We undertook this unannounced inspection on 14 March 2017. Whitchurch Lodge is registered to provide personal care and accommodation for a maximum of 32 people, some of whom may have dementia. At this inspection there were 28 people living in the home.

At our previous comprehensive inspection on 24 March 2016 we rated the service as “Requires Improvement”. We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The registered provider did not ensure that at all times the premises and equipment were safe and did not do all that was reasonably possible to mitigate against health & safety risks to people. At this inspection the service demonstrated that they had taken action to comply and the required checks and documented evidence were in place. The second breach was in respect of Regulation 17 Good governance. This service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. At this inspection the service had the necessary checks and audits for ensuring quality care.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adult's policy and suitable arrangements for safeguarding people.

The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medicines.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Care workers prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen by us. People’s healthcare needs were monitored and attended to. Arrangements had been made with healthcare professionals when required.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Fire drills had been arranged.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that no authorisations had been applied for. The assistant manager was aware of the requirements of the law, however, at the time of this inspection she stated that no person needed a DoLS authorisation.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and special preferences were met. People informed us that they were satisfied with the meals provided. Catering staff checked daily with people to ensure that their preferences were responded to.

There were enough care workers deployed to meet people's needs. They were knowledgeable regarding the needs of people. Teamwork and communication within the home was good. Care workers had received induction and training to enable them to care effectively for people. There were arrangements for support, supervision and appraisals from their managers.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Care workers were caring and knowledgeable regarding the individual choices and preferences of people. Regular residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people could participate in social and t

We undertook this unannounced inspection on 24 March 2016. Whitchurch Lodge is registered to provide personal care and accommodation for a maximum of 32 people, some of whom may have dementia. At this inspection there were 28 people living in the home.

At our last inspection on 10 July 2014 the service met all the regulations we looked at.

The home has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and dignity and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Care workers were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them had been assessed and care workers provided with guidance on minimising identified risks.

Care workers prepared appropriate care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were closely monitored and arrangements made for them to be attended to. There was evidence that people had access to community healthcare professionals and specialist hospital services. This was confirmed by people and their relatives.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme and we saw people being encouraged to participate in social activities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of meals to ensure that people’s dietary needs and cultural preferences were met. People were satisfied with the meals prepared and healthy eating was encouraged. People had been given their medication and this was confirmed by them and recorded in their medicine administration charts (MAR)

There were arrangements to ensure that care workers were carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough care workers to meet people's needs.

People and their relatives expressed confidence in the management of the service. The results of satisfaction surveys and feedback from people indicated that they were satisfied with the care and services provided. The staff survey indicated that care workers were satisfied with the way they were managed. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity and proving a high quality of care within a homely environment.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out on equipment. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. We however, noted that there were no regular temperature checks of the h

An inspector carried out a planned inspection and gathered evidence against the outcomes we looked at to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Procedures were in place to protect people from abuse. We found staff had been trained and were able to respond appropriately to allegations or suspicions of abuse or neglect. Records showed people experienced safe and appropriate care. Their needs had been

assessed and their care and treatment planned and delivered in accordance with individualised care and risk-management plans. For example, staff followed guidance in care plans to minimise risk of falls when people were moving around the home.

The provider and staff understood their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). At the time of our inspection no one was subject to a DoLS authorisation or application.

Procedures were in place for dealing with emergencies and staff were suitably trained to ensure people's safety and welfare. People told us they felt safe. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service well led?

We found the provider carried out monitoring and reviews of the service and highlighted actions were completed in a timely manner. This meant the quality of the service could be assured by people living at Whitchurch Lodge, their relatives and staff.

Staff told us they felt very supported by the manager and deputy manager. Comments included, “The manager is very nice. She always listens to and reassures me.”

Is the service effective?

People’s health and care needs were assessed and we saw evidence to show they (or their relatives where appropriate) were always involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support they needed.

Is the service responsive?

We saw the provider had effective complaints, accident and incident reporting procedures. We found these were addressed within appropriate timescales. We found the provider monitored people's support needs and was able to respond appropriately if and when those needs changed. For example, we observed a person was supported to access an emergency psychiatric assessment in hospital when their mental health needs suddenly changed.

Is the service caring?

A relative and advocate of people gave positive feedback about staff and said were caring. People were dressed in clean and appropriate clothing. Attention had been given to their personal hygiene and grooming. We found staff to be knowledgeable about people's preferences, for example, their choice of food and beverages and these were accommodated. We observed people were supported by kind, attentive staff and empathetic staff. Staff showed patience and gave encouragement when supporting people. People using the service told us, “The staff are lovely, they really are.” A relative we spoke with told us, “It is absolutely wonderful. I’m surprised by how good they actually are. It’s a very homely sort of place compared to other places I’ve been to.”

We spoke with six people who used the service and ten members of staff including the manager. Only one person remembered being involved in moving to the home but they all were positive about how they were treated by staff. They commented that their culture was both respected and supported. Although there was a lack of choice and variety available for different aspects of their care, we found that peoples' privacy and dignity were maintained and people were involved in their care, .

People told us they were happy with the care they received. Comments included "It is a very good home. I doubt you would find a better one anywhere. On a scale on 1:10 I would give it 10." Although we observed care being provided safely, the quality of care was inconsistent.

All the people we spoke with enjoyed the food and drink that was provided. They explained they were able to have the food they wanted if they did not like what was on the menu. Although the food and drink provided was not very varied and there were instances of food stored past its sell by date, it was all nutritious and met peoples' needs.

Although there were aspects of the premises and furniture that were either not used appropriately or in need of repair, the premises was safe and checked to ensure care was provided safely.

The provider had in place appropriate policies and procedures, and records were stored appropriately. Although care plans were not very detailed, they were fit for purpose.

We looked at the care records of seven people, spoke with 11 people who use the service and their relatives. Comments people made were “its awful here I just grin and bear it” and “the manager is nice but she is not effective.” One person told us " I am happy, although I never get to go out and see the cricket anymore."

Care records we looked at showed people were not protected from the risk of receiving inappropriate or unsafe care because the provider had not taken proper steps to ensure care was appropriately planned and delivered. We also found that people were treated with a lack of dignity and respect. For example people were left using a toilet with the door open, where they could have been seen by other people living and working in the home as well as people visiting.

We checked the food choices available to people and looked at how people's nutritional needs were being met. We found the service was failing to ensure people had a choice of nutritious foods. They did not always receive adequate amount of fresh fruits and vegetables as directed by health professionals.

We looked at the maintenance of the home and found some areas to be in a good state of repair. We also noted that some areas that were not adequately maintained.

We did not speak with people using the service about this outcome area. The main aim of

the inspection was to assess whether the provider had appropriate arrangements in place

to manage medicines so that people were protected against the associated risks.

People were involved in their care and given the opportunity to make choices about their care and support and in their daily life, whenever possible. When this was not possible their relatives were involved. Relatives said that they had been involved in drawing up and reviewing people’s care plans and risk assessments so that they were aware of the care and support people needed for their needs to be met.

All relatives we spoke with said people appeared well cared for and appropriately dressed when they visited. Our observations during the inspection confirmed this.

People said they received a variety of meals that they enjoyed. Relatives confirmed that the provision of meals had improved to provide more choices and variety to people. Most people joined in communal recreational activities. Some preferred to engage in personal activities and this was respected by staff.

Relatives told us they liked the environment and the ‘ambience’ that the home provided for people. They thought that it was homely, warm and friendly.

Relatives informed us that they had completed satisfaction questionnaires to give feedback about the quality of the services provided. We also saw minutes of a relatives’ meeting which the manager had arranged to offer relatives the opportunity to share their views and to make suggestions about improving the quality of services provided.

We found that the arrangements in place were not adequate to fully protect people against the risks that can arise when medicines were not managed appropriately.

People said that they were given the opportunity to make decisions about their lives. For example they told us that staff asked them about their choices during meal times and whether they wanted to take part in recreational activities and respected the choices made.

Most relatives told us that the home kept them informed of changes in people’s condition and discussed the care of people with them. One person said that staff had discussed the care records with them. Relatives commented that at times they were involved in the review of the care of people and at other times they were not.

People and relatives told us that they have not attended any home meetings. The manager said these were arranged for people and their relatives but no one attended. A notice was displayed in the home with details of the next meeting that had been arranged.

One visitor said that their relative was “generally well cared for” and when asked what could be improved in the home they said “to talk more to the person to keep their mind active”. Another said that “staff are cheerful with my relative”.

With regards to personal care one person who was unshaven said that they were not always shaved and that sometimes they had to wait for a week before they received a shave. A visitor said that their relative was most of the times clean shaven but there were times when they were not shaved. Another person told us that their teeth did not always get cleaned.

Relatives told us that the activities coordinators in the home were very good. They engaged with people and organised recreational and social activities. Relatives also said that nothing much happened in the home when the activities coordinators were not on duty, such as when they were on leave or during the weekend.

Relatives told us that they chose the home because it provided a “homely” environment for people and “looked like a real home”. They liked the fact that the main lounge was warm and bright. One person said that they liked the quiet lounge where they could sit peacefully. A visitor said that the carpet in some areas should be replaced.

People liked their bedrooms and one person said that they would have liked to be more involved in rearranging their rooms. Some said that they were able to bring small items of furniture to personalise their bedrooms.

Relatives said that they were given satisfaction questionnaires for them to give their views about the quality of the service that was provided. These were however not summarised to provide a report of the findings and to identify areas where improvement was required.