About the service: Whitehall Lodge is a care home service. It is registered to provide personal and nursing care to people for up to 29 people aged over 65 and adults under 65. At the time of our inspection 24 people were living in the service.

People’s experience of using this service:

People’s mental capacity was not assessed in line with current guidance and legislation.

However, staff involved people in decisions about their care and treatment and sought permission from people before care and treatment was given.

There were systems in place to monitor and assess the quality of service being delivered but there was no regular schedule for these checks. The provider had minimal oversight of the service.

People felt safe and staff understood how to safeguard people from abuse.

Individual risks to people and environmental risks had been identified and managed.

Staff were safely recruited and received ongoing support and training to carry out their role.

People’s medicines were managed safely.

Opportunities were available for people to engage with their local community and take part in activities in the home.

People were cared for in a way that promoted their independence and respected their privacy and dignity.

People’s care was planned according to their individual needs and preferences.

People’s views and opinions were sought to improve the quality of the service.

More information is in the full report.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to need for consent. Details of the action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Requires improvement (report published in January 2018)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to inspect as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected the service over one day on the 6 November. 2017 The inspection was unannounced and carried out by one inspector and an expert by experience.

Whitehall Lodge is a care home which provides residential care and accommodation to older people. It is not registered to provide nursing care; this would be provided by the community district nursing team. People in care homes receive accommodation and 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. Whitehall Lodge accommodates up to 29 people in one adapted building. At the time of our inspection there were 25 people living in the home.

There was a registered manager in post who had come into post since the last inspection. 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 to the service on the 31 August and 1 September 2016, we rated this service as requires improvement overall and in three out of the five areas we inspect. We found two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They were for: Regulation 12 Safe care and Treatment and Regulation 17 Good Governance. The registered manager had left the home a few days before that inspection. Following this inspection, the provider sent us an action plan to show how our concerns had been addressed.

At this inspection, we found the service was run in the interest of people using it. Staff knew people well and there were enough staff to provide timely, effective care. Improvements had been made but we identified a breach in Regulation 12 as we were not confident individuals and generic risks were well managed.

There were some issues with the environment and some remedial work which required attention. Audits and maintenance checks were being completed but did not always produce clear audits of actions and when actions had been achieved.

Staff understood what constituted abuse and what actions they should take including reporting it to necessary agencies as and when required.

There were adequate systems in place for the safe administration of medication and people received their medicines as intended.

Staff recruitment was good and systems and processes helped ensure only suitable staff were employed. Staff were supported through adequate induction, training and supervision of their work practices although the latter was not always recorded.

Staff supported people to eat and drink sufficient to their needs and monitored this to ensure people were protected from the risks of malnutrion and dehydration. Weights were regularly monitored and steps taken to reduce unplanned weight loss.

Staff understood how to provide care according to peoples expressed wishes and needs and knew how to act lawfully to support people with consent and decision making.

Staff were caring and supported people with positive mental health and keeping active. People’s health care needs were met and people had opportunity to stay mobile and connected with their communities and their family.

Staff encouraged people to stay independent and respected their privacy and diversity.

Care plans gave enough information about people’s needs and how care should be provided in line with their need and wishes. There was a programme of planned activities and spontaneous activities which helped people stay engaged and active.

There was an established complaints procedure and systems to capture people’s feedback and views of the service. This helped identify what people would like to change or were happy with.

Overall the service was an improving one and people were sati

The inspection took place on the 30 and 31 August 2016 and was unannounced.

Whitehall Lodge provides care for up to 25 people. The home supports older people with physical and mental health needs. The accommodation comprised of four interconnected Victorian terraced properties.

The registered manager had left the service a few days before the inspection took place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The deputy manager was managing the home until the provider finds a replacement.

People’s medicines were not always administered and stored in a safe way. Sometimes people did not receive their medicines as the prescriber had intended. Staff did not always check people had received their medicines. Staff did not always follow the guidance of the service in administering people’s medicines.

People were not always kept safe as electrical products were not tested yearly to ensure they were safe to use. Equipment used to support people to mobilise was not always tested, to ensure it was safe to use.

The management team and the provider did not have effective systems to test the quality of the service provided.

These issues all contributed to breaches in the health and social care act.

The service was not responding to people’s social needs who lived at the service. There was a lack of social stimulation for many people at the service. The service had not considered ways to engage with people and seek their views on the service.

We gave a recommendation about improving activities.

People benefited from being supported by staff who were safely recruited, trained and who felt supported in their work by their colleagues and by the deputy manager. Staff received yearly appraisals. Staff also had regular supervisions. There was enough staff to safely meet people’s care needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. Staff knew and understood the health and care needs of people who lived at Whitehall Lodge.

Staff told us they were happy and proud to work at Whitehall Lodge. They assisted people with kindness . People’s dignity and privacy was maintained and respected. People were treated as individuals.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team and was working within the principles of the MCA.

People’s care plans contained important, relevant and detailed information to assist staff in meeting people’s individual needs. People were involved in the care they received. People’s needs had been reviewed. People’s care was person centred.

People were supported to maintain good health and wellbeing. The management team reacted proactively to changes in people’s health needs.

The service encouraged people to maintain relationships with people who were important to them. People’s relatives and friends were welcomed to the service and encouraged to visit.

There was a positive culture and a friendly atmosphere at Whitehall Lodge. The service felt welcoming and homely.

We found a breaches in Regulation 12 Safe Care and Treatment (2) (d) (e) and (g). We also found breaches in Regulation 17 Good Governance (2) (a) (b) and (e).You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The purpose of this inspection was to follow up the areas of concern we identified during our previous inspection on 2 May 2014.

As part of this inspection we spoke with the registered manager and looked at the records relating to complaints, safeguarding and staff supervisions. We also carried out a tour of the premises, to check on the cleanliness, hygiene and infection control practices that were being used.

We focussed on three of the key questions that were relevant to this inspection: Is the service safe? Is the service effective? And, is the service responsive?

This is a summary of our findings. If you would like to see further evidence supporting this summary, please read the full report.

Is the service safe?

During this inspection, the manager showed us a copy of the safeguarding policy that they had implemented, which contained the most recent Norfolk Safeguarding information, issued by the County Council. We also saw a memorandum dated 25 June 2014 that requested all staff read the policy and sign to confirm they had done so.

We saw that the whistleblowing policy had been reviewed in July 2014, so anyone referring to it would know that the policy was up to date.

This meant that people were better protected against potential abuse because staff had up to date policies and reporting procedures to follow if they saw or suspected abuse.

A tour of the premises showed that hygiene, cleanliness and infection control practices had greatly improved. People’s bedrooms, commodes, sinks and communal toilets were found to be clean and we did not see any inappropriate disposal of soiled waste.

Although some building work was in progress, this was not presenting a hazard to people living in the home in respect of hygiene or safety.

This meant that people were being cared for in a clean, hygienic environment.

Is the service effective?

A discussion with the manager, and records looked at, showed that staff had started receiving regular supervisions. The manager told us that appraisals were currently being organised and were scheduled for discussion at the next team meeting, due to take place on 25 September 2014.

This meant that people were being cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Is the service responsive?

We looked at a copy of the complaints policy and procedure and saw that this now provided suitable guidance for staff on how to respond appropriately to verbal or written complaints.

The minutes from the staff meeting dated 25 June 2014, stated that there had already been one residents’ meeting and that these would continue on a regular basis. The manager showed us copies of the satisfaction surveys that had recently been compiled. We saw that these were in the process of being given out for completion to people living in the home, visitors, external professionals and staff.

This meant that the provider had an effective system to regularly assess and monitor the quality of the service that people received.

The home is not usually occupied to its maximum level as the provider uses some rooms that could be shared, for single occupancy as this is what people prefer. On the day of our inspection there were 23 people living in the home.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us that they felt safe. The staff we spoke understood their responsibility to report any signs of abuse or suspected abuse. There was not a safeguarding policy or procedure in place. This meant that there were not clear instructions or information available for staff about safeguarding. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to ensuring that Government and local guidance about safeguarding people from abuse is accessible to all staff and put into practice.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.

The service was not clean and hygienic. This predominantly related to people’s bedrooms, commodes and communal toilets. This was putting people at harm and at risk of infection. We have asked the provider to tell us what they are going to do to meet the requirements in law to maintain appropriate standards of cleanliness and hygiene in relation to both the premises and the equipment used by people.

Is the service effective?

People told us that they were happy with the care and support they received and felt their needs had been met.

People’s care records showed that their needs had been comprehensively assessed and that care and treatment was planned and delivered in a way that intended to ensure their safety and welfare. The records were regularly reviewed and updated. This meant staff were provided with up to date information about how people’s needs were to be met.

People had comprehensive risk assessments in relation to their needs. These were reviewed on a regular basis. This meant that staff could determine if there was any deterioration in a person’s health and well-being as well as whether they required any additional care or support.

We noted that people’s records and charts were effectively completed and had no gaps. These charts related to their needs and included pressure area and fluid intake charts. This meant that people were being effectively monitored and helped ensure they were receiving effective care and support.

The service had an effective induction programme for all staff. The manager showed us the training schedule for the service and we saw evidence that annual mandatory training took place. We noted that some staff members had accessed additional specialist training to help meet the needs of people who used the service. The provider had a process in place for managing the poor or variable performance of staff.

Staff had not received regular appraisals and supervisions. The manager in post was in the process of ensuring an effective system for staff to receive yearly appraisals and bi-monthly supervisions. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to ensuring all staff have adequate appraisals and supervisions.

Is the service caring?

We spoke with seven people living in Whitehall Lodge and they all told us that they were happy there and well cared for. One person said, “The staff are very caring”. Another person said, “It’s wonderful here. I don’t have any concerns and get well looked after”.

People were cared for and supported by kind and attentive staff. The staff had compassionate attitudes and it was evident that they had built positive relationships with the people who used the service.

The staff knew the individual needs of people and this was observed during their interaction with them.

People’s preferences and interests were documented in the service’s activities folder. There was evidence that people’s social needs were met but that this was mainly dependent on the two modern apprentices being on duty. We did not see evidence that people’s social needs were always met when these people were not working. One person who used the service said, “Sometimes it is really boring and there’s nothing to do. I feel well looked after but I just sit in the chair all day. I used to go out for a walk but that doesn’t happen anymore”.

The staff had effective communication skills and communicated in an appropriate and respectful manner.

Is the service responsive?

There was evidence that the provider effectively worked with other health and social care professionals to respond to the varying needs of people. Visits from people’s General Practitioner (GP) and district nurse were clearly documented.

We noted that the provider effectively responded to people’s varying health needs. This included caring for people at risk of developing pressure ulcers, on pressure relieving mattresses. Another example was ensuring a person had ‘build-up’ drinks as specified by their dietician.

There was information for people that explained how they could raise a complaint or concern. However, the service did not have an effective complaints procedure in place. There was no information or procedure for staff to follow if they received a written or verbal complaint. We did not see any evidence that learning from complaints had taken place to improve the service. We have asked the provider to tell us what they are going to do to meet the requirements in law to ensure there is an effective system in place for the management of complaints.

The service did not currently hold ‘residents’ meetings and the last time service satisfaction surveys were issued was during 2012. This meant people who used the service, their representatives, and visiting health and social care professionals were not asked for their views about their care and support in order for them to be acted on. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to regularly seeking the views of people who use or visit the service.

Is the service well-led?

During our inspection we saw evidence that the manager was in the process of ensuring effective governance arrangements. This meant that they were putting systems in place to identify, analyse and manage risks to help ensure the care and welfare of people who used the service and the staff.

We saw evidence that the registered manager had attempted to prioritise the improvements they recognised as being required. The manager did have a list of what was required. We noted that structural work to the service was being undertaken in order to improve the environment and facilities for the people living there.

The manager was actively promoting team working and there were processes in place to develop teams within the staff, inclusive of a team leader who would undertake the supervisions, and key workers for the people who used the service.

All of the staff we spoke with said that they felt well supported by the manager. There was evidence that staff were encouraged to give feedback about the service and how it was run. The staff told us that they felt confident to raise any issues or concerns with the manager and that these were acted on.

We spoke with four people living in the home and two visitors. People told us that they felt the staff were caring and they had no concerns about the way they were treated. They told us they were treated with respect. One said, "Some staff go that little bit further." They felt that all staff were good and some were like "...family."

We found that people's needs were assessed and guidance was set out in care plans about how staff were to support them. We saw examples of staff following this guidance to ensure people had the support they needed. We also found that, where people's needs had changed, care plans and guidance were reviewed and updated promptly. There was guidance about risks and what staff needed to do to manage .

People said that staff would arrange for them to see a doctor if they were unwell. A visitor commented that staff were alert to any small changes that might indicate someone was becoming unwell and always sought medical advice without delay.

Staff tried hard to meet people's needs and prioritised caring for people above other tasks. They maintained a calm and caring approach during our inspection. However, staffing levels and temporary absences compromised standards of both hygiene and cleanliness and their ability to support people safely at all times. People commented to us that sometimes people had to wait for the assistance they needed because of staffing levels.

We did not speak with people as part of this inspection. This was because we were following up specific aspects of care included in records, the safety and suitability of the premises and the checks that the provider and manager made on the quality of the service. However, we did observe that people were calm and comfortable and that there were no signs of agitation or distress. At our last visit people told us they were happy with the way that staff supported them and felt they were all very good.

We found that the provider and manager had taken action to ensure people's needs were properly assessed and that care was planned to meet these needs. We could see that the support people needed was reviewed regularly and prompt action was taken where people's needs had changed.

We saw that repairs and redecoration had taken place to ensure the home was safe and suitable for people and that a plan for ensuring further work was completed was being put together by the provider and manager.

We also found that systems for assessing and monitoring the quality of the service had improved to ensure that risks were properly identified and managed.

People told us that they felt the staff looked after them well. One said, "They're all very good and they know what they are doing." "I ring my bell and they come and see what I need." All were satisfied with the way they were supported. One person said that they used to be a bit scared when they were being helped with their mobility, using a 'stand-aid'. They said that the first few times it was a bit frightening but that staff had explained things and that they were fine with it now.

The told us that the food was good and that they had a choice.

People told us there were no strict routines in the home and they had many choices in their day to day lives.

Everyone we spoke with was happy with the staff. They commented that they were kind and treated people well. A number of people told us that there were not always enough staff on duty but there were no examples of people not receiving the care they needed.

People were happy with the care and support they received. Most people said they were able to retain their independence. People were satisfied with the meals and those we spoke with said there was enough to do during the day.