We inspected The White House on 18 and 19 June 18. The inspection was unannounced. The service is primarily for elderly people, some of whom may have physical disabilities or dementia. At the last inspection, in May 2016, the service was rated as ‘Good,’ and as a consequence of this inspection the service retains this rating.

The White House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The White House accommodated up to 34 people, and the service had no vacancies at the time of the inspection.

The service had a 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.

The service was viewed by people we spoke with as very caring. We received positive comments about the service about the attitudes of staff. For example we were told, “Staff are very good,” and “kind.” A relative told us, “I am extremely pleased. (My relative) has said it is really, really nice being here. All the staff are kind and friendly.”

People told us they felt safe. A relative told us: “Yes I think it is most definitely safe.” and an external professional told us: “The home has always felt safe, and all the care I have witnessed has never caused me concern.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. The service had a suitable recruitment procedure, and appropriate checks were carried out on new staff to ensure they were suitable to work with vulnerable people. Staff were suitably trained. Staff received a comprehensive induction when they started to work at the service, and they received regular supervision to provide them with feedback and guidance about their work.

The medicines’ system was well managed, medicines were stored securely, and comprehensive records were kept regarding receipt, administration, and disposal of medicines. Staff who administered medicines received suitable training.

The service was exceptionally clean and hygienic. Relatives told us, “It is clean and tidy,” and “General cleaning is very good. My relatives en suite is cleaned daily.” The building was well decorated, well maintained and well furnished.

Assessment processes, before someone moves into the service are comprehensive. These assisted in helping staff to develop detailed care plans. The managers and staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.

People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard, although we did witness some delays when food was initially served. Meal times were very well organised, and were a sociable occasion. Comments about food included, “It is very nice,” “Excellent,” although some people made less positive comments such as “It is nothing special but I get enough to eat.”

The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. External professionals were very positive about the standards at The White House. For example we were told, ““We have a good relationship with the home,” and, “The White House is proficient in continuing with recommended

This inspection took place on 31 May and 2 June 2016 and was unannounced.

The White House Care Home, known locally as The White House provides care and accommodation for up to 34 people who are living with old age, dementia, mental health issues or physical disabilities. Accommodation is provided over three floors, most rooms are en-suite and there are also shared lounges and dining areas. There are spacious gardens surrounding the building. At the time of the inspection the service was full and there were a number of people with their names on a waiting list.

The White House 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.

We observed consistently positive, warm and caring interactions between people and staff. Staff took the time to stop and chat with people to make them feel involved and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection. One staff member said; “I love it here. The people are the best bit”. Staff creatively used specialist and personalised communication skills to interact with people and make them feel part of what was happening. The registered manager was committed to sharing best practice and finding innovative ways to promote the rights of those living with dementia.

People’s care plans were highly detailed documents which contained information about their background, history, like and dislikes. Staff confirmed that the care plans contained the correct guidance and information in order to support people and provide high quality, personalised care. Life story books had also been developed to help staff to know and understand the people they care for. Staff referred to these and used them to assist them in communicating and engaging with people.

People enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people told us they had their medicines as prescribed and on time. People were supported to see a range of healthcare professionals including district nurses, chiropodists, doctors and social workers.

People were kept cognitively and socially engaged through a range of activities, both inside the service and in the local community. There was something on offer each day. People were involved in planning the activities and the atmosphere at the service whilst activities were being undertaken was pleasant and vibrant.

People were kept safe by suitable staffing levels. People told us there were enough staff on duty. This meant that people’s needs were met in a timely manner. Interactions between people and staff were unhurried. Staff recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff had sufficient training to carry out their roles effectively. Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. Staff were supported by a comprehensive induction and there was an ongoing programme of supervision, competency checks and appraisals.

Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, process ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal processes had been followed. People were involved in planni

At our last inspection on 13 January 2014 we had concerns regarding medicines management and the maintenance of records. We set compliance actions for these outcomes. These are actions a provider must take so that they achieve compliance with the essential standards. The provider sent us an action plan detailing how they would address the concerns raised at the inspection.

We spent time with the registered manager and two staff. We reviewed the records for seven people who used the service and checked the medicine records to reach our judgement.

We found people’s care needs had been assessed and care and treatment was planned and delivered in line with their individual care plan.

We found people received their prescribed medicines at the appropriate time.

We found the White House had reviewed their record keeping procedures. Care records we reviewed were clear and concise, and had been reviewed to take account of any changes in people’s needs. Accidents and incidents were recorded in accordance with the Date Protection Act 1998.

During this inspection we spoke with the registered manager, the care manager, three staff, six people who lived at the White House, a visitor and visiting healthcare professionals. Comments included “it is really home from home”, “the staff are wonderful” and “the food is always very good”. At the time of our inspection the White House had 33 people living there. We reviewed the care records for five people who lived at the home and looked at documentation provided during the inspection by the registered manager.

We found people expressed their views and were involved in making decisions about their care and treatment. Observation during the inspection showed staff supporting people to make their own choices.

People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided.

We found people were not protected from the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found there were enough qualified, skilled and experienced staff to meet people’s needs at the White house.

We found complaints were responded to appropriately and in a timely manner.

We found records were not always kept accurately, reviewed or monitored in order to identify any issues or concerns.

We used a number of different methods such as reviewing records, we observed staff supporting people, we talked to staff, the care manager and a stakeholder to help us understand the experiences of people using the service. This helped us to review the care and support as people using the service had complex needs.

People expressed their views and were involved in making decisions about their care and treatment. Observation during the inspection showed staff supporting people to make their own choices.

People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We saw that staff had received most mandatory training. Formal supervision of staff was ongoing. Annual appraisals were underway with a view to being completed by the end of June 2013.

People said they were very happy living in the home. People said that staff were hardworking and caring. Staff were also seen as attentive and said to respond promptly to individual needs. People said the food was to a good standard, and there was enough to eat and drink. Everyone said they were happy with their accommodation. People said they were happy with the activities that are provided at the home.