We carried out this unannounced comprehensive inspection on 23 January 2017. This inspection was undertaken to ensure improvements that were required to meet legal requirements had been implemented by the service following our last inspection in July 2015. At the previous inspection the home was found to be in breach of the following regulations. Regulation 17 (2) (b) (e) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance and Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing. At this comprehensive inspection on 23 January 2017 we found improvements had been made to meet the relevant requirements previously identified at the inspection in July 2015.

Whitegates Care Home can accommodate up to 21 older people with a variety of care needs. At the time of our inspection there were 13 people using the service.

There was a registered manager at the home. 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 using the service we spoke with told us they felt safe in the home and staff were aware of the procedure to take to safeguard people from any suspected abuse.

Staff were recruited safely and records included appropriate checks on them as well as proof of identity to ensure they were appropriate for the role they were employed to undertake.

Medication policies were appropriate, comprehensive and medicines were administered, stored, ordered and disposed of safely.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and knew the circumstances that would require an application to be made.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

There were a number of quality audits in place to assist the provider in assessing and reviewing the delivery of care in the home.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with three people who use the service, three visitors, five members of staff, two visiting health professionals and the deputy manager. We also looked at seven care plans and records related to the management of the service. Our inspection team was made up of one inspector. We used the evidence to answer five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was safe. People told us that they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the provider to maintain safe care. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and understood their responsibilities in this area. At the time of inspection, no-one was subject to Deprivation of Liberty Safeguards authorisation.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that care plans reflected their current needs.

Is the service caring?

The service was caring. We spoke with people who live at the service and visitors. We asked them for their experience about the staff that supported them. Feedback from people was positive, for example one person said, "This is a fantastic place". A visitor told us, "We looked at a dozen or so homes before choosing this one. It's the best by far".

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

Is the service responsive?

The service was responsive. The home worked well with other agencies and services to make sure people received care in a way that met their needs.

People knew how to make a complaint if they were unhappy.

People engaged in a range of activities both in the home and in the wider community.

People who live at the service and their families were asked to complete a satisfaction survey by the provider. These were used to help improve the service in the future.

Is the service well-led?

The service was well-led. The service operated a quality assurance system which identified and addressed shortcomings. As a result, a good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

At our inspection of Whitegates Care Home in June 2012 we found that people's care was not always assessed or planned appropriately to ensure their welfare and safety.

The provider wrote to us in September 2012 to tell us about the action they were taking to ensure people's needs were assessed properly and care plans reflected people's needs. We carried out this inspection to check that the home was now compliant with the law and people's care was assessed and planned appropriately. We also looked at outcomes for people who lived in the home in relation to respect and involvement, safeguarding people from abuse and records.

We found that improvements had been made to ensure that people's needs were assessed and care was planned appropriately. People who lived in the home spoke positively about the care they received telling us that staff were "very good" and they received the support they needed.

People told us they were treated with respect and were able to make choices about their care. They told us that they felt safe in the home and staff were kind towards them.

Records about people's care were maintained appropriately which helped ensure they were protected against the risks of inappropriate or unsafe care.

As a result of this inspection we have made one compliance action in relation to safeguarding people from abuse. This was because action had not been taken by the provider to ensure that a possible safeguarding concern was reported appropriately.

We talked with three people who lived in the home about the staff who supported them. They told us that staff were "very good" and understood their needs well. One person commented: "They know what they are doing...they are very good people." Another person said: "They look after me...if you ask for help, it is provided."

People told us that staff received training to ensure they knew how to meet their needs. They had confidence in staff to meet their requirements and treat them with respect when providing them with their care.

We carried out this unannounced inspection because we received information of concern about staffing levels in the home and the care provided to people who used the service. We also carried out this inspection to check whether the service was now compliant with the law about staff training, supervision and appraisal following shortfalls identified at our last inspection in October 2011.

We talked with five people who used the service about their experience of receiving care. People spoke very positively about the support they received from staff. They told us that care workers were respectful and understood their needs.

People told us that, on the whole, there were enough staff on duty to meet their needs although one person commented that the home needed more care workers to make things easier for existing staff who sometimes looked exhausted. They were aware that the home was trying to recruit more staff but said that, in their opinion, the home experienced difficulty recruiting and retaining staff with the right skills.

The people we talked with told us they had confidence in the staff who supported them and that they received the help they needed with their care.

The interactions we observed between care workers and people who used the service were mostly positive and demonstrated that staff were kind and considerate in their approach.

Although the feedback we received from people who used the service was positive, our inspection identified concerns around the care and welfare of some people who used the service. We also found that our previous concerns about staff training, supervision and appraisal had not been fully addressed. The home was not compliant with these regulations. We have told the home to take action in response to our concerns.

People living at Whitegates Care Home told us they received support from caring and friendly staff. They said that staff were respectful and responded to needs as they arose. They were confident that they would be supported if they had concerns or if they were unwell. They were involved in the planning of their care to ensure that it was appropriate. They said they received support whilst their dignity and privacy was respected. They found the staff and management helpful and approachable. They confirmed that they were also asked for their opinions in surveys and on a day to day basis such as about the choice of food.

Whitegates Care Home can accommodate up to 21 older people with a variety of care needs. At the time of inspection, there were 13 people living at the home and one person who was staying for a respite break.

This was an unannounced, comprehensive inspection carried out over two days on 7 and 8 July 2015.

There was a registered manager at the home at the time of the 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.

The manager explained to us that particular circumstances had meant they had not been able to fully undertake their role. They explained this had impacted upon staff support, including supervisions and training and their ability to check that people were receiving a high quality service. This was evidenced by the findings of the inspection.

We found a number of breaches of the Health and Social Care Regulations 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of this report.

The feedback we received from people was that care workers were kind and they were happy living at Whitegates Care Home. Some of the individual comments we received included, “I am very well looked after here and I am happy” and, “They do their best and their best is good” and, “The overall picture is good”. The inspection findings showed that staff knew people well and understood their likes, dislikes and what was important to them.

There were systems in place to reduce the risk of harm to people using the service. Risks to people were assessed and plans put in place to ensure staff safely supported people.

Recruitment systems were robust and made sure that the right staff were recruited to keep people safe. New staff did not commence employment until satisfactory employment checks such as Disclosure and Barring Service (DBS) certificates and references had been obtained.

Medicines were kept within their recommended temperature ranges and the service had processes and record for obtaining and disposing of medicines. Storage for some medicines was not compliant with the relevant legislation. When administering medicines, the care workers lacked a process to secure medicines if they had to undertake another task.

The Medicines Administration Records lacked clarity around the time “when required” medicines had been administered and therefore we could not be assured that the minimum interval between doses had been maintained or the total daily dose for two “pain killers” taken “when required” had not been exceeded.

The management team undertook a variety of audits to check the environment was safe. However, these audits did not identify some environmental issues we saw during the inspection.

We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

Staff had not received supervision in accordance with the home’s policy and in addition, a significant amount of training was either out of date or not competed. This meant we could not be sure that staff had been supported to understand how to safely and effectively meet people’s needs.

People chose what they wanted to do. Some people spent time in the communal lounges and others preferred to spend time in their rooms. Where people spent time in their rooms they had the equipment they needed to maintain their independence.

Whitegates Care Home did not have an effective system for listening to, recording and acting on people’s feedback to drive improvements to the quality and safety of the service.