This inspection took place on 10 October 2018 and was unannounced.

Whitebirch Lodge 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. Whitebirch Lodge can accommodate 19 people. At the time of our inspection there were 14 people living at the service.

Accommodation is spread over 2 floors in a large detached property. There were 2 communal lounges and a dining area where people could choose to spend their time.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Whitebirch Lodge was last inspected March 2018. At that inspection it was rated as 'Requires Improvement' overall. A number of breaches of Regulation were found during that inspection. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least good. Although we found improvements at this inspection, there were still two breaches of regulation and other areas that required ongoing improvements. This is the second consecutive time the service has been rated ‘Requires Improvement.’

People were protected from the risks of avoidable harm and abuse. Staff knew how to recognise and respond to abuse. However, the registered persons had failed to ensure staff received refresher safeguarding training in line with their own policy. The policy had been reviewed in December 2017, however it did not refer to relevant legislation. We pointed this out during the inspection and the registered manager showed us an updated policy before we left.

There were enough staff to keep people safe, however, the system to assess how many staff were needed was not clear. Staff were recruited safely. Staff had begun to receive training updates and support to enable them to carry out their roles effectively. However, many staff had not completed refresher training in several topics at the time of the inspection. A new e-learning training package had been recently introduced at the service. Staff received supervision and appraisal to discuss their development.

Care records had improved since our last inspection and each person had a care plan. The provider had invested in a new electronic care recording system since our last inspection and was in the process of fully introducing this to the service.

Checks and audits had begun to be undertaken, but were not yet fully effective. This was mainly due to the introduction of new systems and processes within the service. Policies and procedures had been reviewed, however, most were outdated.

People, relatives, staff and stakeholders were asked their views on the quality of the service. However, not all surveys had been received back so the feedback had not been fully collated or analysed. Those that had been received had been responded to. The feedback we viewed gave positive feedback about experiences at the service.

Accidents and incidents were documented and reviewed to look at ways of reducing the chance of them happening again. Risks to people were assessed and managed to ensure their health and safety. For example, there was guidance in place for staff to safely support people with unstable health conditions.

People received their medicines when they needed them and in a way that was safe. They were stored safely. Temperatures were recorded on a daily basis.

Staff monitored people’s health and referred them to health professionals when required. Staff followed the guidance from health professionals to keep people as healthy as possible. Staff

This inspection was completed on 14 March 2018 and was unannounced.

Whitebirch Lodge 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.

Whitebirch Lodge provides accommodation for up to 19 older people who need support with their personal care. Accommodation is arranged over two floors and a stair lift is fitted to assist people to get to the first floor. There were 16 people living at the service at the time of our inspection.

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 2008 and associated Regulations about how the service is run.

The provider and registered manager lacked oversight of the service. There was no formal system of checks or audits to ensure compliance with the fundamental standards and regulations. At the start of our inspection the registered manager told us they were aware, ‘some of their paperwork was lacking’ and ‘some of their care plans required updating.’ Although they had contacted a specialist nurse from the local clinical commissioning group for advice and had updated three people’s care plans we found concerns regarding risk and medicine management, staff training and restrictions to people’s freedoms had not been appropriately authorised.

Some people had no care plan in place to give staff guidance about what support they needed and risks relating to their care and support had not been assessed. One of these people had developed a pressure sore, and there was no plan in place to help keep their skin healthy. Staff did not monitor the fluid input and urine output of a person’s catheter and this had recently become blocked, placing them at risk of an infection. Guidance for staff regarding how people wanted their care to be delivered was also lacking. This limited people’s involvement in planning their care and support. No consideration had been made regarding how people wanted to be supported at the end of their lives. Analysis was not completed when accidents or incidents occurred at the service, limiting the opportunities for learning from them and reducing the risk of them happening again.

The lack of guidance and inconsistent approach to the assessment of people’s needs meant staff relied on their own knowledge of people to support them. Although most staff had worked at the service for some time, and knew people well, they had not received training in topics specific to people’s needs such as pressure care management. Staff had received some training in catheter care and dementia, but most of this was many years ago.

There was no formal system in place regarding the assessment of staff competency. Staff were administering people’s medicines without being assessed as safe to do so. This had been identified as a concern in an external audit of a pharmacist in November 2016 and again in February 2018, but no action had been taken to rectify this concern.

Although 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 did not support this practice. The registered manager lacked understanding regarding Deprivation of Liberty Safeguards (DoLS). One person had been assessed as lacking capacity to consent to their care at the service and was unable to leave. This restriction had not been applied for, and appropriately assessed and authorised.

People, their relatives, staff and other stakeholders had been asked their views on the service, but these responses had not been analysed, and areas for improvement recommended had

This inspection was carried out on 6 October 2015 and was unannounced.

Whitebirch Lodge provides accommodation for up to 19 older people who need support with their personal care. Accommodation is arranged over two floors and a stair lift is fitted to assist people to get to the first floor. There were 19 people living at the service at the time of our inspection.

A registered manager was in post and was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager, supported by two senior staff, provided leadership to the staff and had oversight of all areas of the service. Staff were motivated and felt supported by the registered manager and senior staff. The staff team had a clear vision of the aims of the service which was based on mutual respect and was to treat people as individuals and to give person centred support. Staff told us the registered manager was approachable and they were confident to raise any concerns they had with him.

There were enough staff, who knew people well, to meet peoples’ needs. The needs of people had been considered when deciding how many staff were required on each shift. Staff were checked before they started to work at the service and were trained and supported to provide safe care. Staff met regularly with the registered manager to discuss their role and practice and any concerns they had. One person said “The staff here are all very nice, very pleasant.”

Staff knew the signs of abuse and were confident about how to raise a concern. Plans were in place and staff knew how to keep people safe in an emergency. Possible risks to people had been identified and were managed to keep people as safe as possible.

People’s needs had been assessed to identify the care they required. Care and support was planned with people and reviewed make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to provide all areas of the care and support people needed.

Medicines were stored and administered safely. People had the support they needed to remain healthy and well. Staff responded to any changes in people’s health needs, people told us that staff always called their doctor if they felt unwell.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. Arrangements were in place to check if people were at risk of being deprived of their liberty. Systems were in operation to obtain consent from people and to comply with the Mental Capacity Act 2005. People were supported to make decisions and choices.

People were supported to participate in hobbies and activities they enjoyed. There was a lovely atmosphere, with lots of laughter, during a game of bingo and a crossword session. People were involved in planning the menu and were supported to have a balanced diet, everyone said the food was very good. A variety of equipment was provided to support people to remain as independent as possible. Staff listened to what people told them and responded appropriately. People were treated with respect and their privacy and dignity was maintained. People told us that they had no complaints and if they did they would speak to the staff.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place. Safety checks were completed regularly. Everyone had their own bedroom with en suite facilities and people told us that their bedrooms were comfortable.

The registered manager completed regular checks of the quality of the service provided. When shortfalls were found action was taken quickly to address these and prevent them from occurring again. People, their relatives and staff were asked about their experiences of the care. These were used to improve and develop the service.

Accurate records were kept about the care and support people received and about the day to day running of the service. This provided staff with the information they needed to provide safe and consistent care and support to people.

We found the service to be clean, with a pleasant and calm atmosphere. People who used the service told us that they were happy with the care and support they received. One person told us “I am very happy here the staff are kind and have helped me cope better with things”. Another person we spoke to told us, "The food is really good; there is lots of choice and plenty of it”.

To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

People told us and we saw that they received the care and support they needed to remain well and healthy. We saw records to show how people's health needs were supported and that the service worked closely with health and social care professionals to maintain people's health and well-being.

Staff were able to demonstrate that they were knowledgeable about the needs of the people who used the service and we observed that they approached people with respect and paid particular attention to maintaining people’s dignity.

We found that the provider had implemented ways to gather feedback on the service from people, as well as initiating informal discussions with people about how to continually improve the service.

There were 17 people using the service. We met and spoke with some of them and everyone we spoke with said that they were happy living at Whitebirch Lodge. One person said “I am very happy here.”

People told us that they felt safe and well looked after. People looked relaxed, comfortable and at ease with each other and staff. One person said “I couldn’t find a better place, everything is wonderful” and “The staff are very patient, they really are” and “This home was recommended to me. I have no complaints at all.”

People said that the home was clean and that their bedrooms were kept clean. People said that they thought the staff were kind and caring. One person said “This is a lovely place to be, they (staff) are very kind to you.”

People said that they had enough to do and enjoyed the organised activities and said “We have lots going on here. At Christmas there were all sorts of things going on.”

People’s health needs were supported and the service worked closely with health and social care professionals to maintain and improve people’s health and well being.