The White House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this provider at this location which they took over from the previous provider in July 2024. This key question has been rated Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to people not always being involved in their planning of care and the principles of the Mental Capacity Act 2005 (MCA) not being followed. Staff ensured when people required support with their health needs, they took action. People had access to regular health checks including with the GP, dentist and optician.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication. However, people told us they were not always involved in the planning and reviewing of their care. People’s communication methods were not always outlined within their care plans to enable them to receive care and treatment which worked for them.

Staff did not always have a good understanding of good practice and guidance. There were some staff that were very knowledgeable on how to support people living with dementia. However, other staff lacked knowledge of dementia and there was a lack of guidance in care plans on how a dementia diagnosis directly impacted people. Two staff we spoke with described people living with dementia as though they were children which was not respectful. One told us, “I have to be kind because they [people] are like children. I have to be calm and patient. Sometimes people will shout but I have to be calm.” Given the majority of people were living with dementia, this meant they were being supported by staff who did not fully understand their specific needs. Staff used universal recognised tools to assess people’s health needs including for their skin integrity and malnutrition.

Relatives said they were kept updated about their loved ones changing health needs. We also found that appropriate professionals were consulted as required in relation to people’s changing health. However, staff were not always sharing information with each other when they came on shift. Staff told us they did not always attend handovers, with one telling us, “I didn’t have any handover this morning, I came here at 08.00 and my friends told me what I needed to do, senior staff tell me. If I am in doubt I will read the documents.” This meant there was a risk they were not given up to date information about people’s needs from staff on the previous shift. Prior to the assessment, concerns were raised that staff on duty would not know how to access important information should an ambulance be required to attend the home for person. Actions had still not been robustly taken to address this. Staff we spoke with told the responsibility to have this information would be for the senior to provide it. However, this meant, if the senior was not available, this information may not be provided quickly to emergency services.

There were at times, a delay in receiving support from external professionals in relation to people’s health. For example, where referrals had been sent to the Continence Team, staff had been unable to email the relevant documentation as they provider had not ensured staff had appropriate equipment to scan the documents. This had caused a delay. Senior staff had now arranged for the Continence Team to visit the home instead however this had caused a delay in the people receiving the support they needed.

We saw from care records the majority of people were able to access health appointments with a dentist, GP and hospital appointments. We observed a visiting optician and paramedic from the GP surgery visit the home on the day of the assessment.

As reported, there were times where the monitoring of people’s continence needs was delayed. However, the manager and staff told us they monitored people’s fluid intake, oral health care and other health needs. There was evidence of staff referring people to the fall’s clinician, the dietician or the district nurse. We noted 1 member of staff accompanied a person to have their ECG done and they were working with the hospital in relation to 1 person’s mobility needs.

Where decisions were being made for people, there was not always evidence that their capacity had been assessed. For example, 1 person’s care plan stated throughout that the person had capacity. However, we noted that an application had been submitted to the Local Authority in relation to a deprivation of their liberty (DoLS). This related to them living at the service. There had been no assessment of the person's capacity to determine whether they were able to consent. Where other capacity assessments had been undertaken for people, there was no record of any best interest discussions with families or professionals to determine this was in the person's best interest or whether less restrictive measures had been considered. We also found not all people had not consented to the use of their photos on the service’s social media page. There was a lack of understanding by staff of the principles of MCA with comments from them including, “It’s about when they don’t know how to tell something” and “I don’t know what that is.”