This unannounced comprehensive inspection took place on the 27 November 2018. At our last inspection in December 2015 the service was rated as good. At this inspection, we judged the home as ‘requires improvement’.

Whitehorse Care is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Whitehorse Care accommodates up to eight people with learning disabilities in one adapted building. There were seven people living at the home at the time of our inspection visit.

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.

We found the provider did not have robust systems in place to safeguard people from the risk of harm or abuse and therefore we could not be assured people were consistently safe. Whilst staff understood the importance of recording any accidents or incidents there was no oversight by the provideron patterns and trends and how to reduce the risk of these incidents from happening in the future. There were sufficient numbers of staff to meet people’s needs and the provider had a system in place to recruit staff safely. People’s medicines were managed safely. People were protected from the risk of infection and cross contamination because staff members were provided with sufficient personal protective equipment.

We found people did not always have their rights upheld in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards People were supported by staff who had undergone induction training and who knew them well. People were supported to access healthcare services in the community. People received care from staff that had the knowledge about their individual nutritional needs. People’s nutritional needs had been assessed and people had food that they enjoyed.

People were supported by staff who were often caring but this was not consistent and embedded into the service. People’s dignity was not always respected. People were encouraged to maintain their independence and received regular visits from family and friends.

People and their families were not always involved in care reviews. People’s cultural and religious beliefs were respected. The service had looked at ways to make sure people had access to the information they needed in a way they could understand it, to comply with the Accessible Information Standard (AIS). People were encouraged and enabled to take part in activities and hobbies that interested them.

The provider had failed to send in statutory notifications as required by law. There were no robust systems and processes in place to effectively assess, monitor and improve the quality of the service provided. Staff felt supported by the Registered Manager. The provider worked with other agencies to support the well-being of the people living at Whitehorse Care.

During this inspection we identified three breaches of the Health and Social Care Act 2008 and You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 17 December 2015. At our last inspection on 24 July 2014, the provider was meeting the regulations we looked at. Whitehorse Care provides accommodation and personal care for up to eight people with learning disabilities. At the time of our inspection there were eight 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.

People received care from staff who knew how to keep them safe. Staff knew what they would do to protect a person from the risk of harm and how to respond to any concerns. There were sufficient numbers of staff available to meet people’s individual needs. The provider had recruitment processes in place which ensured staff had the appropriate checks completed before they began working in the home. People were kept safe by staff that had the skills and knowledge to support their needs.

Risks to people’s health and welfare were assessed and managed in a way that promoted people’s independence. People received their medicines as prescribed and these were stored and managed safely. People were asked for their consent before care was provided. People’s care and support was planned in a way that did not restrict their rights and freedom. People were supported to eat and drink where required and a variety of different foods and drinks was provided. Staff worked with a variety of different healthcare professionals to ensure people’s health needs were met.

Staff were kind and caring and understood people’s choices and preferences. People’s dignity and privacy was respected by staff when support or care was being provided. People were supported to take part in a variety of different activities and hobbies. Relatives told us they knew how to raise complaints or concerns and were confident the registered manager would listen and take appropriate action.

The provider had systems in place to monitor the quality of care that people received. This included gathering feedback from people and relatives. Relatives and staff spoke positively about the approachable nature of the registered manager.

We carried out an inspection on the 5 November 2013 and found that the provider was not meeting the regulations for consent to care and treatment and records. The provider wrote to us and told us what actions they were going to take to improve. During this, our latest inspection, we looked to see what actions had been taken.

From our previous inspection some action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were eight people living at the home on the day of the inspection but most people were out at the local day centre. During our inspection we met three people who used the service, but due to their complex health needs they were unable to speak with us so we observed how they were supported to help us understand their experiences of care. We spoke to one person at the end of our inspection who arrived back from the day centre and was willing and able to speak with us. We spoke with three members of staff who supported people, the manager and the provider who was supporting the inspection process and three relatives by phone after the inspection. We looked at three people's care records.

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

Is the service safe?

We found that there were systems in place to support learning from events like accidents, incidents and complaints. All the relatives we spoke with knew who to complain to, but told us they have never had to complain. Records showed there was a process in place that was displayed and available to people in other formats so that the information was accessible to them. This meant that people or relatives knew how to share any concerns they had.

One person we spoke with said, "I do feel safe here". Our observations of people were that staff interaction was good and people responded to staff in a relaxed and confident way. Staff were able to explain how they would keep people safe, and what action they would take where they had concerns around people's safety. This meant that staff had the knowledge and skills to keep people safe.

We found that risk assessments were in place and where people had specific health conditions, staff had the knowledge and skills to meet people's needs. For example where people were at risk of choking we saw that the appropriate training was available. This meant that people could be confident that staff were able to support them safely.

The home had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager had a good understanding of MCA and DoLS and confirmed that there had been no DoLS applications submitted to the local authority. All the staff we spoke with told us they had not been trained in the MCA or DoLS. Records we saw confirmed that not all staff had received training and staff were unable to explain what was meant by both terms and the implication for people who lacked capacity. Staff were able to explain how people were safeguarded and the actions they would take were people were at risk of harm.

We found from our previous inspection that medication was not secure. We found that improvements had been made to ensure medicines were now more secure. This meant that where people were being administered medicines, they were now being stored securely.

Is the service effective?

Records showed that the appropriate assessments and support plans were in place to highlight to staff how people's support needs should be met. Where people had health conditions like epilepsy, management plans were in place so staff had the right information to support them. Our observations were that people's needs were being met how they wanted. Where people attended a day centre so they were able to take part in social interaction and stimulation, this was identified in their support plan. Their development plan which was reviewed yearly highlighted why they attended a day centre and the benefits to them. One relative we spoke with said, "I am more than happy with how X is being cared for". This meant that people were receiving the support they wanted as highlighted in their support plan.

We found that where people needed support from health professionals this was available. Records however did not show how often people had appointment with health care professionals. For example, there was no optician or dentist visits. One relative we spoke with said, "The manager always let me know when X has a health visit". This meant that where people was seen by their health care professional this was not being recorded.

Where people had their meals supplemented or needed a special diet we saw this information displayed in the kitchen. This meant that staff who supported people to prepare meals or prepared people's meals could access the information as needed to support people's nutritional needs.

Is the service caring?

All staff we spoke with had a good understanding of people's needs and knew how to support them. We saw that people interacted with staff in a friendly manner having a laugh and a joke amongst themselves. Our observations of people were that they were relaxed and able to wonder around the home how and when they wanted. At meal times people were supported to eat their meals with staff encouragement and support where needed. One person who had a swallowing difficulty, we saw staff reminding them in a compassionate way to slow down and not rush what they were eating.

All staff were able to explain how they would support someone they found on the floor. Staff told us they had received training in first aid and where they were unsure as to a person's medical condition they would contact the emergency services and the person would not be moved. One person said, "The staff are all alright here". This meant that staff were caring in ensuring people's needs were met.

Is the service responsive?

We found that since our previous inspection records were now kept secure. The provider had a filing cabinet in place so records could be locked away and the office door was also locked. This meant all records were now meeting the providers confidentiality procedures.

All relatives told us they were able to be kept up to date on a regular basis about people's support needs. One person we were able to speak with told us that any concerns they had would be discussed with the manager. This meant the provider had a good communication process in place to ensure people's and relatives were kept up to date with information.

Is the service well-led?

The service was led by a registered manager, who was supported by the provider. We met both of them who were both present at the time of our inspection and assisted us with any information we needed.

We found that the quality assurance process used to gather people's views needed to be improved. We found that the questions used needed updating and all the relatives we spoke with told us they did not remember ever being sent a questionnaire to complete. This would enable the provider to improve their services based on the feedback from people.

This inspection was unannounced which meant the provider and the staff did not know we were coming. Some people using the service had multiple needs and limited communication. We saw the staff interacted well with the people they cared for. People were happy with the care and support they received, one person said, “The staff are good I like them.” Some people using the service were not able to communicate verbally with us. We were able to find out about their experiences of living at the home by observing care and talking to their families and the care staff.

Where people did not have capacity, a suitable assessment had not been carried out. Important decisions were made for people and the registered manager could not demonstrate they had been made in people’s best interest.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We checked to ensure medication was stored and administered in a safe way. We found medication management was suitable.

We saw there were sufficient staff to meet the needs of the people using the service.

We saw records relating to people using the service were not stored securely.

During our visit we spoke with the registered manager, the staff and people living at WhiteHorse Care - Brownhills.

We looked at five outcomes to assess whether people were involved and participated in the service they received; whether care was provided appropriately; whether the home could adequately ensure people's safety; whether staffing requirements were appropriately carried out and whether there was a system for ensuring ongoing quality assurance within the home.

One person living at the service told us, “It’s nice here. I like the staff”.

A relative told us, "It is a very good and very homely service. The staff are very friendly”.

Four people living at the service were not available to talk to us as they were doing activities and working in the community on the day of our inspection.

Staff we spoke with told us they had completed safeguarding training and understood how to identify abuse and what to do if an incident occurred.

We found that there were effective systems in place to manage risks to the health, safety and welfare of people living at the home.

We found that the home was compliant in all five outcome areas.

We carried out this review to check on the care and welfare of people using this service. There were eight people living at the home on the day of the visit and no one knew we would be visiting. We spent time with seven people who live at the home and spoke with two staff.

The atmosphere was calm, relaxed, friendly and homely. We saw that people were very relaxed and at ease with staff and within their home environment.

We saw that people had a good rapport with the staff. Staff interacted well with the people who lived there, in a warm, friendly and positive manner. There was lots of laughter in the home.

We looked at care records for two people living at the home and found their records

provided clear and up to date information for staff to follow so they could assist people with the care and support they needed.

People’s medication was well managed so that they received their medicines as prescribed.

We saw that people living at the home took part in various activities and worked, so that they had an interesting and meaningful lifestyle.

People are offered a choice of meals and drinks and are encouraged and assisted to eat a balanced diet.