Whitestones Care Home provides accommodation and personal care for up to 41 older people. At our inspection visit, 40 people were receiving care.

This included people living with dementia.

The first day of inspection took place on 13 June 2017 and was unannounced; we completed a second day on 15 June 2017 and this was announced. The service was last inspected on 15 May 2015 and was rated 'Good' overall. At this inspection we found the service remained 'Good' in four out of five questions, which gives a rating of 'Good’ overall.

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.

Systems and processes to monitor and coordinate staff training in line with the provider’s requirements were not always effective. Prescribed creams were not dated when opened in line with the provider’s policy on medicines management.

Other systems and processes to check on the quality and safety of services were in place. Risks were identified and managed. Accidents and incidents were reported and monitored. Other systems for medicines management were in place and helped to ensure people received their medicines as prescribed.

Systems were in place to ensure people’s care was in line with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff created a cheerful, relaxed and happy atmosphere for people. Staff were friendly, polite and took time to greet people. People were treated with dignity and respect. People were supported to maintain relationships with family and friends and to stay connected to their local communities.

People were able to access healthcare professionals when needed to maintain good health. People were supported by staff and other professionals who worked together to provide appropriate end of life care.

People enjoyed their meals and their preferences were met. People were supported to maintain good levels of hydration that helped their overall health. Special diets, such as any modified texture diets were provided when appropriate.

Activities for people and the general environment had been used creatively to enrich people’s experiences of living at Whitestones Care Home.

Individual care plans had been developed with people and their families; and meant people received personalised and responsive care.

People and relatives were involved in the service and their views were listened to. The management team and staff were viewed as approachable.

Further information is in the detailed findings below

This unannounced inspection was carried out on the 15 May 2015.

Whitestones Care Home provides accommodation and personal care for up to 41older people. At the time of the inspection there were 41people living in the home all of whom were living with dementia.

The service has 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.

During the last inspection carried out on the 12 August 2014 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people’s health, safety and welfare, were not fully safeguarded as sufficient numbers of suitably qualified, skilled and experienced care staff were not always provided. We found that this had now been addressed and that there was enough staff to provide the support people needed and that they were deployed appropriately.

People were protected from avoidable risks and staff were aware of their duty of care to the people living at the home. Staff were trained to recognise and respond to signs of abuse. Risk assessments were carried out and reviewed regularly.

Medication was administered, recorded and managed appropriately.

The staff had appropriate training, supervision and support, and they understood their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

There was a variety of choices available on the menus and people were supported to have sufficient food and drinks to meet their dietary needs.

People were supported to access other health and social care professionals when required. People were supported to continue their relationships with their family members and friends.

Staff were caring, kind and compassionate and cared for people in a manner that promoted their privacy and dignity. People felt listened to and had their views and choices respected.

Where possible people were involved in the decisions about their care and their care plans provided information on how to assist and support them in meeting their needs. The care plans were reviewed and updated regularly.

The home was managed in an inclusive manner that invited people, their relatives and staff.to have an input to how the home was run and managed.

The home had systems in place to assess, review and evaluate the quality of service provision.

Whitestones is a care home for up to 41 people. It provides care and support to older people who have dementia. There were 34 people in residence when we undertook our inspection.

The service had a registered manager in post. There were clear management structures offering support and leadership. This meant the home had a positive, empowering culture. Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

People told us that they were happy living at the home and they felt the staff understood their care and support needs.

We found that people were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services. We saw the staff understood people’s care and support needs, were kind and thoughtful towards them, and treated them with respect.

We saw the staff had received training and understood the needs of people with dementia.

There were insufficient staff to meet the needs of people at all times. People were left without staff for long periods and relatives, staff and other visitors told us people using the service had to wait during busy periods. There were not enough staff to keep people safe.

Improvements were required in relation to the recording and auditing of medication to ensure the information was current and up to date to ensure people were properly protected.

People spoke positively about the range of activities in the home and the activities met everyone’s individual needs and preferences.

We found that the home was clean, hygienic and well maintained.

Each member of staff received an induction before starting work and core training. The staff had also completed training in areas such as caring for people with dementia and equality and diversity. This meant the staff could meet people’s individual needs.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions about their care, support and safety. These systems followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This legislation sets requirements to ensure that where appropriate decisions are made in people’s best interests.

The problems we found breached some areas of the Health and Social Care Regulations. The action we have asked the provider to take can be found at the back of the full report.

At our visit there were 41 people accommodated. Many people had medical conditions such as dementia, which meant we were not able to ask them about the care they received. We observed how people were supported and cared for, looked at six people’s care records and spoke with three people, two relatives and eight staff about their experiences of the service. This helped us to understand people’s experience of the service.

Three people told us they were mostly satisfied with their care and support and two people told us about some of the activities regularly organised, which they could choose whether to join. One person said, “I like the music sessions, I love old time music and dancing.” Another person told us, “I think I pretty much get the care I need. We found activities were planned in a way that suited people’s preferences and dementia care needs.

We saw that people were supported to eat and drink sufficient amounts to meet their needs. They were also cared for in a clean hygienic environment and protected from any risks from infection.

However, we found that people’s recorded needs assessments and care plans did not always ensure their welfare and safety. This included risks from their nutritional status and their medicines, which were not always safely administered. We also found that sufficient numbers of care assistant staff were not always provided to meet people's needs. However, we found the provider and manager, were taking action to address this.

We visited the home in December 2012 and found that the provider and registered manager had not ensured that people were receiving care, treatment and support that met their needs or protected their safety and welfare. We issued a warning notice to ensure that improvements were made quickly in order to protect people. We also found that there were not always enough staff to meet people’s needs.

During this visit to the home we found that peoples’ needs were being appropriately assessed and that guidance was available to staff on the support people required. Detailed risk assessments were in place and were specific to the person concerned. This showed that peoples’ safely and welfare were being protected.

The number of staff was more consistent and peoples’ needs were being met. Additional members of staff had been employed in order to increase the numbers of staff working overnight and the registered manager was in the process of recruiting to newly vacant positions within the home.

We spoke with three members of staff during our visit. They felt that the number of staff working at any one time had improved and they found they were able to meet people’s needs more effectively.

At our last visit to Whitestones on 17 July 2012 we found that there were not always up to date risk assessments in place, there were insufficient numbers of staff allocated to work the night shift and that vacant shifts were regularly not covered. In their action plan, the provider had told us that arrangements were in place to address these issues and monitor them on an ongoing basis.

During our visit we looked at the care files for five people living at Whitestones. We found that everyone did not have a care plan and that risk assessments for falls were not being completed.

As a number of the people at Whitestones are living with dementia, we were unable to speak with them to gain their views. We did speak with the relatives of three people living at Whitestones and they told us “I am more than happy with the care my (relative) receives but staff have a lot on their plate”, “I feel sorry for staff as I feel they are understaffed but they all do work very hard” and “My (relative) seems happy there, I haven’t seen their care plan but it would be nice to.”

We looked at the staffing rota for Whitestones for the six weeks prior to our visit and these showed that staffing levels Monday to Friday had improved although this was inconsistent. Staffing levels on a weekend were considerably lower than during the week. Staff we spoke with raised concerns about the needs of people in home not being met consistently as they were busy and didn’t have enough time.

We spoke with four people using the service at Whitestones. All of the people we spoke with said that they were asked for their views about their care and the home. One person told us "we do have (residents) meetings which are nice".

One person said "I am happy and have no problems here". Two people told us that they felt well cared for at Whitestones One person told us "the meals are great, sometimes too much but you can ask for smaller portions and you can choose what you like to eat".

All of the people we spoke with said they felt safe at the home.

People expressed concerns about staffing levels in the home. One person told us "if someone is off sick they don’t always get a replacement" and another told us "they could do with a couple more staff". We were also told "there’s not always enough (staff) but it’s hard to say, sometimes you see lots of them together and other times there are none".