Archived: The White House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance at the service, notifiable incidents not being sent to CQC and the failure to display the CQC rating at the service.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

As at the previous inspection, leaders did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. We identified a closed culture at The White House. (A closed culture is a poor culture in a health or care service that increases the risk of harm.) Leaders including senior care staff were not consistently demonstrating or role modelling a positive culture at the service. At this inspection, there had been no improvements. For example, whilst we were speaking to a senior member of staff, they used the emergency call bell to request staff make a cup of tea for a person. When they pressed it, they said, “This will get them (staff) all running.”

We saw other examples of senior staff not displaying positive role modelling for other care staff. For example, we heard a senior member of staff sitting in the lounge with their phone and state, “I’m going to have a moan on our group WhatsApp.” Another senior member responded, “When do you not have a moan?” This was an inappropriate conversation to have in front of people and care staff. On discussion with a senior member of staff, when asked about the leadership at the service they told us, “(The manager) just needs time to pull the service up by its boots. (The manager) will discipline people [staff]. I say to them [staff] if you don’t do what I’ve asked you, it’s me they come after first, then I’ll come after you.” Asserting authority in front of other staff can negatively impact team dynamics, communication, and ultimately, the quality of care provided which we have identified during this inspection.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Throughout the inspection, senior carers were seen abruptly instructing care staff to undertake tasks that they could have performed themselves. This included making drinks and supporting people with their continence needs. When leaders do not value their staff, it can lead to a decline in staff morale and has a negative impact on the safety and quality of care provided to people as we identified on this inspection. We found that leaders did not respond to poor performance in relation to more senior staff which created a poor culture and made care staff feel undervalued.

Leaders did not ensure that when staff spoke up, their voices would be heard. We were made aware of instances where staff had confidentially fed back their concerns about other members of staff to the manager. Whilst the manager thanked staff for raising this, robust action was not taken to address the concerns. A good service will create an atmosphere where care stafffeel able to report concerns and will thoroughly investigate and address such concerns within the service. We found this was not taking place.

Leaders did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them. We found senior staff were not speaking to particular staff in a respectful way. They were very directive and authoritative in their tone in front of people and visitors.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The majority of the relatives and other visitors we spoke with (who visited regularly) were not aware that there had been a new manager in the service since February 2025. One person told us, “I know (the deputy manager) but wouldn’t know if the manager was a man or a woman.”

Throughout our visit, we found there was a lack of leadership and accountability. When we arrived at the service, we were informed the manager was not in the service that morning. When asked who the senior member of staff on duty was, there was a reluctance by staff to confirm this information despite the rotas clearly stating who this was. We found there was a lack of direction around the service by the senior staff and no oversight from leaders of where care staff were and what they were doing. This was also reflected on the notes of a visit the manager undertook to review the care at night. It was recorded that the senior on duty was not aware of what care the other staff were undertaking. During our observations we found there was no directive for staff and staff were starting care tasks, not completing this and them moving on to another task.

The provider’s governance systems remained inadequate and failed to recognise a range of shortfalls in people’s care and the service. This included the lack of monitoring of people’s health and welfare as identified in this report. Leaders had failed to robustly address a poor culture and as a result this placed people at risk. The provider was still unable to provide evidence of an effective system to assess, monitor and improve the quality and safety of the services provided and to ensure they had met the regulatory requirements. The provider also failed to submit safeguarding allegations to the CQC where appropriate.

Leaders did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement. Health care professionals told us that leaders and senior staff did not always report to them when people’s health needs had changed. They told us staff were frequently not following the guidance they had provided in relation to people’s care. We found leaders had not shared important information to stakeholders including safeguarding concerns.

The provider did not focus on continuous learning, innovation and improvement across the service. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Where incidents had occurred, there remained a lack of analysis of these to look for themes and trends. Leaders had not considered that incidents where people had sustained skin tears and bruising, may have as a result of poor moving and handling practices by staff. They had not considered that unwitnessed falls at night may have been as a result of how staff were deployed.

There was no of analysis of behaviour charts to understand people’s triggers. One member of staff said, “I suggested we use both lounges to separate out people. It worked really well and there were less incidents, but if the team isn’t right, it doesn’t happen.” Leaders had not considered permanently implementing this or other ways of reducing the risks of people being triggered by other people’s distressed behaviours despite there being multiple examples of this taking place.