The inspection took place on 18 August and 27 September 2016 and was unannounced.

At the previous unannounced inspection in January 2016 breaches of legal requirements were found. This was because recruitment procedures were unsafe. People were not protected from the risks associated with fire, emergency evacuation plans were not developed for people using the service. The provider did not have an effective system for assessing and monitoring the quality of service provision, and did not make proper provision for identifying and addressing shortfalls in the service. After the comprehensive inspection in January 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. During the comprehensive inspection on the 18 August and 27 September 2016 we found that the provider had followed their plan and legal requirements had been met.

Whitworth House is a small residential care home situated within a residential area of Croydon. The premises are an adapted family house, and do not offer en-suite facilities. People share communal bathrooms and toilets. The home can accommodate up to nine older people. Accommodation is provided over three floors and is accessed by a passenger lift. There are communal areas that offer a small lounge and dining room. At the rear of the premises is a small back garden.

There is a registered manager who has been in post over 20 years. ‘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.

Improvements were made to promoting safety in the service. Individual risks associated with care and welfare were assessed and care arrangements were in place to ensure these were managed safely. We found that people had personal emergency evacuation plans (PEEP’s) in place. This meant that in the event of an emergency situation people may be evacuated effectively.

People told us they felt safe and well cared for by the staff in this homely environment. Staff undertook safeguarding training and knew the correct procedures for responding to and reporting any suspicion of abuse. Recruitment procedures had improved and were satisfactory and relevant checks had been carried out to make sure staff were suitable to work in the home.

Staff were attentive to people with high levels of engagement observed. This created a friendly, suitably stimulating environment with a ‘family’ feel. Staff consistently sought people’s agreement before assisting them with activities of daily living. This meant that people were empowered to express their wishes and their rights were respected.

Staff knew and understood people’s care needs well and the small team were able to easily share information. The care documentation was handwritten and totally person centred; it supported staff with clear guidelines and reference to people’s choices and preferences. This helped staff respond to people on an individual basis.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. A number of people were restricted lawfully under Deprivation of Liberty Safeguards, the service had the required authorisation to do so. People who did not have capacity to make decisions due to illness had their capacity assessed; best interest discussions took place. People were not restricted without the service having the required authorisation to do so.

The small family style environment met the needs of people living there in a homely manner. Regular staff were employed, three were family members. Staff had developed meaningful relationships with people and demonstrated a caring approach. People said, tenderness and kindness were the qualities displayed by staff. People s

The inspection took place on 26 January 2016 and was unannounced. At the previous inspection on October 2014 we found the provider was not meeting the regulations in the following area. The provider did not have an effective system for assessing and monitoring the quality of service provision, and did not make proper provision for identifying and addressing shortfalls in the service. We asked the provider to provide an action plan outlining how they would improve to meet the Regulations.

Whitworth House is a small residential care home situated within a residential area of Croydon. The premises are an adapted family house, and do not offer ensuite facilities. People share communal bathrooms and toilets.The home can accommodate up to nine older people. Accommodation is provided over three floors and is accessed by a passenger lift. There are communal areas that offer a small lounge and dining room. At the rear of the premises is a small back garden.

There is a registered manager and she has been in post over 20 years. ‘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 this inspection we identified the quality assurance process had not been sufficiently developed and there was a lack of good governance. Breaches were also found in areas relating to fit and proper persons employed, personal evacuation plans, people being restricted without the service having the required authorisation to do so, completion of Mental Capacity Assessments and best interest decisions.

We also made recommendations about making appropriate adaptations to the environment to support people living with dementia.

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Individual risks associated with care and welfare were assessed and arrangements were in place to ensure these were managed safely. We found that people did not have Personal Emergency Evacuation Plans (PEEP’s) in place. This meant that in the event of an emergency situation people may not be evacuated effectively.

People told us they felt they were safe and well cared for by the staff. Staff undertook safeguarding training and knew the correct procedures for responding to and reporting any suspicion of abuse. Recruitment procedures were not satisfactory and relevant checks had not been carried out before staff started working in the home. This was a breach of regulation and placed people at risk of being cared for by people who may be unsuitable for the role.

Staff knew and understood people’s care needs well and there were systems in place for all staff to share information. The care documentation supported staff with clear guidelines and reference to people’s choices and preferences. This helped staff respond to people on an individual basis.

Although staff had completed training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) in practice staff demonstrated limited knowledge of the principles associated with the legislation and in promoting people’s rights. Staff were not consistently applying the principles of the Mental Capacity Act 2005. People who did not have capacity to make decisions due to illness did not have their capacity assessed; best interest discussions did not take place. People were restricted without the service having the required authorisation to do so. This was a breach of regulations.

People’s healthcare needs were promoted, and referrals were made to specialist services as appropriate. People were encouraged to have a healthy diet. Staff knew people’s likes and dislikes and the menu was planned around these. People enjoyed meals and found they met their dietary and cultural needs. Some people needed a soft diet and extra fluids due to their condition and staff made sure people had the nu

This inspection took place on 23 October 2014 and was unannounced.

Whitworth House provides accommodation and personal care for up to nine older people. At the time of this inspection there were seven people using the service. The provider and his spouse have been running this home for more than 20 years.

The registered provider’s spouse is the registered manager. 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.

Whitworth House is a small home with a strong emphasis on a “family” style environment; however the environment displayed significant signs of wear and tear and was not appropriately designed for people who used the service. There were issues regarding the upkeep of premises, and we saw that refurbishment work was required to provide an environment that met people’s needs comfortably.

People using the service had their care needs kept under review and any changes were responded to and addressed promptly and appropriately. Assessments were undertaken to identify risks to people and plans were in place to appropriately manage these risks.

People were supported by staff to maintain their safety. Staff understood the provider’s safeguarding procedures and they understood the importance of reporting any concerns about the welfare and safety of people using the service.

People felt valued, they attributed this to living in the homely family style environment, and having a steady staff group who knew them as ‘individuals’. Staff were aware of people’s individual needs, their preferences, likes and daily routines.

Staff were caring in their approach; they were polite and respectful and maintained people’s privacy and dignity. People found they were able to discuss the care and support they received, and ensured it was in line with their wishes.

People received their medicines as required. Medicines were stored securely and safely for those requiring support with administration. However, safe practice was not always being followed around the storage of medicines for people who retained their medicines in their bedrooms and who were self-administering.

Staff received the training they required to meet people’s needs and undertake their roles and responsibilities.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). The Deprivation of Liberty Safeguards provides legal protection for vulnerable people who are, or may become, deprived of their liberty in a hospital or care home.

While the service provided a caring reliable service, the provider had not developed the audit system and quality assurance processes necessary for assessing, monitoring and improving the quality of the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there were six people residing at Whitworth House. Due to their needs, some people we met were unable to share direct views about their care. We therefore used a number of different methods to gather evidence of people's experiences. These included observing care practices; interactions with staff and reviewing records. To help us understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spend their time, the type of support they get and whether they had positive experiences.

On the day of our inspection we met with all six people who used the service and observed how staff supported and cared for individuals. We saw that the registered manager and staff respected people's privacy and dignity, and took account of what people expressed and said in relation to the way their care and support was provided.

People who were able to communicate with us said they were happy in the home. One person told us, “I like it here, the manager is very nice”. Another person told us “The food is great. I like hot and spicy food which the manager makes for me”. We saw that people were supported to undertake a range of activities in the community and had varied and individual routines. During our inspection several people attended a local club with support from staff.

We spoke with family members and representatives of people who use the service. One person told us “I am very happy with the care and support that is provided. I like the home because it is small and homely and the manager and staff are very friendly and welcoming”.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people’s families or representatives fully involved. People we spoke with said they had choice and control over the support they received.

At our last inspection in January 2012 we identified areas where the provider was not meeting the essential standards of quality and safety. The provider sent us an action plan to tell us how it was going to become compliant with the regulations. We carried out this inspection to review improvements.

There were two people using the service at the time of our visit and we met with both of them. People said they felt well cared for and that the staff were kind and helpful. They spoke positively about the care and support they received. Comments included, “we're very well looked after" and one person described the registered manager as, “she’s like a mother to us, smashing!”

Since our last inspection, we found that the manager and staff had taken action to address the compliance actions. The registered owners had also been working with Croydon local authority to make required improvements. Following our visit we asked for written feedback from the council’s Care Support Team. Their report stated, “On visits to the home we have observed that the management and care staff had treated people with dignity and respect.” They also wrote, “We have found the proprietor and the manager very committed to the training session delivered by the team or London Borough of Croydon. They have attended all the training sessions and given valuable feedback.”

Prior to our visit, Croydon local authority contracts and commissioning team told us they had some concerns about the care and support being offered to people at Whitworth House. Commissioners had also carried out two monitoring visits to the home in November 2011 and January 2012 respectively.

The views of people who were able to comment on their experience can be summarised as follows, "lovely people, I’m very happy here”. Another person said “the food’s very good".

One resident who had recently moved to the home told us they were made to feel welcome and that they were pleased with the service so far.

Our observations showed that staff were kind and considerate although both they and the manager had not received regular training to keep their knowledge and practice up to date. The registered owners lacked an understanding of the government standards of quality and safety and the Health and Social Care Act 2008.

We found that there were not enough structured activities within the home to provide interest and stimulation for people.

The service has failed to demonstrate that accurate up to date records of people's care and support needs were being regularly maintained, reviewed and monitored. At the time of our visit Croydon local authority were funding placements for all four residents at Whitworth House.

We will continue to monitor our concerns with Croydon Council and we will check to make sure that improvements have been made.

Please refer to each outcome below and within the main report for more detailed comments about specific aspects of the service