The inspection visit at Whitelow House Nursing and Residential Home took place on 03 April 2017 and was unannounced.

Whitelow House Nursing and Residential Home is a 32 bed care home with nursing, situated on Morecambe seafront. A passenger lift is available allowing access between the four floors. It offers both long term and short-term care. At the time of our inspection visit, 32 people lived at the home.

There was a registered manager and they were present during our inspection visit. 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.

During this inspection, we walked around the home, found it clean, and maintained to a safe standard. We noted the provider had systems that ensured people who lived at the home were safe. We found staff were knowledgeable about the support needs of people in their care. They were aware of what help people needed to manage risks and remain safe.

Records we looked at indicated most staff had received safeguarding training related to the identification and prevention of abusive practices. They understood their responsibilities to report any unsafe care or abusive practices related to safeguarding of adults who could be vulnerable.

New staff had safeguarding training identified, planned and booked by the registered manager. Staff we spoke with told us they were aware of the safeguarding procedure and knew what to do should they witness any abusive actions at Whitelow House Nursing and Residential Home.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with people who may be vulnerable. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home. The deployment of staff was comprehensively organised directing staff with their allocated tasks.

Staff responsible for administering medicines were trained to ensure they were competent and had the skills required. We investigated and noted medicines were kept safely and appropriate arrangements for storing medicines were in place.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their relatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

Care plans were organised and identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Comments we received demonstrated people and their relatives were satisfied with the care delivered. The provider and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded pro

We carried out an unannounced comprehensive inspection of this service on 05, 06 and 09 November 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 14 Meeting nutritional and hydration needs and of Regulation 18 Notifications of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They sent us an action plan setting out what they would do to improve the service to meet the requirements in relation to the breaches and identified a date by when this would be completed.

We carried out an unannounced focused inspection on 26 May 2016. The provider was not present. We wanted to speak with the provider and check the actions had been completed. We therefore returned to the service on 21 June 2016 on an unannounced visit.

We carried out this focused inspection to check they had followed their plan and to confirm the provider now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Whitelow House on our website at www.cqc.org.uk

Whitelow House Nursing and Residential Home is a 32 bed care home with nursing, situated on Morecambe seafront. A passenger lift is available allowing access between the four floors. It offers both long term and short-term care. At the time of our inspection visit, 32 people lived at the home.

There was a registered manager in place. 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 registered manager had systems to record safeguarding concerns, accidents and incidents and took necessary action as required. Not all staff had received refresher training. However, staff we spoke with showed they understood their responsibilities to report any unsafe care or abusive practices. The registered manager told us they were working towards all staff receiving the training.

Staff felt supported in their roles, however there was no formal system in place to provide staff with regular formal supervision.

The environment was clean and hygienic when we visited. The home was tidy, well maintained and smelt pleasant throughout.

During this inspection, we found the registered manager had met the requirements of the regulations. People were happy with the variety and choice of meals available. Staff were available when necessary, to offer people support with their meals. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found staffing levels were sufficient with an appropriate skill mix to meet the needs of people who lived at the home. Staffing levels were determined by the number of people being supported and their individual needs.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working in the care centre. This was confirmed from discussions with staff.

We found medication procedures were safe. Staff responsible for the administration of medicines had received regular training to ensure they maintained their competency and skills. Medicines were kept safe and appropriate arrangements for storing were in place.

Staff received training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People’s representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Dep

We observed care at Whitelow House, talked with staff, residents and visitors and examined records. We took particular heed of nursing staff training, in the light of concerns brought to our attention earlier in the month of the inspection.

We found that people were well cared for, and that the home was nicely decorated and clean. Cleaning staff took pride in their work. People we spoke with were mainly happy with their care or that of their relatives. Answers to a survey conducted by the home confirmed that most people were happy with the quality of care in the home.

We saw that staff were pleasant and patient with residents, and appeared to know people well. Care plans were comprehensive and records up to date. We examined how well medication was stored and administered and found it to be safe. Minor issues were addressed at the time of the inspection.

We found that nursing staff had either received, or were due to receive, training in most of the procedures which had caused concern. These included PEG feeding, compression bandaging, syringe driving and taking blood. There had been some problems maintaining sufficient numbers of care staff in the last few months, necessitating the use of agency staff. This had been resolved at the time of the inspection visit.

We found the owners were involved in the running of the home, and led by example. One of the owners was the registered manager. Quality audits were conducted by an external agency.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. People also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience and a practicing professional. An Expert by Experience is a person who has personal experience of using or caring for someone that uses this type of service. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

During the course of the visit we spoke individually with nine people living at Whitelow House and six relatives and friends who were visiting. More informal discussion with people also took place in communal areas at various times throughout the day. People told us they were happy living at the home and that staff were always kind, polite and respectful. People spoke positively about how they were able to make decisions about their care, spend their time and enjoy shared interests and social events with others. Staff spoke in a friendly way and there was a relaxed, comfortable and homely atmosphere.

One person commented that, “Nothing is too much trouble. If you ask, they do it straight away”. Another person said, “Everything is alright, I am happy here”.

People who used the service made positive comments about the meals provided. One person told us “The food is very good. The staff are very good, they help you any way you want”. Another person who had a poor appetite and needed encouragement to eat said, “They (the staff) treat me very well”.

People spoken with said they were happy with the meal arrangements in place and that they always had a sufficient amount of foods that they enjoyed.

The people spoken with expressed positive comments about the care and support provided at Whitelow House. We saw that people were treated with kindness and compassion and appeared comfortable enough to be able to speak with staff about any concerns. All the people spoken with had positive things to say about the staff team describing them as, “Good", "Kind" and "Nothing is too much trouble”.

One person, when asked if she knew how to raise any concerns said that she would tell her son, but then went on to say she had no concerns. Another person said that staff came quickly if the nurse call alarm was pulled but then pointed out that it did not have to be pulled often. We were told, “Most staff are very attentive”. A third person told us that they would simply put their coat on and walk out if they were not happy.

We observed that staff were not rushed and had time to spend with people in a relaxed and friendly way. Nobody spoken with expressed any dissatisfaction or concern about assessed needs not being met in a timely and caring way.

People living at the home all spoke positively about the qualities of the staff team and the care and support they received.

The inspection visit took place on 05, 06 and 09 November 2015 and was unannounced.

Whitelow House Nursing and Residential Home is a 32 bed care home with nursing situated on the Morecambe seafront. A passenger lift is available allowing access between the four floors. It offers both long term and short-term care. At the time of our inspection visit there were 31 people who lived at the home. Whitelow House Nursing and Residential Home can accommodate up to 32 people who require nursing or personal care, diagnostic and screening procedures and the treatment of disease, disorder or injury. People who live in Whitelow House Nursing and Residential Home are older people and may have conditions such as dementia, mental health needs or a physical disability.

There was a registered manager in place. 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 last inspection on 29 May 2013 the service was meeting the requirements of the regulations that were inspected at that time.

Through our observations and discussions with people during this inspection we noted a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition we also found a breach of The Health and Social Care Act 2008 (Registration of Regulated Activities) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We have made a recommendation about the deployment of staff at night time and to review the lines of responsibility and accountability within the management structure.

During this inspection, the registered manager had systems in place to record safeguarding concerns, accidents and incidents. However we noted that one safeguarding concern had been recorded and investigated but not reported to the Care Quality Commission (CQC). A second safeguarding concern had not been recorded or reported. Records we looked at showed staff had received safeguarding training which indicated they had been told of their responsibilities to report any unsafe care or abusive practices. People who lived at the home said they felt safe and their rights and dignity were respected.

The environment was clean but not well maintained in some areas when we visited. No offensive odours were noted during the inspection.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff spoken with and records seen confirmed a structured induction training and development programme was in place.

We found medication procedures in place were safe. Medicines were safely kept and appropriate arrangements for storing medicines were in place. People told us they received their medicines at the times they needed them. Extra nursing staff worked on the day medicines were delivered to Whitelow House. This was to allow the medicines to be booked in safely without interruption.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their personal care needs. We found daytime staffing levels were sufficient with an appropriate skill mix to meet the needs of people. Staffing levels were determined by the number of people being supported and their individual needs. Staffing levels at night require further analysis to ensure staff are able to meet people’s care needs. This was because the three staff on duty were expected to cover all four floors and were required to provide personal care in addition to completing cleaning and laundry tasks. The personal care could require two staff to complete. This left one staff member available to respond to people across the four floors of the home. This increased the risk of failing to monitor and respond to people in a timely manner.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met. We saw an alternative meal was offered if people wanted something different. However through our observations we noted at lunchtime there was not enough staff to ensure that everyone received a hot meal.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussion with the registered manager confirmed they understood when an application should be made and in how to submit one.

Care plans we looked at contained an assessment of people’s support needs before they moved into the home. We saw the person or a family member had been involved in the assessment and had consented to the support being provided. People we spoke with said they were happy with their care and they liked living at the home.

People’s health needs were being met and any changes in health were managed well. The people we spoke with said they had access to healthcare professionals when they needed them. This was observed on the day of our inspection when a health professional visited.

A complaints procedure was available and people we spoke with said they knew how to complain. We saw there had been five complaints documented with four having had an investigation and outcome documented.

The registered manager had sought feedback from people receiving support or their friends and family. They had consulted with people they supported and their relatives for input on how the service could continually improve. External quality audits had been completed regularly. People we spoke with during our inspection and their visiting relatives and friends said they were satisfied with the service delivered.