this inspection. We also looked at the quality assurance systems and some records. This helped answer 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. This helped answer 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.

Was the service safe?

People who used the service told us, "I feel safe and would say if I wasn’t happy about something", "I’m really satisfied and I would complain if necessary but there’s nothing wrong, I’ve no complaints whatsoever" and "I have visitors who come at any time. I feel safe and would tell my relatives if I wasn’t happy about anything". A visitor told us, "I have no complaints. Management check that things are all right. They are outstanding. The quality of care is brilliant and we would complain if necessary. It is a safe place and we can visit anytime. We can go to her bedroom if we want to visit in private". We looked at the safeguarding policies and procedures, complaints procedures and plans of care. The service was under investigation by social service for allegations of abuse around pressure area care, moving and handling and the attitude and foul language of some staff. The investigation had not reached a conclusion at the time of the inspection. However, we did see that the registered manager had taken action, for example, she had sent around a memo to staff that inappropriate language would not be tolerated and was a disciplinary offence. Staff were trained in topics such as safeguarding and moving and handling techniques. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, safeguarding incidents, concerns, whistleblowing and investigations.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

Was the service effective?

Plans of care showed us that people who used the service or a family member had been involved in developing them. People's choices and wishes had been recorded for staff to give individualised care. People's health and care needs were assessed with them if possible and they were involved in writing their plans of care. Two people confirmed they had been involved in care planning and a visitor told us they were also kept up to date and involved.

People who used the service told us, "The food is quite good. You can have snacks and drinks between meals", "Good food, I would recommend it to all my friends”, "Food is very good and we have a choice" and "The meals are very good. They tell you what’s on the menu and if you don’t like it there are alternatives". A visitor told us the food was very good. People's nutritional needs were assessed and professional help sought where needed. We saw that some people were prescribed supplements. Specialist dietary, medication and community support needs had been identified in care plans where required.

People used the service told us, "Staff knock on my bedroom door and wait for permission to enter" and "Staff knock on my door and any care is given privately". We observed that any care was given in a private manner and did not compromise the dignity of people who used the service.

Was the service caring?

The people we spoke with told us, "Staff are very good, helpful and polite and they speak nicely. I have not heard any swearing", "Staff are excellent always", "Staff are polite and I’ve not heard them shout" and "The homes staff are very good, polite nice girls who don’t shout or swear". A visitor said, "Staff are friendly and there is a homely atmosphere". We saw that care workers showed patience and gave encouragement when supporting people. People were given their care privately to help preserve their dignity. People were supported by kind and attentive staff.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. One person who used the service told us, "I am kept busy. I am not bored”. Another person said, "I choose what I do all day. I go out a lot with my family who can visit when they want". Activities outside included people going out with their relatives, going shopping and taking a holiday. Entertainers were brought into the home and games, exercises, gardening, reading and watching television helped keep people active.

Managers held regular meetings with people who used the service and staff to take note of their views. There was a web site where people could fill in a quality assurance questionnaires and we saw the results of other surveys, which were positive. People who used the service told us, "It's a great place. We’re looked after", "“I’m looked after very well" and "I like it here. It's a nice place".

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Staff training was on-going, as was supervision and appraisal. Staff told us, "Management are approachable and supportive" and "I like the work and have had a lot of training". The staff we spoke with felt management were supportive.

During the visit, we spoke with two people who use the service and the relative of another person using the service. They told us the staff always asked permission before they provided care and explained what they were doing.

The people we spoke with told us they were happy with the care they received. They told us the staff were friendly and helpful and that they were well looked after by the staff. They also told us they were happy with the way staff supported them with their medication.

We spoke with two people who use the service. They told us that the staff were helpful and supportive.

The people we spoke with told us they were happy with the staff and the care they received and that they had no concerns.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.