Whitway House is registered to provide accommodation and nursing care for up to 39 people. The people living in Whitway House had diverse support needs: Some people living in the home had needs associated with enduring mental health problems, others need support with needs related to a learning disability or dementia. At the time of our inspection there were 34 older people living in the home.

The service had a registered manager 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 2008 and associated Regulations about how the service is run.

At our last inspection in July and August 2016 we found people were at risk of harm, the requirements of the Mental Capacity Act 2005 were not being met and the systems in place to ensure the quality and safety of the care people received were not effective. There were continued breaches of regulation. We took enforcement action and required the provider to detail the improvements they would make and make monthly reports on their actions to the Care Quality Commission. At this inspection we found that the actions detailed in reports had led to significant improvements.

People felt safe and well cared for. They were protected from harm because staff understood how to reduce the risks people faced. They also knew how to identify and respond to abuse and told us they would be confident to do so.

People had support and care when they needed it from staff who had been safely recruited and understood their needs. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs. They told us they felt supported in their roles and had received appropriate training that provided them with the necessary knowledge and skills. Staff also told us they felt valued and part of a strong team. Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection.

People saw health care professionals when necessary. Records and feedback from healthcare professionals reflected that staff responded appropriately to both on going healthcare needs and health emergencies. People received their medicines as they were prescribed.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. Care plans and practice reflected the framework of the Mental Capacity Act 2005. Deprivation of Liberty Safeguards had been applied for when people needed to live in the home to be cared for safely but did not have the mental capacity to consent to this.

People were engaged with a wide range of activities that reflected their preferences, including individual and group activities.

Everyone described the food as good and there were systems in place to ensure people had enough to eat and drink. When people needed particular diets or support to eat and drink safely these were in place.

Quality assurance had led to improvements being made and people, relatives and staff were invited to contribute their views to this process. Staff, people and professionals spoke positively about the management and staff team as a whole.

The inspection took place on the 28 July and 1 August 2016.

Whitway House is registered to provide accommodation and nursing care for up to 39 people in a rural area of West Dorset. At the time of our inspection there were 33 older people living in the home.

There was a registered manager in post at the time of our 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.

The home was last inspected in December 2015 and found to be in breach of regulations relating to: good governance and safe care and treatment including concerns about the safe administration of medicines. We told the provider to make improvements regarding the monitoring of the service people received by 7 March 2016. The provider told us they would make improvements regarding the safe care and treatment of people living in the home. At this inspection we found that the leadership of the home had not made adequate improvements and did not have sufficient systems to monitor the service people received and ensure that their care and treatment was safe. People remained at risk of harm because these improvements had not been made.

Audits had been undertaken but missed areas identified by inspectors. This meant health and safety issues had not been addressed and care plans were sometimes inaccurate or had omissions. Incidents and accidents were not always recorded and when they were their analysis did not always lead to people receiving safer care.

Staff used their knowledge of people to develop caring relationships with people. They also sometimes audibly discussed care tasks with reference to people in communal areas which did not promote dignity and respect. We have made a recommendation about promoting people's dignity and autonomy.

People felt safe but some people’s risks were not reduced effectively because their care plans were not followed or records were not kept to review how these plans were working.

Staff understood the need to make decisions in people's best interests but decisions made did not always reflect the principles of the Mental Capacity Act 2005 (MCA). Opportunities for day to day choice making were missed.

People told us they saw health care professionals when necessary and were supported to maintain their health by staff. With the exception of evidence around care of people’s skin, we found people’s needs related to ongoing healthcare and health emergencies were met and recorded. People received their medicines as they were prescribed although the recording of creams was not consistent. We have made a recommendation about the recording and monitoring of people's creams.

People were positive about the care they received from the home and told us the staff were kind. Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection. care was not, however, always delivered in ways that reflected people's assessed needs. We have made a recommendation about embedding person centred approaches to the care people receive.

People usually had support and care when they needed it from staff who had been safely recruited. These staff understood people’s care needs and spoke confidently about the support people needed to meet those needs. They told us they felt supported in their roles and had undertaken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received the training they needed to stay up to date with the care needs of people living in the home.

People were at a reduced risk of harm because staff knew how to identify and respond to abuse. Information about how to report abuse was available to staff.

Deprivation of Liberty Safeguards (D

Whitway house was last inspected on 4 December 2013 where it was found that medicines were not administered safely. The provider wrote and told us that they had made the necessary improvements with medicines management.

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.

Whitway House provides care and support for up to 39 older people. At the time of the inspection there were 37 people living at the home.

The leadership within the home needed to be improved. The provider did not have an effective system to check the quality of care people received at the home. Peoples individual care records were not always complete and the systems in place to evaluate and improve the care being given were not robust.

The systems and procedures for handling medicines were not safe and improvements were required. The system in place for the auditing of medication required improvement as it had not identified areas that needed improvement.

Care records were not always accurate and reliable. Where people said they needed assistance to achieve certain outcomes they we not supported to do so, care records did not consistently record these wishes.

People’s care records were not kept in a safe and confidential manner. During the inspection we noted people’s personal records were left unattended in communal areas.

People were able to raise concerns with the staff who in general terms took action to resolve the presenting issues. One person told us about how they were able to negotiate a different room when they were unhappy sharing. However, when a person expressed a wish to live somewhere else they provider had not responded appropriately.

People told us the staff were kind and caring and supported them in a caring way. One person told us “if I ask for help there is always someone around, they are patient with me when I want to do things myself” another person described the staff as “very kind to me”. A visiting relative told us about how kind and compassionate staff were.

People and their relatives were given information about the running of the home and how they could comment on areas for improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

People’s needs were assessed and care was planned and delivered to meet people’s needs. One person told us, “I started feeling better as soon as I came here.” One person’s relative said, “The care is so good, it’s marvellous here.”

People’s medicines were not always administered. We found that a number of people had not received their medicines on one occasion. Medicines were stored securely and appropriately.

The provider carried out appropriate checks before staff started work. We looked at staff recruitment files and found that appropriate checks and references had been completed.

The home had a complaints procedure and responded to people’s complaints and concerns. People felt able to raise complaints. One person told us, “I have nothing to complain about, if I had I would ask to see the manager and I’m sure she would listen.”

People’s agreement was sought prior to staff supporting them. One person told us, “They help me out of bed in the morning, they ask if I want to get up first.” People’s needs were assessed and care was planned and delivered to meet their needs. One person told us, “They always make sure you are alright.” Another person said, “We get everything we need, we are very happy.”

There were sufficient numbers of staff who were knowledgeable about people’s needs and how these should be met. One person’s relative told us, “There is always someone around, there are enough staff.” Another person’s relative reported, “There are enough staff, they are always quick to meet his needs.”

Medicines were administered appropriately. One person told us, “My tablets are given to me before my meals, there is no problem with that.” However, controlled drugs were not always recorded appropriately in the controlled drugs register, and hand written entries on medication administration records were not countersigned as required to confirm accuracy.

The provider operated an effective quality monitoring system and people felt able to express their views as to the quality of the service they received. One person’s relative told us, “We have regular meetings with the manager. We feel listened to.” One person said, “I feel able to raise concerns if I needed to.”

We asked a person if they felt safe living in the home. They said “yes, it does feel safe. People know where you are and how you are”. A regular visitor told us they had no concerns about the safety of their relative in the home. Another visitor said staff demonstrated open relationships and a detailed knowledge of people living in the home.

A person who preferred to spend most of their time in their room told us staff came quickly in response to call bells. They felt involved in development of their care plan: “the nurse has checked what I need help with and that they do it right for me”. They felt that staff support to their enjoyment of feeding garden birds was seen as being as important as their physical care needs.

We saw a person asleep in bed. Staff completed charts, which showed they checked on the person frequently and attended to their needs in line with the person’s care plans.

One person gave examples of choices they made. They chose rising and retiring times, where to eat their meals and how they passed their time. We spoke with a person who shared a room. They told us they chose to do so and that there was plenty of personal space for each person to have belongings and visitors as they chose. They said staff made sure all personal care was given in private.

We observed a music and movement group run by an external specialist activities provider. Two members of the care staff assisted with this. Five people from the home chose to join in. There was an atmosphere of fun and involvement.

Visitors spoke of the accessibility of the manager and willingness of all staff to discuss any issues. One person told us that when they attended quarterly reviews of their relative’s care plan, they were always asked about their satisfaction with the quality of service provided.