This inspection took place on 12 and 18 April 2017 and was unannounced. At the last inspection of the service on 21 and 22 June 2016 we found a breach of regulation of the Health and Social Care Act 2008 in that staff were not supported through regular supervision and appraisals of their practice and performance in line with the provider's policy and staff administering medicines had not received appropriate up to date training and competency assessments to ensure safe practice.

Whiteoak Court Nursing Home provides personal care and nursing support for up to 27 older people. The home is situated within a quiet residential area of Chislehurst, Kent. At the time of our inspection the home was providing support to 25 people. The home had 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.

At this inspection we found the previous concerns in relation to staff receiving regular supervision, support, appraisals and appropriate training had been addressed and significant improvements had been made.

Risks to the health and safety of people were assessed and reviewed to ensure people’s safety was maintained. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals to ensure best practice. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and their support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint and people using the service were provided with opportunities to share their views about the service. There were systems in place used to monitor the quality of the service on a regular basis.

This inspection took place on 12 and 18 April 2017 and was unannounced. At the last inspection of the service on 21 and 22 June 2016 we found a breach of regulation of the Health and Social Care Act 2008 in that staff were not supported through regular supervision and appraisals of their practice and performance in line with the provider's policy and staff administering medicines had not received appropriate up to date training and competency assessments to ensure safe practice.

Whiteoak Court Nursing Home provides personal care and nursing support for up to 27 older people. The home is situated within a quiet residential area of Chislehurst, Kent. At the time of our inspection the home was providing support to 25 people. The home had 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.

At this inspection we found the previous concerns in relation to staff receiving regular supervision, support, appraisals and appropriate training had been addressed and significant improvements had been made.

Risks to the health and safety of people were assessed and reviewed to ensure people’s safety was maintained. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals to ensure best practice. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and their support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint and people using the service were provided with opportunities to share their views about the service. There were systems in place used to monitor the quality of the service on a regular basis.

Following a previous inspection of the service on the 06/06/2014, we identified essential standards of quality and safety were not being met in respect of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take appropriate action to achieve compliance with this regulation.

We did not speak to people using the service at this inspection but spoke with them in June 2014 when we last visited the service. We gathered evidence of people's experiences of the service by observing care practices, speaking with staff and reviewing records related to the running of the home.

The manager and owner showed us the changes that had been made since our last inspection in June 2014. We saw the service had reviewed, updated and changed its record systems to gain further detailed information on people’s needs and risks and reviews of care plans had been conducted and recorded. We saw evidence that people using the service and their families/representatives had been involved in the assessment and or review process and people’s wishes and choices had been considered and respected. We noted that people’s care plans contained a section that recorded visits from health and social care professionals. We reviewed the home’s fire safety policies and procedures which were comprehensive and noted that people using the service had a Personal Emergency Evacuation Plan (PEEP) in place.

We considered our inspection findings to answer questions we always ask providers when we visit to inspect a service; is the service caring, responsive, safe, effective and well led.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were twenty four people using the service. We used different methods to help us understand the experiences of people who use the service. We used our Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care provided which helps us to understand the experiences of people who were unable to talk with us.

Is the service caring?

People using the service we spoke with told us they were treated with respect and dignity by staff and that staff checked with them and confirmed their choices and wishes with regards to the delivery of their care. Staff addressed people respectfully when talking with them and people using the service were spoken to by their preferred names. We heard members of staff speak politely with people and consult them about their choice of meals and the support they were offered with mobilising around the home or which activities to engage in. People using the service who we spoke with told us they were very much a part of the planning of their care and had been given choices about their support and how it was delivered. One person told us “Staff are respectful to me at all times and I am always asked for my views and choices”.

Is the service responsive?

During our inspection we spoke with several people using the service and visiting relatives. They all spoke positively about the service. One person using the service told us “It’s like the Dorchester here; I am treated very well and have never known such a homely and warm place to be. Staff have nothing but compassion and respect.” Another person said “I am very well looked after, the staff are gentle and kind, on the whole it is very good.” A relative visiting the service told us “I am seriously impressed, the staff are terrific.

We found that following an initial assessment process relatives were not involved with any on-going formal review process of the care provided or the risk assessments that had been conducted. These were undertaken by staff members alone. We were told that people who used the service were regularly consulted as part of the review process which was conducted every three months; however this was not evident from records seen. There was no recorded evidence of discussions with people using the service and records were only signed by members of staff. This meant that people's care plans were potentially not reflective of their current needs or wishes.

We saw from records when someone using the service had fallen or an injury had occurred this was recorded on a body map tool within people's care plans. Medical assistance was sought and a doctor or an ambulance was called as appropriate. However records within peoples care plans were not reflective of this and did not allow for the recording of visiting health and social care professionals involvement. This meant that staff may not be aware of peoples care and treatment needs if someone had suffered a fall or had been taken to hospital to receive medical treatment.

Is the service safe?

People we spoke with using the service told us that they felt safe in the home and well supported by staff. Observations during our inspection showed there was a relaxed friendly atmosphere within the home environment and people chatted freely and openly with each other, the staff and management.

The service had clear procedures on safeguarding vulnerable adults from the risk of abuse including how to recognise types of abuse and what action to take. The owner showed us the homes safeguarding adults from abuse procedure and told us this procedure was used in line with the "London Multi Agencies Procedures on Safeguarding Adults from Abuse" (PAN London). They also showed us the local authority’s procedure for reporting abuse and the contact information they had with details of who to contact within the local authority should they have any concerns.

Is the service effective?

In discussions we had with staff they were able to explain how they monitored people's nutritional intake and the action they took if people were losing or gaining weight. This included monitoring people’s weight on a regular basis and making referrals to the GP for dietician involvement if required.

During lunchtime we carried out a SOFI (Short Observational Framework for Inspection) in the dining room of the home. We used our SOFI tool which helps us to see what people’s experiences at mealtimes were. We found that people had positive experiences. We saw that people were assisted to the dining room and supported with their choice of meal and drink. Staff members supporting people with their lunch knew what support they needed and respected their wishes if they wanted to manage on their own. We saw that people were offered a good size portion and people seemed to enjoy their food. Where relevant, people were provided with suitable adapted crockery to help them feed themselves and staff monitored discreetly where needed to ensure people had enough to eat. We saw that food was pureed for those who had possible choking or swallowing difficulties and concerns. We observed that for people not well enough to come to the dining room they were supported by staff members to eat their meals in their rooms. We saw that people were spoken to and assisted respectfully.

Is the service well-led?

During our inspection we observed that there were sufficient numbers of staff on duty to attend to people's needs and nobody was left alone for any length of time. We looked at the records for staffing arrangements within the home and found there were enough qualified, skilled and experienced staff to meet people's needs. We spoke with the owner and several members of staff who told us that the home had a stable team of staff. The owner explained to us that most members of staff had been employed by the home for many years and that the home did not use agency staff to cover staffing shortages. We were told that the home operated its own bank of staff who could be contacted if required.

The home had a system in place for the recording and monitoring of accidents and incidents. The owner told us that all accidents and incidents were monitored on an annual basis. We were given examples of how this monitoring helped to improve service delivery. For example they told us how statistics showed the level of falls within the home and how these could be minimised and addressed for people using the service. They also told us of the various audits they undertook on a frequent basis. Audits included; medication, equipment, the homes environment, water and refrigeration temperature checks and electrical and gas appliances safety checks. Records we looked at confirm this. This meant the provider had effective systems in place to regularly assess the risks and benefits to people that used the service.

People and their representatives told us they were very happy with the home in all but one case. Everyone we spoke with on the day of our inspection told us they felt the standard of care at the home was good. One person said they were "very glad" they had decided to move to the home and that they were "amazed" at how good the staff were. Another person said they "couldn't wish for much better" care than the home provided. Another person told us "staff treat me like a king". The relative of one person said "staff do over and above" what they expected.

When we inspected the home we found that people were asked verbally to consent to care and treatment and people's end of life wishes were recorded appropriately in most cases. People's care was delivered in line with their individual needs. Staff were aware of how to respond to any allegation of abuse in a way that safeguarded vulnerable adults and the provider had effective recruitment procedures in place. The provider took steps to monitor the quality of the service and take action where required.

We spoke to five people using the service and three friends or relatives of people at the home when we inspected the home. All the people we spoke with were happy with the home and some people described the care they received as "excellent". We found that people were treated with dignity and respect on the day of our inspection and received care in line with their individual needs and preferences. Medication was administered safely. We found that the majority of staff had received training in safeguarding of vulnerable adults, dementia care and fire safety. Supervision had been completed at least once for staff in 2012 and the provider had a plan in place to supervise staff further. The provider stored records appropriately.

People using the service told us that they were well-informed about the services and involved in decisions about their care. They said that the home provided a good service and they felt safe in the home.

People told us that staff were “lovely,” “very nice” and “thoughtful.” The staff were responsive to people’s needs and that they felt that there were enough staff on duty within the home.

People were happy to raise any issues although those we spoke to had no cause to complain.