Whitestone Lodge is a residential care home situated in the area of Roby, Liverpool. The service provides residential care for up to 20 people including people who are living with dementia. There are two floors accessed via stairways and passenger lift. At the time of our visit there were 18 people living at the service.

At the last inspection in November 2014, the service was given a rating of “Good” with one area highlighted for improvement which related to consent to care and treatment. At this inspection we found the area for improvement had been met.

People told us they felt safe living at Whitestone Lodge and were supported by staff that knew them well. One visiting relative told us “I have total peace of mind”.

The registered provider had appropriate policies and procedures in place for the management of safeguarding concerns. Staff had received training and demonstrated their understanding of abuse and actions they would take if they were concerned.

Staff recruitment procedures were safe and robust. Staff had received appropriate training and told us they were well supported. Staff demonstrated a good knowledge and understanding of the people they supported.

People told us sufficient staff were on duty at all times to meet their needs. Discussions with staff, relatives and our observations confirmed this.

Medicines were appropriately ordered, stored and administered by trained and competent staff. Medication administration records (MARs) were fully completed and signed. The registered provider regularly audited the medicines and completed actions as required.

Care plans and risk assessments were person centred and demonstrated the involvement of people and their relatives, where appropriate. These documents were reviewed and updated regularly.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People told us they were always offered a variety and choice of meals. Individual dietary requirements were met in accordance with people's care plans. We saw people had access to regular snacks and drinks throughout the day.

The building was well maintained, clean and free from unpleasant odours. All equipment was well maintained and regularly serviced.

People living at the home and their relatives knew how to raise a concern or complaint.

The registered provider undertook regular audits to monitor the quality of the service. The registered provider regularly sought people’s views to continually improve and develop the home.

We visited the service on 28 November 2014. This visit was unannounced.

Whitestone Lodge is registered to provide care for up to 20 people. The accommodation is provided on two floors with access to the first floor from stairs and a passenger lift. The home is situated in the Roby area of Huyton, Liverpool, close to Huyton village. There is a large enclosed garden to the rear of the home with a ramp and rails. Car parking is located at the front of the building.

At the time of our visit three of the home deputy managers were in the process of registering as the registered managers of the home in a job sharing capacity, with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, the 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 our previous inspection of the home in December 2013 we found the service was meeting the regulations we assessed.

People told us that they felt safe and well cared for at the home. Staff demonstrated a good awareness of safeguarding procedures and how to keep people safe.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act (MCA) 2008 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place in relation to the MCA. Records in place did not contain all of the information required in order for decisions made in people’s best interests as required under the Mental Capacity Act (MCA) 2005.

Care planning documents and records were in place that detailed people’s needs in relation to their care and support. Staff demonstrated a good awareness of the needs and wishes of the people they supported. We saw staff supported people in a manner that respected their privacy and maintained their dignity.

Staff told us that they felt supported in their role and were confident in what they did. We saw that staff had the opportunity to attend training and received supervision for their role.

The deputy managers carried out monthly checks to help ensure that people received the care and support they required. In addition, regular checks on people’s medicines and care plans took place.

During our visit, we observed people using services being regularly asked their opinion in different areas of care and at all times the provider acted in accordance with their wishes. Consent was sought in all areas of care including assistance with personal care which showed respect for the person using services. Although the care plans we observed were a little dis-organised we were assured the issue would be addressed when a new manager was recruited. However, they were personalised and showed the person using services, their representatives and staff members were involved in the development of the care plans. There was also evidence of multi-professional involvement for people using services.

During our visit, we observed all medication was stored appropriately and securely which ensured the safety of all people using services. Close monitoring of all processes were in place that identified who was responsible for any handling of medication at any given time which provided an acceptable audit trail. Records confirmed all staff members had received training on all aspects of their role as part of a comprehensive induction training programme which included a period of `shadowing` a senior member of staff and a period of probation prior to confirmation of permanent employment. We found that people using services at Whitestone Lodge had their complaints listened to and acted upon and systems were in place that supported people to make a complaint.

We spoke to five relatives, friends and carers and three people who used the service. They said they were more than happy with the service received. They were all very positive about the staff who supported them. We also spoke to two professionals who were visiting the service. They stated the service was very caring and professional.

We observed a good rapport between the people who used the service and staff. Our observations indicated that staff were attentive and had a caring attitude towards the people who used the service. We also spoke with the manager and four staff. We looked at the care records for five people to see how their needs should be met.

There were practices in place to ensure that the people who used the service were respected and that they were involved in the delivery of the service they received as far as this was possible.

Records showed that people had been assessed before they began to use the service. They had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

Staff were provided with the support they needed to enable them to meet the needs of the people who used the service.

There were systems in place to monitor the quality of the service.

We interviewed both residents and relatives during our visit to Whitestone Lodge. They told us: 'I have settled here and the staff have helped me to do this-I am more relaxed.

'Staff do what they can for me'

'I am happy here'

'I am pleased with the care, my relative is very well looked after-staff are very caring and I feel very involved'

'I am happy at the moment, all staff are really good'

'It is fantastic and beautiful, staff are excellent and they are all for the residents, I am involved with the care'

'Staff are centred on the residents'

'The new manager has made a big difference'

People who use the service and relatives were complimentary about the care provided by the careworkers. The comments received included:

"The staff here are absolutely the best I can't fault them",

"they are lovely, kind girls and good company",

"Don't think there are nicer care staff, these staff are excellent".

"‘staff are lovely",

"staff are very friendly".

People discussed with us how they thought their medical needs were met comments included:

"someone comes with me if I go for a hospital appointment",

"I've always seen the doctor if needed",

"Can't remember when I last saw a dentist but my dentures are okay at the moment", the ladies do eye drops very well’

"if I need painkillers I can ask for them",

"I don't like taking medication and don't really need to know what they are for".

We spoke with people living in the service about the food that they received. Their comments included:

"the food is good",

"it depends on whose cooking as to the quality and tastiness of the food",

"Food always looks nice",

"I really enjoy the food the cook is very good and knows what I like".

"I am offered a choice of food I don't have a big appetite and prefer just a bowl of soup".

People living in the service told us that they did not get involved in the running of the service. They had not been involved in writing their care plans and were not aware of "residents" meetings or questionnaires about their opinions.

We spoke with people about they environment they told us:

" I like my room",

"my room is lovely and tidy staff come in and do it daily",

"it's always clean and tidy".

When we spoke to people about the levels of staff working in the home they told us:

"the staff are hard-working as they are really busy, I don't like to disturb them",

"can't get out and about as there is no-one free to go with us",

"girls here do everything, cooking, cleaning, laundry they are great",

"I really like all the girls they work so hard. Sometimes you have to wait quiet awhile as they are really busy".