- Care home
The White House
All Inspections
7 December 2022
During an inspection looking at part of the service
The White House provides treatment and care to people with eating disorders. The service provides support to people who are transitioning from hospital into the community. The residential service has six bedrooms over three floors. Four bedrooms were en-suite and two bedrooms shared a bathroom.
The provider is also registered to provide personal care to people living in the community.
At the time of our inspection there was six people living in the residential care home and three people in receipt of supported living.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
The provider was not registered to support people with learning disabilities or autistic people. However, they were supporting people with eating disorders who were autistic. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were autistic people using the service.
Right Support: Staff understood their responsibilities in relation to the Mental Capacity Act 2005.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Where people had given consent to do so, their relatives were involved in their care and no decisions about care were made without the person being at the centre of discussions before plans were agreed.
Right Care: Care and support provided was person-centred and promoted people’s dignity, privacy and human rights.
Right Culture: The ethos, values, attitudes and behaviours of nurses and support staff ensured people using services were treated with kindness and supported in line with their recovery plan. Further work was needed to ensure the management of quality and safety assurance systems were strengthened.
We found medicines continued not to be managed safely. The service had good care outcomes for people but there was a lack of clear and consistent systems to ensure the registered manager and provider had good oversight of the service.
We recommended the provider refers to current guidance to ensure all pre-employment checks are received prior to a new staff member starting work.
The service was clean and well maintained. However, further work was needed to ensure fire safety checks were carried out as required and staff, including the registered manager have access to the records maintained.
For the care service to be correctly registered for the regulated activity of Personal care, there must be a real separation between the provision of personal care and the accommodation agreements. This was not in place for people in receipt of supported living.
People were supported by staff who had received a variety of training including autism, and eating disorders. People told us staff treated them with kindness.
People were supported to access all relevant health professionals in order to support their recovery and ensure their health and wellbeing were being appropriately monitored.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
Whilst the last rating for this service was good (published 24 January 2020) there was a breach of regulation. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
We undertook this focused inspection to check the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The White House on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
03 December 2019
During a routine inspection
We rated The White House as good because :
The White House is an independent hospital that provides treatment and care to male and female patients with eating disorders.
- Staff completed and regularly updated risk assessments of the environment at the service. Staff knew how to keep patients safe. The service was clean, well maintained and well decorated.
- Staff assessed the physical health of all patients on admission. They developed individual care plans which reflected patients’ needs and set clear goals. They provided a range of treatment and care for patients in line with the National Institute for Health and Care Excellence (NICE) about best practice.
- The service had access to a full range of specialists within the multi-disciplinary team. They were discreet, respectful, and responsive to patients. Patients were supported to understand and manage their own care treatment or condition and staff supported access to other services if needed.
- The service had an extensive admissions process. The provider liaised with services that would provide aftercare managing the discharge care pathway for patients. They understood the arrangements for working with teams both within the service and externally to meet the patients’ needs.
- Managers at the service had the right skills and abilities to run a service providing quality care. Staff at the service knew what the vision was and demonstrated this in their day to day work, they felt respected, supported and valued. They were proud to work for the provider.
However:
- The provider did not accurately record the administration of medicines. Staff undertook audits but the concerns we found had not been identified. Therefore, we were not assured that audit processes were effective in identifying errors; this could impact on patients’ safety.
- Patient records did not show that individual risk assessment was reviewed regularly.
- Incidents reported had no documented evidence of lessons learnt or feedback to staff from the investigation of these incidents. There was nowhere to record the closing dates of the incident. It was clear this was a documentation and recording issue at the service.