The White House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

Good: This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Learning from incidents, such as episodes of self-harm, was routinely discussed with both staff and residents where appropriate. This included reviewing plans, promoting positive risk-taking, and encouraging ownership and empowerment for the individual involved.

Staff were clear on what actions were needed if there was an incident or accident. The provider kept a record of all accidents and incidents involving people using the service. All staff automatically received a copy of the incident form via email at the time an incident was reported.

Staff attended Quality Network for Eating Disorders events. This enabled them to seek lessons learnt on a wider basis and keep progressing their knowledge. We found the provider looked at lessons that could be learned when incidents had happened. There had been a recent incident where a resident had gone back to their home without informing staff. Important details about what the person was wearing was not recorded which meant that it would be harder for the police to identify them if required. Following this incident a new care plan was introduced to provide information in case of unexpected absences from the service. This change was made to ensure people remained safe out in the community.

During our inspection visit we observed an injury to a person. We found that staff dealt with the situation appropriately and calmly. We also found that staff recorded the incident appropriately and took action to ensure the persons safety.

One person told us, “Enough information was given on admission.”

People spoke about plans made for home visits and how these were enabled to happen safely.

The Whitehouse had a clear admissions policy and a rehabilitation pathway that staff were aware of and adhered to. Staff and leaders demonstrated good knowledge of referring to external professionals when needed. The doctor at the service linked in with people’s psychiatrist in the community and also linked with their community mental health teams where appropriate.

The doctor at The Whithouse spoke of regular involvement of the local GP and the referring consultants ongoing involvement with the regular multidiscipline meeting. The doctor for the service told us “We have patients from across the country. It’s really important when patients transition that the community team are linked in. The Whitehouse does carry on virtual support with the dietician post discharge.”

Feedback received from providers was mixed. Feedback from one provider was, “Ahead of admission, it was very difficult liaising with White House staff and agreeing admission goals and communication needs for the service user.”

There were clear policies and procedures in place to ensure safe admission to the service and transition between services. Staff were aware of these and gave examples of them being followed for the safety of people at the service. One staff member said, “We’re very strict with the admission criteria. We won’t accept people below a certain BMI and we won’t accept people with active suicidal ideation and active self-harm. We don’t accept people at risk of swallowing items.” Staff were aware that the admission criteria allowed people to remain safe whilst at the service.

One person told us, “I feel listened to.” People had opportunities to speak with others external to the service should they need to raise safeguarding concerns. People told us they had not witnessed anything of concern relating to safeguarding.

The provider shared concerns quickly and appropriately. Staff were knowledgeable and confident about safeguarding processes. They understood their safeguarding responsibilities to keep people safe, how to challenge discrimination and report any concerns. They knew how to recognise the signs of potential abuse and knew how to raise alerts and report concerns, by whistleblowing if necessary.

We observed people accessing their community. People were returning from a local shop visit, others were accessing voluntary work in the community and attending church.

There was a safeguarding and whistleblowing policy in place, and staff confirmed they had read the policies as part of their induction and training. The service worked within the principles of the Mental Capacity Act (MCA). A keystone of the organisation was that people had capacity and consented to care and treatment. Therefore, no one was deprived of their liberty. At the time of the inspection one person had consented to being on one-to-one observations at all times to keep them safe.

People were involved and agreed to the risk assessments in place. People were encouraged to use ice-packs as a distraction if engaging in headbanging. No one would experience being restrained as the practice was not used by staff.

Staff and leaders were clear that some people who used the service were at high risk relating to their eating disorder, therefore key risk assessments were in place that were regularly reviewed in multi-disciplinary settings and involved the person themselves. These involved regular monitoring and health screening such as weight, bloods, blood pressure, electrocardiograms (ECG) and well as monitoring food and fluid intake. Mealtimes were all taken together in a central dining room. People were closely monitored to ensure agreed meals were eaten.

We observed a culture that from the outside could be perceived as a rigid framework, but for the people who have chosen to be within it can be a supportive path to recovery.

The framework was supportive of their wish to change behaviours and recover. Therefore, the risk assessments in place and the observation of them in action had been agreed to by people at the service. We observed the use of water bottles and access to water was closely monitored and assessed to ensure no one could excessively drink water but remain hydrated.

Risk assessments were linked to best practice and national guidelines and were kept under review. Staff applied blanket restrictions on peoples’ freedom only when justified. For example, kitchen access was restricted to all residents. We were assured by staff that kitchen access would always be individually risk assessed. Access to the kitchen was under supervision once people had progressed to the stage of their own meal preparations.

People liked the environment in which they lived. Telling us they liked the facilities it offered. They also said that on occasion parts of the listed building could be too hot or too cold. One person said a shower took too long to be repaired.

Staff were aware and spoke of a recent fire risk assessment being completed that led to 4 fire doors being replaced. The electrical fixed wire assessment had recently been completing and remedial work was actioned. A gas landlord safety certificate had been issued. Staff spoke of regular testing and flushing of water systems to prevent Legionella. Therefore we were assured that staff and leaders were aware and took action to maintain a safe environment.

The environment was well maintained, both internally and externally. The environment met the needs of the people living there.

An external person had audited the environment to ensure the service was compliant with health and safety. An audit of potential ligature points had been completed. CCTV was in place in 1 corridor to ensure people were safe. There was a policy and procedure in place for its usage.

One person said, “Some of the staff are lovely.” And also stating that not all staff had experience in the specialised area of eating disorders. One person described staff as very helpful, another stated the service on offer was business like.

People were supported by a host of different professionals with complimentary roles for the setting. Nurses and dieticians directed the clinical input, whereas the therapists and lifestyle staff had a more complementary role.

Staff confirmed that the recruitment procedure was robust with 1 person telling us, “They were exceptionally thorough. They telephoned my references. Until I got enhanced DBS I couldn’t start.” The same staff member spoke about the thoroughness of the induction program they had undertaken that included 2 weeks of e-learning and then shadowing more experienced staff. They spoke of a positive ongoing regular support to understand their role, where any questions were answered in detail to aid their knowledge and understanding.

We observed sufficient staff being on duty that matched the planned roster. Staff had differing roles and responsibilities to ensure that people at the service had their needs met.

Records showed that staff were safely recruited. Information sent showed staff had completed appropriate training for their different roles with ongoing professional development being available to maintain professional qualifications. Staff had access to national conferences.

We were assured that the provider was supporting people living at the service to minimise the spread of infection. People were able to use the laundry separately and launder only their clothes.

Staff had completed training in relation to infection prevention and control. Staff responsible for food preparation had also completed relevant food safety training level 3.

We observed that the service was clean and well maintained.

We were assured that the provider was using PPE effectively and safely. Staff had completed this training based upon the policy and procedure in place. We were assured that the provider was responding effectively to risks and signs of infection. We were assured that the provider was promoting safety through the layout and hygiene practices of the premises.

Staff had access to medicines related care plans to support them. However, we found that these care plans did not always include enough detail. We saw that 1 person who was having seizures had a detailed care plan guiding staff on how to support them. We saw that when people were self-administering their medicines, risk assessment documents detailed all the relevant medicines information and staff had adequate oversight of this. However, 1 falls risk assessment did not acknowledge that a person was taking medicines that placed them at increased risk of falls.

A person was prescribed 2 when required non-steroidal anti-inflammatory medicines (NSAIDs). However, there was no care plan guiding staff on when to use each one or telling them not to use them together. This placed the person at potential risk of therapeutic duplication. In addition, there was no information guiding staff to use a when required gastroprotective medicine for 1 of the NSAIDS. As the medicines were not taken regularly, the impact of this was minimal.

Staff were given training and competency assessments before they were able to handle medicines. The provider had systems for monitoring the physical health of each person.

Medicines were stored safely and securely. Staff wrote the date of opening on medicines. Staff had access to information on where to apply topical medicines. Staff had access to information on people’s allergies.

Staff conducted numerous medicines audits which helped to identify areas for improvement. We saw that medicines issues were shared in team meetings. The provider had appropriate systems for the management of medicines no longer required. Staff received written confirmation from the prescriber when doses were changed in line with NICE guidance.

Staff had access to information to guide them on how to administer medicines requiring administration in a way that differed from the manufacturer’s instructions. This information was on the prescription proving that the prescriber had taken clinical responsibility for this. At the time of this inspection, whilst the provider was receiving safety alerts, there were no records to confirm how they were being managed. The provider informed us of their plans to rectify this. The impact of this was minimal as the alerts received prior to this inspection were not relevant to the organisation.

We saw examples when staff had not administered 2 medicines at least 2 hours apart as per the instructions on the MAR chart. The impact of this was likely to be minimal. At the time of this inspection, the provider did not have a system for ensuring that blood glucose testing kits were suitable for use. This placed people at the potential risk of incorrect blood glucose results, which could result in delayed medical attention being sought. However, the impact of this was likely to be minimal. The provider informed us of their plans to rectify this.