We inspected The White House Care Home on 22 March 2017. The inspection was unannounced, which meant the staff and registered provider did not know we would be visiting. When we last inspected the service in January 2015 we found that the registered provider was meeting the legal requirements in the areas that we looked at and rated the service as good. At this inspection we found the service remained 'Good'.

The White House Care Home is registered to provide care and accommodation to a maximum number of 29 older people and older people who are living with a dementia. There are bedrooms over three floors, which are accessible by a lift. All bedrooms have a toilet and sink within them. At the time of the inspection there were 24 people who used the service.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies around administering medicines were regularly checked. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

We received mixed reviews when we asked people, staff and relatives if there were enough staff on duty to meet the needs of people. After the inspection the registered manager reviewed people’s needs and met with staff and increased the amount of staff who were on duty. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and all staff had completed up to date training. We did note some gaps in health and safety training, however, the registered manager took immediate action to rectify this and those staff who had not completed this training were to be signed up by 11 April 2017. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were able to choose meals of their choice and staff supported people to maintain their health and attend routine health care appointments.

People who used the service told us that staff were kind and caring. Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making. People who used the service had access to a range of activities and leisure opportunities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and registered provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought from people who used the service through regular meetings’. This information was analysed and action plans produced when needed.

The inspection visit took place on the 27 January 2015 and was unannounced.

The White House Care Home is a 29 bedded care home in Stockton on Tees. There are bedrooms over three floors, which are accessible by a lift. All bedrooms have a toilet and sink within them. The home provides residential care for older people and people who are living with dementia.

We last inspected the service on 7 October 2013 and found the service was compliant with regulations at that time.

There is 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.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The manager had the appropriate knowledge to know when an application should be made and how to submit one. The manager also ensured that capacity assessments were completed and ‘best interest’ decisions were made in line with the MCA code of practice. This meant people were safeguarded.

People told us they felt safe at the service. We saw that staff were recruited safely and were given appropriate training before they commenced employment. There were sufficient staff on duty to meet the needs of the people. The staff team were very supportive of the manager and each other.

Medicines were stored in a safe manner. We witnessed staff administering medication in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.

There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development. We spoke with kitchen staff who had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. One person told us that they had raised an issue regarding the food, it was dealt with immediately and they were very satisfied with the outcome.

We saw people’s care plans were personalised and had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved, when they were able, the person. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service. We witnessed staff using a communication book with one person who had difficulties in verbalising. A visiting occupational therapist was highly impressed that the service had used their initiative to source this aid and implement it themselves.

The service encouraged people to maintain their independence and the activities co-ordinator ran a full programme of events which included accessing the community with people as much as possible and using assistive technology to keep people in touch with their families.

The service undertook regular questionnaires not only with people who lived at the home and their family but also with visiting professionals and staff members. We also saw a regular programme of staff and resident meetings where issues where shared and raised. The service had an accessible complaints procedure and people told us they knew how to raise a complaint I f they needed to. This showed the service listened to the views of people.

We witnessed the manager welcoming to people to the home who just turned up without appointment to view as a potential place for their relative. We saw they were professionally and warmly welcomed by staff and the manager offered them a tour of the home as well as offering to discuss their views and wishes confidentially.

People who used the service were very happy with the care and support they received. They told us; “They look after me like I am their family, like I am their mum or their daughter.” This person also added, “The staff are amazing, really amazing, I know they would do anything for me, I just have to ask”, “I’m pretty independent and don’t need much help, but if and when I do, I know they will be there to support me in whatever I need”, “I know that if I am feeling poorly or need to see the doctor they will arrange an appointment for me.”

Relatives of those who used the service also told us that they were happy with the care and support people received. They told us; “They just care, it’s that simple”, “There seems to be a low turnover of staff here and they all know my relative, so there is consistency of care and they pick things up straight away if there is something wrong”, “They noticed my relative had problems with their teeth, so they organised a dentist and now my relative can eat a much wider diet that before”, “They are marvellous here.”

We found that people received the care and support they needed. This was delivered by staff that were caring, compassionate and knowledgeable. Care records were comprehensive and risk assessments and care plans were reviewed regularly to ensure that staff had access to the most up to date and appropriate information about people’s needs. Thus, people received the most appropriate and safe care which met their specific needs.

People who lived at The White House Care Home were happy with the care and support they received. One person told us, “Oh yes, they look after me fine here, I’ve no complaints at all, they are lovely.” People told us they were settled and content. During our inspection we observed that people were enjoying the activities organised for them.

Most of the care plans we looked at had been reviewed regularly, however some health assessments had not been carried out. This meant that people were at an increased risk of receiving care that did not meet their needs. On the whole care plans did reflect when there were changes in people’s needs.

We found that White House Care Home communicated with other health professionals and worked in a collaborative way to ensure that peoples’ health and wellbeing was maintained.

There was sufficient equipment within the service to protect the safety and comfort of people and this had been cleaned and maintained in line with recommendations.

People who used the service and their relatives were able to express their opinions about the care and support received in a number of ways. There was a complaints policy in place which ensured that any formal complaints were investigated and dealt with appropriately.

During the inspection we spoke with five people who used the service and one relative. People who used the service expressed satisfaction with the care and service that they received. The people we spoke with who used the service told us the staff were lovely and very sensible, they are always polite. They also told us they can get up and go to bed when they want; one person told us “If I want to lie in I can.” They told us the food was lovely, one person said “if you want to lose weight don’t come here.” People told us they spend time in the garden but they had "not been out much due to the rotten weather."

The relative we spoke with told us everything was fine, there were enough staff around and they answered the buzzers quickly.