This inspection took place on 21 November 2018 and was unannounced.

White Lodge is a ‘care home without nursing’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

White Lodge accommodates up to 25 people living with dementia and physical frailty. There were 21 people at the home when we inspected.

At the last inspection in April 2018, the service was rated Inadequate and nine breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were found. Following the inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least ‘Good’. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

This inspection found that whilst improvements had been made and number of regulatory breaches had been met. There were areas still to improve and embed in to everyday practice. The service has been taken out of special measures.

There had been no registered manager in place since August 2018. A manager had been appointed and they had begun the process of being registered with CQC. They will be referred to as the manager in the report. 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 had been improvements to the management of medicines, although further improvements were needed. Actions had been taken to address medicine errors made by staff, and supervisions and daily audits had been implemented to improve the management of people’s medicines in the home. However, there were still concerns about some medicines management. For example, maintaining accurate records regarding the safe administration of medicines.

A quality assurance framework was in place. However, this was not consistently effective and shortfalls in the provision of care were not always identified.

There had been an improvement in the assessment and mitigation of risks associated with falls. Most of the risk assessment and management plans to minimise risks to people from falls were completed in sufficient detail and risk management plans were followed by staff.

Staff were knowledgeable about the risks associated with people’s care. The information available to new and unfamiliar staff, such as handover notes and care plans was consistent to guide staff on how to support people safely. However, work was still needed for care records to be more person centred.

There was robust recruitment procedures in place and staff had been safely recruited. Sufficient staff were available to meet people’s needs. The provider told us there had been changes to the number of permanent staff on duty and the more effective shift management and allocation of staff. However, people and their relatives told us they did not think there were always enough staff available.

The provider told us about the recent staffing changes they had made and were confident these would achieve improvements for people. This included recruitment to an operations manager post. Further time was required to embed these changes into practice and ensure sufficient staff were available to meet people’s needs and keep them safe at all times.

People told us they felt safe living at the home. Staff understood their responsibilities to protect people from abuse and referrals had been made to the local authority when incidents or allegations occurred.

Staff protected people from the risk of infection and followed procedures to prevent

The inspection took place on 23 and 24 April 2018 and was unannounced on day one and announced on day two.

White Lodge is a ‘care home’ situated in Emsworth near Portsmouth. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home sits within its own grounds and provides accommodation and support for up to 25 older people. Nursing care is not provided. Accommodation is sited over two floors. On the day of the inspection there were 23 people using the service.

The service requires 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. At the time of the inspection there was no registered manager, although the manager had made an application to CQC to be registered. They will be referred to as “the manager” throughout this report. The previous registered manager had also been at the service on the first day of the inspection and where applicable they will be referred to as “the previous manager”.

At the last inspection in January 2017 the service was rated Requires Improvement and there were three breaches of the Health and Social Care Act 2008. Regulation 11, Need for consent; Regulation 12, Safe care and treatment; and Regulation 12, Good governance. At this inspection we found continued breaches in Safe and Well Led, together with other concerns.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive, Effective and Well led to at least a rating of Good. We had to contact the previous manager to request an action plan, as one had not been sent.

At this inspection, although people and relatives gave mainly positive feedback about the service, we continued to have concerns about the safety and well-being of people. Emerging risks were seen in areas where there had been no previous concerns and breaches and continued breaches of Regulation were found.

Risks including those associated with medicines, people’s care, the spread of infection and fire drills had not been properly assessed or minimised in order to keep people safe.

People were at risk because staff did not administer or manage medicines safely. For example, there were no assessments of risk associated with blood thinning medicines. This was a repeated breach, and we saw deterioration since our last inspection in January 2017.

Accidents and incidents were not competently managed. We found the approach to reviewing and investigating causes to be insufficient. There was little evidence of learning from these occurrences.

The provider did not always make referrals for appropriate care and treatment at the right time. In some examples, we found that recommendations for care and treatment by other professionals were not always carried out as directed.

People's care needs were not regularly reviewed. We found care plans did not sufficiently inform staff of people's current care, treatment and support needs, which left people exposed to the risk of receiving inappropriate care or treatment.

Staff had not received training for them to be able to undertake their role and meet people’s needs.

There was minimal evidence to show the service was monitored to ensure its’ safety and there was no evidence that lessons had been learned and improvements made when things went wrong.

People's healthcare had not been effectively monitored and concerns escalated in a timely way. Care plans did not always reflect people’s needs which left people exposed to the risk of receiving inappro

This inspection took place on 17 January 2017 and was unannounced. This is the first inspection of the home under its current registered provider.

White Lodge Care Home is situated in Emsworth near Portsmouth. The home sits within its own grounds and provides accommodation and support for up to 25 older people. Nursing care is not permitted. Accommodation is sited over two floors.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since August 2014. 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 2008 and associated Regulations about how the service is run.

People told us they were safe living at the home and staff had a good understanding of safeguarding issues and how to recognise and report them. There was regular maintenance of the premises and fire risk and other safety checks were undertaken. A gas safety certificate was not available on the day of the inspection but a new certificate was forwarded to us later. People had emergency evacuation plans in place. Accidents and incidents were monitored and any individual issues or concerns addressed.

Most staff had been subject to a suitable recruitment procedure and checks, to ensure staff had the right skills. Not all staff on induction at the home had received two references or a final Disclosure and Barring Service (DBS) check. We have made a recommendation about this. People told us there were enough staff at the home to meet their needs. We found some issues with the recording and management of medicines at the home. The home was clean and tidy. We found some issues with infection control around the use of commodes at the home and the storage of cleaning equipment.

Staff told us they had access to a range of training and updating. Individual records confirmed completed staff training, although there was no overall record to monitor this. Staff told us, and records confirmed they received annual appraisals. Records showed some supervisions had taken place, but the registered manager told us some staff still required supervision sessions.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists, district nurses and other specialist health staff. We witnessed staff responding immediately and appropriately to health concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager confirmed appropriate applications had been made where people may need to be assessed for a DoLS application. People were asked their consent on a day to day basis. We noted records, where relatives had Lasting Power of Attorney and where best interests decisions needed to be made, were not always detailed.

People were happy with the quality and range of meals and drinks provided at the home. Special diets, individual dietary requirements and likes and dislikes were catered for.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People said they were always treated with respect and dignity.

Care plans contained good person centred detail related appropriately to the individual needs of the people living at the home. Care plans often lacked detail to assist staff in supporting people. Reviews of care were not always comprehensive or carried out in a timely manner. A range of activities were offered for people to participate in. We witnessed a session by en