CQC report explained · a nursing home
What the CQC found at The White House
Not yet rated: the CQC has not published a rated inspection for this home, which is usual for a new registration.
What inspectors found, February 2023
Rated Requires Improvement; inspectors found ongoing medicines and fire safety risks, plus weak systems for checking and improving the home.
This was an unannounced focused inspection on 7 and 20 December 2022. Three inspectors reviewed care records, medicines, recruitment records, incident reports, audits and policies. They spoke with six people, two relatives and seven staff.
The home provided care for people with eating disorders, including some autistic people. Inspectors found kind, person-centred care, specialist training and access to health professionals. The home was clean and well maintained.
However, medicines were still not managed safely. There were missing medicine signatures, differences between prescriptions and records, expired medicines and a lack of clear instructions for some medicines. Fire safety checks and the systems used to identify problems were also not reliable.
The overall rating changed from Good to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The report says this meant there was limited assurance about safety and an increased risk that people could be harmed.
Kind and person-centred care
People told inspectors that staff were kind. Care plans were tailored to individual needs, and people were involved in decisions about their care.
“People told us staff treated them with kindness.” from the report
Specialist support
People received support from relevant health professionals, including specialists in eating disorders, psychology and dietetics.
“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.” from the report
Clean premises
Inspectors found the home clean and well maintained. They were also assured that infection prevention arrangements were in place.
“The service was clean and well maintained.” from the report
Medicines were not safely managed
seriousRecords did not always show that medicines had been given. There were also expired medicines, medicines out of stock, differences between prescriptions and records, and missing guidance for some medicines.
“There were gaps on the electronic medication administration system (EMAR) where doses of medicines had not been signed for.” from the report
Fire safety checks
seriousTwo fire doors were wedged open. The fire risk assessment had not been reviewed since May 2016, and routine fire safety checks had not been completed since August 2022.
“Fire safety checks including weekly fire bell checks had not been completed since August 2022.” from the report
Weak quality checks
seriousThe provider's audits did not find the medicines and fire safety problems. There was no action plan to improve care and record keeping after the previous inspection.
“There was no action plan in place for improving standards of care and record keeping.” from the report
Recruitment checks
needs fixingReferences were not always received before staff started work. Three staff files contained DBS checks completed by previous employers in 2019, without newer checks or documented risk assessments.
“Recruitment processes were not always safe. References were not always received prior to staff being employed.” from the report
- 01What changes have been made to prevent missing signatures and differences between prescriptions and the electronic medicines record?
- 02How are expired, out-of-stock and unlisted medicines now identified and dealt with?
- 03When was the fire risk assessment last reviewed, and can you show the recent weekly fire bell and other fire safety checks?
- 04What action plan was sent to CQC, and what evidence is there that the medicines and governance breaches have been fixed?
- 05How do you make sure staffing in the home is sufficient when staff leave to support people in the community?
This was an unannounced focused inspection covering Safe and Well-led, including infection prevention and control under Safe; the other key questions were not covered. This explanation was written from the published report of 7 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
Rated Good overall, but inspectors found that medicines recording and some safety checks required improvement.
Inspectors made an unannounced visit on 3 December 2019. They spoke with patients and staff, observed care and meetings, checked five care records, reviewed medicines and examined policies and other records.
The home was clean and well maintained. Staff provided individual treatment for eating disorders, involved patients in care planning and had access to a range of specialists. Patients generally said they felt safe and supported.
The Safe rating was Requires improvement. Medicines were not always recorded correctly, some risk assessments were not reviewed regularly and incident records did not show clearly what had been learned or when incidents were closed.
The Effective, Caring, Responsive and Well-led ratings were Good. The overall rating was Good. The provider was told it must improve the safe management and recording of medicines.
Clean and safe environment
The home was clean, maintained and well furnished. Staff completed environmental risk checks and took action to reduce identified risks.
“The service was clean, well maintained, well decorated, well-furnished and fit for purpose.” from the report
Specialist treatment
Staff assessed patients' physical health and provided individual care and treatment for eating disorders. Inspectors found this was based on national best-practice guidance.
“Staff provided a range of treatment and care for patients based on national guidance about best practice.” from the report
Skilled team
Patients had access to a wide range of professionals, including medical, psychological, dietary and nursing staff.
“The service had access to a full range of specialists within the multi-disciplinary team including a psychiatrist, psychologist, dietician, general practitioner, nurses and health care assistants” from the report
Respectful care
Inspectors saw staff treating patients with privacy, dignity and respect. Patients were supported to understand and manage their care.
“Staff were discreet, respectful, and responsive when caring for patients, we observed staff knocking on patients’ doors before entering throughout the inspection.” from the report
Planning for discharge
The home worked with patients, commissioners and outside services to plan admissions and discharge. It aimed not to discharge people before they were ready.
“Managers and staff worked to make sure they did not discharge patients before they were ready.” from the report
Medicines records
seriousMedicines were not always signed for or recorded correctly. Inspectors found 17 missed doses in one month, including two medicines that could have had a high impact if not taken as prescribed.
“In the month of November 2019, we found 17 missed doses of prescribed medicines for four out of five patients.” from the report
Risk assessments
needs fixingRecords showed risk assessments were completed when patients arrived, but did not show that individual risks were reviewed regularly afterwards.
“There was no documented evidence that risk was regularly reviewed following the initial assessment.” from the report
Incident learning
needs fixingIncident records did not clearly show lessons learned, feedback to staff or when investigations were closed. This made it difficult to confirm that incidents were reviewed promptly.
“There was no documented evidence of lessons learnt or feedback to staff from the investigation of the incidents.” from the report
Raising complaints
needs fixingSome patients said they did not know how to complain or felt pressured not to proceed. This could make it harder for patients to raise concerns.
“Some patients told us they felt they could not make a complaint without feeling pressured by some staff not to proceed.” from the report
Management oversight
needs fixingMeetings had no clear agenda and minutes were brief. Medicines audits had not identified the problems found by inspectors.
“Therefore, there was no assurance audit and governance systems were effective.” from the report
- 01What changes have been made to medicines administration and recording since the inspection?
- 02How do you now check that every missed dose has a documented reason and that medicines are given as prescribed?
- 03How often are each resident's individual risk assessments reviewed and where is this recorded?
- 04How are incidents closed, and how do you record and share lessons learned with staff?
- 05How can residents and families raise a complaint privately, without feeling pressured?
This was an unannounced comprehensive inspection of specialist eating disorder services, covering all five key questions and including checks of five care records and medicines management. This explanation was written from the published report of 24 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The White House
2 rated inspections over 3 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2020GoodSafe: Requires improvementWell-led: Good
- February 2017
Registered with the Care Quality Commission on 13 February 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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23 live-in carers within about an hour of Suffolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 17 can care for a couple. 7 years' experience on average.
“Not only was she professional, polite and efficient but she bought a lovely smile and laughter to my parents home.”
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