This inspection took place on 24 May 2017 and was unannounced. Whitelodge Care Home is located near the borders of both the City of Bristol and South Gloucestershire and is registered to accommodate up to 21 older people. There were 20 people in residence when we visited. All bedrooms are for single occupancy. The home is accessible to those people with mobility impairments. There is a passenger lift and stair lifts in situ.

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 were safe. Any risks to people’s health and welfare were well managed in order to mitigate the risk. Safe recruitment procedures were followed to ensure unsuitable staff were not employed. Staff received safeguarding adults training and knew what their responsibilities were if bad practice was witnessed, alleged or suspected. The appropriate steps were in place to protect people from being harmed.

The premises were well maintained and all maintenance checks were completed. The management of medicines was safe and people received their medicines as prescribed. The registered manager ensured staffing levels were sufficient to meet the care and support needs of each person in residence.

All staff had a programme of mandatory training and refresher training to complete. New staff had an induction training programme to complete at the start of their employment. Care staff were supported to complete nationally recognised qualifications in health and social care. The staff team were well supported to do their jobs.

People were encouraged to make their own choices and decisions and to remain as independent as possible. Staff asked people to consent before they provided care and support. When people lacked the capacity to make decisions, best interest decisions were made involving healthcare professionals. We found the service to be aware of the principles of the Deprivation of Liberty Safeguards. They had acted accordingly when there was a need.

People were provided with well- balanced and nutritious meals and sufficient fluids. They were encouraged to make suggestions about meal choices. Each person was registered with a local GP and arrangements were made for people to see their GP and other healthcare professionals as and when they needed to.

The staff employed at Whitelodge Care Home were kind and caring towards the people they were looking after. On the whole their interactions with people were friendly and meaningful but we did discuss with the registered manager the competency and approach of one staff member. People were able to participate in a range of different activities.

People and their families where appropriate, were involved in devising their care plans and making decisions about how they were looked after. Their care plan was regularly reviewed to ensure it remained a true reflection of their care and support needs. Staff listened to what people had to say about the things that affected their daily life and how the service was run.

‘Resident’ meetings were held on a two monthly basis and enabled people to express their views and make suggestions about how things could be done differently. Staff meetings were also held every two months. There was a regular of audits and checks in place in order to monitor the quality and safety of the service. These checks enabled the provider and registered manager to identify any shortfalls and to make improvements.

We carried out this inspection on 7 April 2015 and this was an unannounced inspection. During a previous inspection of this service on 9 October 2013 there were no breaches of the legal requirements identified.

Whitelodge Care Home provides accommodation and personal care for a maximum of 21 people. At the time of the inspection there were 19 people living in the home. The home has accommodation over three floors. Access to the upper floors is gained via the stairs, a stair lift or a passenger lift. The home also provides care to some people living with dementia.

A registered manager was in post at the time of 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 and associated Regulations about how the service is run.

The provider had not undertaken the appropriate assessment and documenting of a person’s needs and associated risks.

People told us they felt safe and staff demonstrated the ability to report safeguarding concerns internally or externally if required. Safeguarding and whistleblowing policies provided information for staff as to how they could raise concerns externally.

Staff said that generally there were enough staff to enable them to perform their roles effectively. People said there was enough staff on duty to meet their needs and that their needs were met in a timely way. Appropriate recruitment procedures were completed.

People received their medicines on time and safely. Medicines were stored appropriately and records had been maintained.

People gave positive feedback about the staff at the home and the standard of care they received. Staff spoke positively about the training they received from the provider and said they received regular training and supervision.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). The service had completed and submitted the required documentation to make DoLS applications.

People received sufficient food and drink. Comments about the standard of food provided were good. The service obtained the services of a GP and other healthcare professionals when required.

We observed friendly interactions between people and staff throughout our inspection. People spoke in a very positive manner about the staff at the home. People were involved in making decisions about their care and felt their privacy and dignity was respected by staff.

People received care in accordance with their assessed needs from staff who understood their needs. The provider had a complaints procedure and people felt confident they could complain if required and would be listened to.

Activities were arranged for people and people felt they had sufficient to do at the service.

The registered manager was respected by people at the home and the staff. Staff commented very positively about the management of the home. Staff felt able to raise suggestions and there were systems to continually monitor people’s health and welfare.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This was a follow up inspection to check that improvements had been made. When we inspected the home in July 2013 we found that one person’s bedroom had an unsuitable floor covering which meant it could not be cleaned thoroughly and that there was a very strong odour in this room.

At our most recent inspection we found that the provider had replaced the flooring in this person's bedroom with a more suitable product. However, a referral to the continence service, which the manager in post at the time of our previous inspection undertook to make, had only just been made and the assessment had not yet taken place.

We spoke with four people who lived at the home, one visitor and five members of staff. People told us they were happy living at the home and were complimentary about the care they received from staff. Typical comments included, "It has a nice atmosphere here, it has improved over the last year”, “the staff are so kind". People told us that staff always asked permission before delivering any care.

People were offered a choice of food which was home cooked from fresh ingredients and support was available for those who needed it. People's nutritional needs were assessed and their weight monitored. People told us they enjoyed the food.

Medicines were stored and administered safely and there were systems in place to check that staff were competent and keeping accurate records of medicines.

Appropriate checks were carried out before new staff were employed.

The provider operated an effective complaints system and people were confident that their complaints would be taken seriously.

At our inspection of 29 June 2012 we found concerns with the care and welfare of people living at the home and standards of hygiene and maintenance. Care records were poorly maintained and in some cases did not contain important information about people's needs. Decoration in the home was poor and there was a strong odour in some parts of the home. Staff treated people kindly and were competent but were overstretched. There were insufficient cleaning staff.

On our inspection of 26 November 2012 we found that standards at the home had improved. Many areas of the home had been redecorated with further work planned. New chairs and carpets had been provided in the lounge. People told us that they were happy with the care they received. We saw that staff spoke to people kindly and were able to tell us about people's preferences.

During our visit an activity took place and we observed people laughing and singing and staff told us that activities were a lot of fun. People told us that the staff were very kind and friendly and that they enjoyed the food.

Care records were much improved and now contained appropriate information about people's health needs as well as personal care needs.

There had been an increase in the number of cleaning staff and this had made a significant difference to the standard of cleanliness in the home. Staff told us they had more time to talk to people in the afternoon as the number of staff in the afternoon had been increased.

When we carried out an inspection of Whitelodge care home on 29 June 2012 we found that improvements were needed in assessing, planning, monitoring and evaluation of people's care. The cleanliness of the home was poor in some areas and there were potential risks to people because of the lack of infection control policies and procedures. Following this inspection we told the provider that improvements needed to be made by 9 August 2012.

We visited the home on 10 August 2012 to check if these improvements had been made.

The home had made improvements in both of the outcome areas and whilst we felt they were still not meeting the standards we could see significant improvement and that the home was working towards compliance with the standards.

The manager of the home was not available at the time of our visit so a manager from the provider’s other home came to assist with the inspection. We met with ten people who lived at the home and two relatives during our inspection. One person had only recently come to live at Whitelodge Care Home, while others had lived there for many years.

Some of the people who lived at Whitelodge had a diagnosis of a dementia. There were some people who lived at the home with limited communication; some people were able to express their views clearly whilst others could not.

We did not fully discuss all of the outcomes with the people who live in the home as for some people their dementia or communication difficulties did not give them sufficient understanding of the questions we would have asked. We asked people about how they were being supported and what the staff were like.

One person told us that there were, “Very good staff but if they are busy I’ve got to wait”. When we asked them what they did with their time they told us, “I try to relieve the boredom”, they told us one thing they liked to do was watch football. Another person told us they watched TV or spoke to other people living in the home.

Another person said they were ‘very lonely’ and spent all their time in their room and that staff did not have any time to spend with them. The manager told us this person could not get on with the other people and spent all their time in their room as a result of this.

We saw that several of the people in the home did not leave their rooms during the day and there was no evidence that they were engaged in any activity. The manager told us these people chose to spend time in their room. One visitor told us that their relative, “Always looks tidy and well looked after”.

We had concerns that infection control practices were not appropriate in regard to the decontamination of equipment. The standard of cleanliness in the home was not of a high standard and there was a strong odour in the small lounge and various other places within the home. Interior décor was poor in some areas with wall paper peeling from the walls in the larger lounge and on the top floor there was a hole in the ceiling.

Due to the serious concerns that we identified during our inspection of Whitelodge care home we made a safeguarding alert about the home to Bristol City Council in respect of the care and welfare of people living there.