This inspection was carried out on 09 July 2018 and was unannounced.

The White House Nursing Home 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 Nursing Home accommodates up to 67 people in one adapted building. At this inspection 59 people were using the service.

The registered manager had recently resigned from their role. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. At the time of this inspection the service was being managed by the deputy manager (referred to as ‘the manager’ throughout the report) with the support from clinical colleagues and the previous registered manager. The provider told us that the service was in the process of being sold and consequently decisions about recruiting a registered manager would be taken by the new provider.

At the previous inspection in June 2017 we had identified some areas that required improvement. At this inspection we found that whilst there had been some improvements made the overall quality of the service provided had not improved sufficiently and further work was still needed.

At the inspection in June 2017 we had identified shortfalls in record keeping and that staff meetings were not always effective. We had found that the provider had not routinely assessed the quality of care that people received or how the home was managed and that incidents and accidents occurring in the home had not been robustly managed and reviewed to identify trends or patterns. At this inspection we found that some processes had been introduced to better manage these areas however, further work was needed.

Staff had been trained in how to safeguard people from avoidable harm however, not all staff were confident in their knowledge about how to report concerns to external agencies if needed. People had personal evacuation plans in place for emergencies such as a fire and regular safety checks were completed however, staff demonstrated a mixed understanding what actions they should take in the event of such an emergency. People and their relatives felt that there were not always enough staff deployed to meet their individual needs in a kind, gentle and timely manner. Some further work was needed to ensure the provider’s recruitment processes were robust.

People were supported by staff to take their medicines in a safe manner however, we found that the amount of medicines in the home did not always agree with the records maintained.

There were systems in place to help promote infection control. People said they felt safe living at The White House Nursing Home. Potential risks to people's health, well-being or safety had been identified, were assessed and reviewed regularly to take account of people's changing needs and circumstances. The manager had developed systems to cascade shared learning from incidents around the staff team.

Staff explained to people what was happening and obtained their consent before providing care and support. However, some staff needed further support to better understand the principles of The Mental Capacity Act 2005 (MCA) and best interest processes. Staff members received supervision from line management to support them in their roles but some felt it was not a meaningful or effective process. People and their relatives told us that there were instances where communication with some staff members was difficult. People and their relatives gave mixed feedback about whether their day to day health needs were met in a timely way and if they had access to health care and

This inspection was carried out on 8 June 2017 and was unannounced. At the last inspection on 08 September 2016 the service was found to be meeting all the standards we inspected. At this inspection we found that they were still meeting the standards, however there were areas which needed improvement.

The White House Nursing Home provides accommodation and personal care for up to 67 people. At this inspection 63 people were living at the service.

The service had a manager in post who had recently applied to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

There were systems and processes in place to monitor and address issues at the service. However in some occasions we found that these were not working effectively.

People`s care records were not consistently accurate. We found that some care records gave conflicting information about people’s needs and were not sufficiently detailed for staff to know how to meet people`s needs.

People were supported by staff to eat sufficient amounts. Those people at risk of weight loss were regularly weighed and monitored and referred to specialist health professionals if there was a need for it. However at meal times people did not always receive personalised care, staff often supported three people at the same time and at times staff were not attentive to people who were having difficulties eating their meals independently.

People told us that staff were kind and they received care that met their needs. People who were able to were involved in planning their care. For people who were assessed as lacking capacity their relatives were involved in planning their care. However we found that not all the relatives who consented to people`s care had lasting power of attorney for health and welfare.

Mental capacity assessments were carried out in most cases to assess if people were able to make informed decisions about matters affecting their health and welfare; however we found that these lacked detail about the decisions made.

People were treated with dignity and respect and they developed positive relationships with staff.

There were enough staff employed at the home to meet people`s needs in a timely way. Recruitment processes were robust and helped to ensure that staff working at the home were of good character and suitable for the roles they performed.

People’s medicines were managed safely by appropriately trained staff who had their competencies checked and followed best practice when administering people`s medicines. Staff were aware of the risks to people’s safety and welfare and they knew how to mitigate these.

People were confident to make a complaint if they needed to and told us it would be addressed. There were meetings for people, relatives and staff and their views were listened to and acted upon.

People were offered opportunities to pursue their hobbies and interests in group or individual activities. Staff also regularly spent time with people who were not able to leave their rooms.

Staff had training and support from the management team to carry out their roles effectively. Some staff were trained as champions in areas such as nutrition, dementia, end of life, infection control and they were regularly involved in training and coaching staff to improve their practices.

People, relatives and staff told us that the management in the home was visible and approachable.

This inspection was carried out on 08 September 2016 and was unannounced. At their last inspection on 07 June 2016 they were found not to be meeting all the standards we inspected. People`s medicines were not managed safely and people were not supported by consistent numbers of staff due to reoccurring staff absence. There were also issues related to governance systems used. At this inspection we found that they made the necessary improvements.

The White House Nursing Home provides accommodation and personal care for up to 67 people. At the time of the inspection 58 people were living at the service.

There was a manager in post who was in the process to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

At the previous inspection on 07 June 2016 we found that people’s medicines were not always managed safely and people were at risk of not receiving their medicines as intended by the prescriber. At this inspection we found that medicines were managed safely. Staff were trained and had their competencies assessed in safe administration of medication. People received their medicines on time and as intended by the prescriber.

At the previous inspection we found that people were not always supported by a consistent numbers of staff due to unmanaged staff absence. At this inspection we found that this has improved and the manager had recruited more staff to maintain staffing levels. They built up a pool of bank staff and also planned the rota`s in advance to identify any gaps and booked agency staff in advance if there was a need for it.

People and relatives told us they felt safe and well looked after. They told us staff were available to meet their needs when they wanted and needed this. Care plans were in place which gave staff clear guidance to enable them to support people safely. Risks to peoples` wellbeing were identified and plans were in place to mitigate risks and keep people safe.

Staff were recruited safely and were not able to start their shifts until all pre-employments checks were done and the manager received at least two references from previous employers.

Staff were trained and knew how to keep people safe from all forms of abuse and they were able to tell us how they would report any concerns internally and also externally to local safeguarding authorities.

At the previous inspection we found that there were newly developed systems in place to monitor and address issues identified at the service. However, some of these systems needed further development and more time to be embedded and to work effectively. At this inspection we found that the systems to monitor the quality and the safety of the service provided were effective and identified promptly areas in need of improvement. These were actioned and followed up by the manager to ensure the service was improving.

Staff were positive about the registered manager and the positive changes brought by them. They felt supported by the manager and the nursing staff working at the home.

This inspection was carried out on 7 June 2016 and was unannounced. At their last inspection on 1 September 2015 they were found to be meeting all the standards we inspected, however there were areas that required improvement. At this inspection we found that they were not meeting all of the regulations.

The White House Nursing Home provides accommodation and personal care for up to 67 people. At this inspection 57 people were living at the service.

The service had a manager in post who had recently applied to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People’s medicines were not always managed safely and staffing levels were frequently reduced due to staff absence.

People told us that staff were kind and they received care that met their needs. People were involved in planning their care and were treated with dignity and respect. Care plans were in place which gave staff clear guidance to enable them to support people safely.

People were offered a variety of foods and received the appropriate support to eat and drink. People had access to health and social care professionals as needed. The staff had a good relationship with visiting professionals.

People were confident to make a complaint if they needed to and told us it would be addressed. There were meetings for people, relatives and staff and their views were listened to and acted upon. Activities were available for people in the communal areas with some further development needed for people in their rooms. Further thought was needed in regards to the environment and information in easy read format for those living with dementia. The manager was in the process of arranging for a dementia champion who would address this as part of their role.

The manager of the service needed to raise their profile so that people and relatives all knew who they were. However, most people told us that recent changes had been positive. Most staff felt the changes made at the home were positive and felt that they were more equipped and supported for their role.

There were newly developed systems in place to monitor and address issues at the service. However, some of these systems needed further development and more time to embed to be working effectively. The manager and the providers were working to develop these and were committed to providing a good service.

This inspection was carried out on 1 September 2015 and was unannounced.

When we last inspected the service on 18 June 2015 we found they were not be meeting the required standards and due to the concerns found the service was put into special measures. The breaches of regulation related to person centred care, safe care and treatment, safeguarding people from abuse, consent and restraint, governance, recruitement practices and the service had not displayed their rating. At this inspection we found that there were significant improvements made in relation to people’s safety, welfare and the quality of the service. Governance systems were being implemented and the management team gave daily oversight and guidance in the home.

The White House Nursing Home provides accommodation and personal care including nursing care for up to 67 older people. The registered manager was not working in the home 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 and associated Regulations about how the service is run. At the time of the inspection, the home was being managed by an interim manager.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty. People were offered choice and their wishes were respected.

People had their individual needs met and were positive about the staff supporting them. Staff knew people well and provided support in a timely manner. There was sufficient food and drink available and people were assisted to eat and drink where needed.

People had regular access to visiting health and social care professionals. Staff responded to people’s changing health needs and sought the appropriate guidance or care by healthcare professionals. Medicines were managed safely to ensure people received them in accordance with their needs.

Staff were clear on how to identify and report any concerns relating to a person’s safety and welfare. There were systems in place to maintain people’s safety and raise awareness of individual risks. The manager and deputy manager where experienced in their roles as safeguarding leads and were guiding the staff appropriately. Staff had all recently undergone training updates in key subjects and people had benefitted from this. Recruitment files were being reviewed and updates to documentation was being carried out where needed.

This inspection was carried out on 18 June 2015 and was unannounced.

The White House Nursing Home provides accommodation, personal and nursing care for up to 67 older people. 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 and associated Regulations about how the service is run.

When we last inspected the service on 12 November 2014 we found them to not be meeting the required standards and they were in breach of regulations in relation to care and welfare, privacy and dignity, safeguarding people from the risk of abuse, management of medicines, respect and involving people and consent. At this inspection we found that they had still not met the fundamental standards and were in continued breach of regulations detailed above and in addition for their recruitment practices and not displaying their rating from the last inspection..

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection the appropriate applications had not been made to the local authority in relation to people who lived at the service and people may have been unlawfully deprived of their liberty. The manager and staff were not clear of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People told us that they felt their needs were met. However, staff were not always able to tell us about people’s individual needs. Care plans and records were not clear and had gaps throughout.

Risk assessments were not in place in all cases, and those in place were not reviewed. Medicines were not managed safely. People told us they felt safe and staff had an understanding in relation to safeguarding people from the risk of abuse. However, some issues that should have been investigated and reported were not.

People had a choice of food and were supported to eat and received regular support from health care professionals.

People and staff felt at times there was not enough staff. Recruitment practices were not always robust and did not ensure the relevant pre-employment checks were sought or on the person’s file. Staff received training relevant to their role and had one to one supervision regularly.

There were inadequate monitoring systems in place. The manager had not provided the CQC with an action plan following the previous inspection and had not taken the necessary steps to improve the quality of the service and were in breach of Regulations 9, 10, 11, 12, 13, 17, 19 and 20a of the Health and Social Care Act (Regulated Activities) 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The inspection took place on 12 November 2015 and was unannounced. At our last inspection on 8 May 2013, the service was meeting the required standards.

The White House Nursing home is a nursing and residential care home which provides accommodation and personal care for up to 67 older people. At the time of our inspection there were 65 people living at the home. There is 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 and associated Regulations about how the service is run.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at The White House Nursing Home.

People were supported by staff who were kind and caring. However, people’s care plans and risk assessments were basic and did not provide staff with the appropriate guidance. Staff were not clear on people’s specific needs.

Staff had received training for areas including Safeguarding people from the risk of abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards. However, their knowledge on these subjects was limited.

People did not always receive their medicines safely and in accordance with the prescriber’s instructions. The nursing staff had responsibility for managing all medicines and maintained the control measures and storage, records and quantities.

People who were living at the service, their relatives and staff spoke highly of the manager. The manager was a visible presence in the home. However, the manager and the provider had not ensured they had kept up to date with changes in requirements.

People were confident to raise concerns with the staff or the manager and were sure they would be dealt with effectively. However, we were unable to assess the effectiveness of the complaints procedure due to limited action plans and internal monitoring systems.

Systems in place for monitoring, assessing, identifying and managing the quality of the service were limited and not robust. For example, except from the nurse’s medicines audit, there were no recent audits completed and an action plan for an earlier audit was basic with no completion of tasks recorded.

At this inspection we found the service to be in breach of Regulations 9, 10, 11, 13, 17, and 18 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.

People we spoke with during our inspection told us they were very happy at the White House. One person told us, “I am very happy, we have a good laugh. I like it here and I don’t want to move.” Another said, “I like it here, it’s a very friendly home.” We also spoke with relatives who were visiting their family members. One said, “I’ve been very impressed from when I first came here. It’s a real positive that people living with dementia aren’t segregated.”

Staff treated people with respect and supported them to retain as much independence as possible. One person said, “The staff let me be independent and just check on me to see how I’m doing. They offer help if I need it.” Care plans gave guidance to staff so that people’s needs were met and people saw other healthcare professionals so that their health was monitored.

Recruitment of staff was carried out well so that only staff suitable to work with vulnerable people were employed. One person said, “They’re marvellous staff. Always trying to help. We couldn’t wish for anything better.” People knew how to complain if they needed to and were confident their complaints would be sorted out in a timely manner. We had been notified of deaths as required by the regulations.

We spoke with three people, and the relatives of three other people who lived at the home. All were complimentary about the care provided. People told us that staff understood and met their needs. One person told us, “I feel silly when I have to call for help, but staff never make and issue of it.” A visitor said, “The staff are all so friendly. Nothing is too much trouble.”

We observed care being provided and saw staff communicating with people in a respectful, kind and patient manner. People told us they were involved in making decisions about their care and their day to day life at the home. For instance, they said they could choose what time they got up, where they ate their meals and the activities they participated in.

It was clear from speaking with staff that they knew the people living at the home well and were meeting their needs. However, we found that care plans were not personalised and did not always explain how to meet the needs of the person. This meant that there was a risk that people could receive inappropriate or inconsistent care.

Everyone we spoke with commented on how approachable the manager was. It was clear from his interactions with the people living at the home and their visitors that he was well known to them. We found that people living at the service, and their representatives, were asked for their views about the care provided and these were acted on.