The inspection took place on 20 December 2017 and was unannounced. White Lodge Residential Home 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. It provides accommodation, care and support for up to 30 older people, some of whom were living with dementia. At the time of our visit there were 26 people living at the home. The home does not provide nursing care. The accommodation was arranged over two floors with a lift for accessing each floor. The home offered single bedrooms with en-suite facilities. The communal areas included a lounge and a separate dining room set out in a restaurant style. The home had a well maintained garden and patio area. White Lodge Residential Home is situated in East Preston, West Sussex. The home is situated in a residential area close to the sea and local amenities.
At the previous inspection, the provider had failed to display the rating received following our inspection in 2014. The rating was now displayed in line with requirements.
The home did not have a registered manager in place as the registered manager had recently left the service. The acting manager was going through the process of registration. 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 felt safe at the service and there were appropriate procedures in place for identifying and responding to concerns of abuse. Staff were aware of their responsibilities in line with safeguarding policies and procedures.
People had their needs assessed and care plans were developed based on the outcome of the assessments however some of them required more detail about how staff should support the person. Environmental health and safety checks were not carried out regularly however equipment was checked regularly and serviced in line with the required frequencies.
We have made a recommendation about health and safety checks.
Staff recruitment procedures were not robust and the service had not adequately sought satisfactory references or obtained full employment histories for staff. There were enough staff to be able to meet the needs of people who used the service.
We made a recommendation about recruitment procedures.
Medicines were managed safely and the provider had procedures in place for that they were stored securely, administered in line with recommended guidance and recorded.
The premises were clean and free of any unpleasant odours and staff managed followed best practice guidance for cleaning the premises. Equipment was available to prevent the risk of the transfer of infection. The building was easily accessible for people with mobility problems and reasonable adjustments had been made for people who needed them. There was a lift in place to allow people to move freely between the two floors.
Care plans were developed ensuring that people's preferences and choices were reflected. Risks to people were identified and safety measures were put in place to control potential adverse situations. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
Staff were given an induction when they started working at the service and were supported to access training required for their roles.
People were supported to maintain a balanced diet and were offered snacks and drinks throughout the day. People were given choices of meal options and staff were able to accommodate special dietary requirements.
People were able to access other healthcare services including GP's and chiropodists and guidance from healthcare professionals was reflected in people's care plans.
Staff spoke to people kindly and made effort to acknowledge people when they encountered them. There was a friendly and relaxed atmosphere throughout the home. People told us that they felt well cared for and relatives were complimentary about the care that their family members had received.
People were supported to engage in activities both inside and outside the home and were able to participate either in a group or a one to one basis.
People and their relatives knew how to raise concerns and the provider responded appropriately and sensitively to any concerns raised. Managers were acting on concerns and had made improvements to processes however they had not always been documented. It was difficult to locate some of the documents required during the inspection.
We made a recommendation about the accessibility of documents and quality assurance.
People were supported to prepare for the end of their life if they wanted to and their wishes and requirements were recorded. Staff were aware when people had Do Not Attempt Resuscitation (DNAR) orders in place.
Some of the audits and safety checks had not been carried out formally. Some informal processes to monitor quality and make improvements had been carried out however formal processes were yet to be embedded.
People who used the service, their relatives and staff said that management was approachable and were visible at the service. People who used the service and staff were able to give their feedback about the service. People and their relatives and staff were invited to meetings to discuss how the service was running.
This is the first time the service has been rated Requires Improvement.