This unannounced inspection took place on 20 and 22 February 2018. Whitefriars Nursing and Residential Home 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. Whitefriars Nursing and Residential Home accommodates 24 people in one adapted building and there were 23 people using the service at the time of our inspection. The service is registered for 28 people, however shared rooms are only used for people who have made a positive choice to share. All the rooms were single occupancy at the time of our inspection.

The last comprehensive inspection took place in April 2016 and the service was rated good. Following concerns received in February 2017 and again in September 2017, focused inspections were carried out to follow up on each set of concerns raised. At our inspection in February 2017 we did not find shortfalls, however at our inspection in September 2017 we identified shortfalls with the management of medicines and the risk assessments for people using the service and found a breach of regulation in relation to safe care and treatment. Following that inspection we asked the provider to complete an action plan to tell us what they would do and by when to improve the rating of the key question ‘Is the service safe? to at least good This was submitted by the provider and they stated they would achieve compliance by 1 February 2018.

The provider’s nominated individual is also the registered manager for the service. 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 said they felt safe living at the service. Medicines were being safely managed and risk assessments were in place and being followed to identify and minimise risks to individuals. People were safeguarded from the risk of abuse and staff knew the action to take if they had any concerns. Recruitment procedures were followed to ensure only suitable staff were employed at the service and there were enough staff available to meet people’s needs.

Systems and equipment were serviced at the required intervals and were maintained to keep them in good working order. There were processes in place to identify and learn from events and to improve practice in the service.

People were assessed and their needs and wishes identified before being admitted to the service. Staff received the training they needed to provide them with the skills and knowledge to care for people effectively. People’s dietary needs and preferences were identified and met, including meals to meet people’s religious and cultural needs. People’s healthcare needs were identified and they received the input from healthcare professionals that they required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People, relatives, and healthcare professionals were very happy with the care and support people received. Staff showed people respect and maintained their privacy and dignity. Staff had a good knowledge of people’s individual care and support needs and met these in a kind and caring way. People’s religious and cultural needs were identified and respected.

All the care records had been reviewed and were comprehensive, person centred and up to date. Activities took into account people’s interests and abilities and people enjoyed taking part. There was a complaints procedure in place and people and relatives felt able to express any concerns so they could be addressed. People’s end of life care wishes were recorded so these were known an

This focused inspection took place on 19 September 2017 at 8.45pm and was unannounced. The inspection was prompted by allegations that procedures for the safe management of medicines were not being followed, that people were not always being referred for healthcare input in a timely way and that staff slept on duty at night.

Previously we carried out a focused inspection on 17 February 2017 at 10.30pm due to an allegation that people were being locked in their rooms, and found this allegation to be unsubstantiated. The last comprehensive inspection was on 28 April 2016 when we rated the service ‘Good’ for all of the five questions we ask about services and Good overall. There were no breaches of the Regulations at our last two inspections.

Whitefriars Nursing and Residential Home provides accommodation and nursing care for up to 28 older men and women. The provider is also registered to provide personal care to people living in their own homes but this service was not operating when we carried out this inspection.

The provider's Nominated Individual is also the 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.

During the inspection, we found that some aspects of the management of medicines were not being carried out safely. Staff did not always adhere to the provider’s medicines policy in relation to the administration of medicines and writing out protocols to administer medicines to be given as required to people. Staff had also not noted on one occasion that the medicine being administered to one person was not the usual dose for an adult and that the dose and instructions on the medicine label did not match the hospital discharge letter. As a result there were risks that people might not receive their medicines in a safe manner.

Risks people faced whilst receiving care were generally well managed. In a few instances, we found that risks management plans were not comprehensive in mitigating identified risks.

We found a breach of regulation in regards to safe care and treatment. You can see what action we have asked the provider to take at the back of this report.

People received the support they needed to meet their healthcare needs. Staff ensured the relevant healthcare professionals were contacted for advice and to visit people to ensure they received healthcare they needed. We noted that people’s care records were not always updated to reflect the support they received and the outcomes of the referrals. The registered manager said they would improve this when we discussed this with them.

This inspection took place on 17 February 2017 at 10:30 pm and was unannounced. At the last inspection on 28 April 2016 we rated the service as Good for all of the five questions we ask about services and Good overall. There were no breaches of the Regulations at our last inspection.

Whitefriars Nursing and Residential Home provides accommodation and nursing care for up to 28 older men and women. The provider is also registered to provide personal care to people living in their own homes but this service was not operating when we carried out this inspection.

The provider’s Nominated Individual is also the 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.

We carried out this unannounced, out of hours inspection after we received information of concern from the local authority’s safeguarding adults team. The information alleged that staff locked people’s bedroom doors at night to prevent them from wandering and to keep them safe. We found no evidence at this inspection to substantiate the allegations.

This inspection took place on 28 April 2016 and was unannounced.

The last inspection of the service took place in May 2014 when we found no breaches of the regulations.

Whitefriars Nursing and Residential Home provides accommodation and nursing care for up to 28 older people. The provider is also registered to provide personal care to people living in their own homes. When we inspected, 23 older people were living at the service. The provider was not supporting any people living in their own homes at the time of this inspection.

The provider’s Nominated Individual is also the registered manager of the service. 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 provider had systems in place for safeguarding people using the service and assessing possible risks. Staff understood and followed these.

The provider carried out checks to make sure new staff were suitable to work with people using the service and there were enough staff to meet people’s care and support needs.

People received the medicines they needed safely.

The provider made sure staff received the training and support they needed.

People told us they enjoyed the food and drinks provided in the service.

The provider arranged for and supported people to access the healthcare services they needed.

Staff were kind, caring and gentle with the people who they were supporting.

Staff offered people choices and respected their privacy and dignity.

The provider assessed and recorded people’s care needs and produced a plan of care to make sure they met these.

The provider supported people to raise concerns and had systems in place to record, investigate and resolve any complaints.

The service had a manager who registered with the Care Quality Commission (CQC) in July 2013.

The provider had systems in place to gather the views of people using the service and others.

The registered manager and provider carried out a range of checks and audits to monitor quality in the service.

We spoke with seven people using the service, the relatives, friends or visitors of four other people, a visiting health care professional and the home’s manager and owner. We also looked at the care plans for four people, four staff recruitment files, medication records and the procedures for responding to complaints received.

People told us they were happy with the care and support they received. One person told us “I’m very well looked after. I had a very nice breakfast today.” Another person said “I get all the help I need. I tell the nurse if I’m worried about anything.” A relative told us “we’re very happy with the home. The owner, manager and staff are lovely.”

We saw people were consulted about their care and treatment and their care plans were regularly reviewed.

People’s medicines were well managed and the provider had systems in place to make sure people received the medicines they needed.

Appropriate pre-employment checks were carried out to make sure staff were suitable to work with people using the service.

Arrangements were in place to investigate and resolve, if possible, complaints from people using the service or their representatives.

We spoke with seven people using the service. They told us they felt safe in the home and staff were kind and helped them. Their comments included “I’m quite happy here, I can choose what I want to do” and “it’s nice here, they have nice things.”

We saw that staff helped people in a friendly and professional way. One person using the service told us “the staff are great, very easy going.” People were offered choices at meal times and they told us they could choose what activities they did during the day. They told us “the food’s good, there’s always plenty of choice” and “the food’s always good, you don’t go hungry here.”

We spoke with eight people working at the home and the home’s owner and manager. Staff were able to tell us how they respected the privacy and dignity of people using the service, how they offered people choices and how they ensured people were safe. Staff also told us they felt well trained and supported by managers and senior staff. Comments from staff included “we work as a team, we’re here to make sure people are well looked after” and “it’s a good place to work, we get all the training we need.”

We also spoke with the relatives of three people using the service. They told us they were very happy with the care provided at the home. Their comments included "we are very happy with the care," "I trust them completely, they are so caring" and "the staff are very good, they make sure people eat well and take their medication."

People said the staff promoted their independence and gave them choices about how they wanted to lead their lives. They confirmed staff treated them with respect and always knocked on their bedroom door before entering the room.

People told us that staff listened to them and they would feel able to make a complaint if they needed to. They reported that they felt safe living in the service and would report abuse if they saw it happening in the service.

People said that visitors were welcomed and that there were activities on offer most days if they wished to take part in them.

We saw that staff interacted positively with people and were caring and respectful when they talked with people.

Whitefriars provides accommodation for up to 28 people who require nursing, personal care and support on a daily basis. When we visited, 23 people were living in the home.

People told us they were very happy with the care and support they received. One person said “it’s more like a family than a nursing home.” People also told us they enjoyed the activities provided in the home. One person told us "one of the care assistants takes me to the shops in my wheelchair sometimes if I ask.”

People who needed assistance to eat and drink were well supported at lunch time and were encouraged to make choices about what they ate and drank.

The care staff we spoke with demonstrated a good knowledge of people’s care needs, significant people and events in their lives and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Staff told us they enjoyed working in the home and many of the staff we spoke with had worked in the home for a number of years. One member of staff told us "we get on well, colleagues are very friendly and cooperative.”

The home’s provider was also the registered manager and had been in post for nine years. She provided good leadership and people using the service, their relatives and staff told us the manager promoted very high standards of care. One member of staff said "management is kind and supportive if we have family problems.” Visitors also told us "people here are very caring. They have everyone's interests at heart" and "staff are very sweet to people; they treat them well and are very patient".

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.