This inspection took place on 20 February 2018 and was unannounced which meant the service did not know in advance we were coming.

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. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The White House is registered with CQC to accommodate up to 28 people. At the time of this inspection, 23 people were accommodated, four people were in hospital and the home had one vacancy.

The White House is a large detached property set in its own grounds, with parking space to the front of the home. The home has a private patio area and garden at the rear of the property which is enclosed at all sides. The home is situated in a residential area of Northenden, within easy reach of the motorway network, public transport and local shops.

At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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.

People told us they felt safe living at The White House. Staff received safeguarding training and knew how to keep people safe and raise concerns if they suspected someone was at risk of harm or abuse.

People had comprehensive risk assessments which were reviewed and updated in a timely way to meet people’s changing needs. This ensured staff had access to the relevant information and guidance to mitigate risks.

Staffing levels remained consistent and the home benefited from a stable workforce. People, relatives and staff told us there were sufficient numbers of staff on duty to meet people’s needs.

The management of medicines was safe. There were appropriate arrangements in place to ensure that medicines had been ordered, stored, received and administered appropriately.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.

People were supported in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were encouraged to make decisions and choices about their care and had their choices respected.

People's consent to care and treatment was sought prior to care being delivered.

People were encouraged to maintain a healthy nutritionally balanced diet and had access to sufficient amounts to eat and drink, at times that suited them. People's health care needs were monitored and maintained; people had access to health care services as and when needed.

People continued to receive care and support from staff that were kind, caring and compassionate.

People were treated with dignity and respect and had their independence promoted by staff that openly expressed their fondness for the people they cared for and supported.

Care plans were person centred and tailored to meet people's individual needs. People were encouraged to be involved in the development of their care plans, which were updated regularly to reflect people's changing needs.

A variety of activities were provided and staff demonstrated a good understanding of people’s needs and adapted activities to reflect people’s individual interests.

The provider had a complaints proce

We undertook an inspection of The White House on 1 December 2015. The inspection was unannounced which meant the provider did not know we were coming.

We last carried out an inspection at The White House in May 2014 where we found the service was meeting legal requirements.

The White House provides residential accommodation with personal care for up to twenty-eight people.

There was a registered manager in post at the time of this 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and was aware of the principles of the Mental Capacity Act 2005. People who were subject to DoLS had their rights respected and the home had operated within the legal framework of the Act.

Staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm.

A robust system was in place to identify and assess the risks associated with providing care and support. A relative told us and care records confirmed, that risks had been discussed with them and actions agreed to keep people safe from accidental harm.

Staff understood the needs of the people they supported. They supported people in making choices and their own decisions as much as possible. The people we spoke with who were using the service, and visiting relatives, told us they were happy with the care provided.

People who used this service received safe care and support from a trained and skilled team of staff. The induction of new staff was robust and they received regular support and mentoring from the registered manager following their appointment. This had been supplemented byfurther training to equip staff with specific skills, which enabled them to provide person-centred care to people who used the service in line with current best practice guidance. Staff fully understood their caring responsibilities and they demonstrated respect for the rights of the people they supported.

During our visit we saw examples of staff treating people with respect and dignity. People using the service and their relatives were consulted and involved in assessments, care planning and the development of the service.

The layout of the home supported people who were living with dementia. People were able to walk around the home and the enclosed garden whenever they wanted to. There were no restrictions in place and people were supported to access all areas of their home.

The registered manager had developed an effective system of quality assurance, which measured the outcomes of service provision. We found that staff, people who used the service and relatives had been involved in this process.

The White House is a residential care home providing personal care without nursing. At the time of our visit there were 27 people resident at the home. Our inspection was carried out by one inspector, who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We spoke with four people who used the service who told us they felt safe and were treated with respect and dignity by the staff. We found safeguarding procedures were in place and staff were able to tell us how they would safeguard the people they supported.

The home had policies in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). No applications had been submitted at the time of our inspection. We spoke with the manager about their knowledge of the Mental Capacity Act and DoLS and what they told us meant they understood the correct protocol to follow in order to make an application, if needed.

The service was safe, clean and hygienic, although in need of re-decoration. The Manager told us they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. Staff told us they had no concerns about staffing levels. This helped to ensure people's needs were always met.

Is the service effective?

People's health and care needs were assessed with people who used the services or their relatives and health care professionals. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with said their care needs were being met. People using the service appeared content and settled and families told us they were able to visit at any time.

Is the service caring?

People were supported by friendly and attentive staff. Staff showed patience and gave encouragement when supporting people. People commented, "I think its very good, staff are very nice." "No concerns about how things are done here." "I'm quite happy here."

Relatives had fedback to the manager via quality assurance questionnaires. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People participated in a range of activities inside the service regularly. The home had a dedicated activities coordinator who organised daily activities and events .

There were complaints recorded in a complaints log which we saw the manager had responded to in a timely manner. People could therefore be assured complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had quality assurance systems in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. The manager was a dignity champion and had ensured all the staff had signed up to the dignity in care standards.

Staff told us they were clear about their roles and responsibilities. They felt supported by the manager. One member of staff told us; "I feel supported, we are a good team".

We used a number of different methods to help us understand the experiences of people using the service, including observing care and speaking to those people who could give their views on the home. We spoke with four people who lived in the home about their care and treatment. We also spoke with one relative of a person who lived at the home. All the people we spoke with were positive about the care they received. One person who used the service told us: "I'm actually chuffed to mintballs with it [the home]". Another said: "I think it is lovely here". A third person said of staff that work in the home: "I've only to say if I want anything; they're usually obliging - very good".

We found that the home was meeting the essential standards we looked at on this inspection and we found people were very well cared for.

We did not seek any feedback from people using the service during this inspection.

We checked whether the provider had improved their processes to ensure that all necessary information was held within staff files. We found that the provider had taken appropriate action and was now meeting the standard on the recruitment and suitability of staff.

The people who use services that we spoke with were very positive about all aspects of

living at the home. They told us that they felt involved in their care. They said they were very happy with the standard of care they received. All the people we spoke with said that they had no complaints about the service. They told us they felt confident if they had any concerns, these would be sorted quickly. They made very positive comments about all the staff who worked at the home. They told us they enjoyed the activities that the home provided.

Comments included: "Its fine. It's really good." "They're looking after me very well." "The staff talk to you and help you. They knock on your door before they come in. It gives you a bit of privacy." "All the staff are very nice - management and everybody." "Staff are very helpful." "The staff are very good. I can talk to all of them."

On the first day of our visit, we spoke with several people specifically about their medicines. On the second day, we spoke with nine people who lived in the home about their more general care and treatment. We also spoke with two relatives of a person who lived at the home. All the people we spoke with were very positive about the care they received. Comments included:

"I think it is wonderful. I've been in a few and this is the best one"; "I am comfortable here, they look after me well" and "If I need medicine, staff do it for me".

We completed this compliance review in response to an incident concerning the home. We communicated with our partner agencies including Manchester City Council and the Greater Manchester Police Authority who were also reviewing the home.

Overall we found people were well cared for and given their medicines safely. We found that the provider was meeting the regulations we looked at, with the exception of the regulation which concerned the recruitment of staff where there were minor issues. We have asked that the provider take action to ensure that recruitment records are improved.