The White House Nursing Home Limited

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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.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider assessed and reviewed people’s needs effectively. People received individualised assessments that reflected their physical, emotional, social and cultural needs. Staff knew people well and used a range of tools and processes to ensure assessments remained up to date.

The registered manager explained that the service used up to 36 bespoke digital risk assessments and associated care plans, stating “These are reviewed every month and updated by our nurses and senior carers. I complete a monthly audit to ensure everything is in date and individual needs are being met.”

Staff and professionals consistently described assessments as detailed and reflective of need. A healthcare professional reported, “Each of the residents have detailed care plans specific to their needs and they are involved in decisions around their care depending on capacity.”

Care records viewed during the inspection showed assessments were comprehensive. They included areas such as mobility, allergies, dietary needs, pressure ulcer prevention, communication profiles, bed‑rail assessments, continence information, and social histories.

People told us that staff understood their needs. One person said they felt safe because staff “check‑up on me at night” showing that assessed needs informed daily care.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

The provider delivered care and treatment in line with nationally recognised best practice. Staff used a broad range of structured clinical tools, clear clinical governance processes and effective medicines management systems to ensure people received safe, evidence‑based care.

Care records demonstrated comprehensive use of validated tools to guide clinical assessment and intervention. We saw evidence of these tools embedded within people’s care plans. These evidenced‑based tools and measures helped staff identify risk levels, track changes and adjust care appropriately. All care plans were linked with NICE guidance, and the registered manager confirmed that staff were “accountable for care plans and risk management planning, in line with NICE guidelines.”

Staff applied evidence‑based approaches to improve clinical outcomes. One example was the introduction of sensor‑based diabetes monitoring for three residents, which removed the need for daily blood‑prick testing. The registered manager explained that this reduced pain and skin tears and was introduced in collaboration with healthcare professionals. Consent was gained from people or representatives.

External professionals corroborated the consistently strong clinical practice. A healthcare professional said: “I have always found the staff to be very well trained, very well informed, polite, friendly, willing to help, keep good records and respond to telephone and email queries promptly. It is one of the best run care homes I visit.”

Partnership working strengthened the evidence‑based approach. Weekly GP “ward rounds,” monthly end‑of‑life reviews, and specialist input from a range of healthcare professionals including speech and language therapists, tissue viability nurses, dieticians and mental health teams ensured multidisciplinary review of people’s care plans. A healthcare professional confirmed, “The team demonstrates a good understanding of clinical risk. They appropriately escalate concerns, seek timely medical input, and involve community services when required.”

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs to support their changing care needs.

The provider worked in exceptionally effective and well‑coordinated ways to meet people’s needs. Staff demonstrated a strong, unified approach, and people consistently experienced seamless care because teams communicated clearly, shared responsibilities and understood one another’s roles. Evidence showed a highly cohesive workforce supported by strong clinical leadership, structured communication systems and deeply embedded multidisciplinary working.

Staff consistently described a culture of collaboration, shared problem‑solving and mutual respect. A nurse explained: “Everyone works hard, and it is a team approach. As nurses we are very supported by the care staff.” Staff told us they regularly received support from managers and colleagues, including informal reflective discussions and guidance during shifts. This reflected a shared commitment to working together.

Stuctured communication ensured all staff understood current risks, priorities and changes in people’s needs. The registered manager described twice‑daily handovers, daily dashboards that highlighted overdue tasks, and ongoing review of care plans. She told us, “We have handovers twice a day. I am in the home and overseeing care standards every day… we ensure staff have training and supervision to support them to deliver good care.” Staff confirmed handovers were detailed and ensured continuity across shifts.

The provider maintained close partnerships with external professionals. The registered manager said, “We work with a range of professionals…we also support universal care plans to ensure people’s wishes are shared.” These relationships ensured that staff received timely specialist advice and could anticipate needs early. A healthcare professional confirmed the quality of partnership working, stating, “The service works collaboratively with primary care, district nursing teams, and other allied health professionals. Communication regarding changes in residents’ conditions is prompt and clear.”

Effective teamwork was also visible in day‑to‑day practice. We observed staff across roles working fluidly together to support lunchtime service, with carers, nurses, chefs and the manager assisting people in a coordinated and responsive way. During these observations, staff were attentive and collaborative, sharing tasks without prompting and ensuring people were supported promptly and with dignity. A coughing episode was addressed immediately by a nurse demonstrating active teamwork and shared vigilance.

People and relatives consistently recognised the strong team culture. One relative said staff were “highly skilled and they mentor and train new staff… they have many staff who have been here a long time… that says a lot about this place.” Another relative described that “everybody from the cleaner to the manager, everyone is wonderful,” highlighting the consistency of teamwork across all levels of the workforce.

Leaders played a central role in enabling this high‑performing culture. Staff described managers as supportive, approachable and invested in their development. Staff across roles reported that they felt listened to, valued and confident to share concerns. This inclusive leadership style enabled transparent communication and a shared sense of responsibility for high‑quality care.

The provider demonstrated an exceptional and sustained commitment to helping people lead healthier, more fulfilled lives. Staff worked proactively and with deep insight into each person’s needs, preferences and aspirations.

They consistently used individualised approaches, targeted health‑promotion activities and a wide range of tailored resources to support people to maintain and improve their physical, emotional and social wellbeing. Evidence showed staff had an exceptional understanding of what mattered most to each person and took meaningful, creative steps to encourage healthier routines, build independence and enhance daily participation.

People, relatives and professionals consistently described significant improvements in people’s health, confidence and overall wellbeing since moving into the service. Day‑to‑day practices, as well as structured support plans, were clearly focused on promoting good nutrition, mobility, hydration, emotional resilience and purposeful activity. One relative told us their family member had previously experienced weight loss at home but “has not lost any more since being here. The food looks OK. There are plenty of drinks.” This reflected the service’s strong and consistent focus on providing nutritious meals, promoting regular fluid intake and monitoring people’s health with care, vigilance and compassion. The provider was also engaged in a hydration pilot, using assisted technology to support care workers to accurately measure peoples’ fluids intake.

People were encouraged to maintain and regain independence wherever possible. A relative observed that their family member, who previously had stiff hands, was now knitting again with staff support, explaining that “with a bit of help my [relative] has been able to start knitting again… it adds up and can make a difference to their demeanour.” This demonstrated how staff used encouragement and support to promote physical activity and dexterity.

We saw care plans that were personalised and updated regularly. Specialist services were readily accessed to maintain people’s health, and the provider supported the use of technology to monitor people’s health remotely, ensuring prompt interventions. Professionals who visited the service described high‑quality multi‑disciplinary collaboration. A healthcare professional stated, “Each of the residents have detailed care plans specific to their needs.” Regular visits from audiologists, opticians and chiropodists further supported proactive monitoring of sensory and mobility needs.

The provider also participated in a wide range of health‑improving pilot schemes, demonstrating a commitment to innovation that enhanced quality of life. These included a hydration pilot which uses technology to ensure people are drinking adequately to prevent dehydration and other related health problems such as urinary tract infections (UTI’s). The provider also uses Reminiscence Interactive Therapy Activities (RITA) for dementia which help to reduce anxiety and isolation and improve interpersonal connections. The provider is also piloting a digital pain assessment tool to aid assessment of pain in people unable to verbally express discomfort. These initiative supported earlier identification of need, reduced the risk of avoidable harm and promoted comfort, safety and wellbeing. All these projects support the provider in their aim to use technology to enhance peoples’ health and wellbeing.

People had opportunities to engage in regular physical, social and sensory activities, which supported mental and emotional health. A staff member described a variety of outings and explained that the provider ringfenced fundraising to ensure these activities could fulfil people’s wishes. These opportunities promoted mobility, stimulation and community engagement.

One example shared by the registered manager described a person who had previously been nursed in bed. Following admission, assessment and targeted intervention, the team arranged for their wheelchair to be serviced and supported confidence in using it. As a result, “the person has been out of bed every day, and goes out every day to the shops with 1:2:1 support..”

The provider had highly effective and well‑embedded systems for monitoring all aspects of people’s care and treatment, ensuring support was continually improving and consistently delivered to an exceptional standard. Monitoring processes were used dynamically to verify that people were experiencing measurably positive and reliable outcomes that not only met clinical expectations but also delivered substantial improvements in people’s confidence, independence and day‑to‑day wellbeing.

Leaders demonstrated an exceptional and sustained commitment to using outcome data as a powerful driver for continuous improvement. Oversight systems were structured, comprehensive and seamlessly integrated into daily, weekly, monthly and quarterly governance cycles. This enabled the service to maintain strong visibility of people’s changing needs and to take timely, proactive action that directly enhanced people’s health and quality of life.

People experienced improved stability in their long‑term conditions, better emotional resilience, increased engagement in meaningful activities and a higher sense of security and wellbeing. Continuous monitoring meant potential issues were identified early, resulting in swift interventions that prevented deterioration and promoted positive progress. Staff consistently adapted support in response to real‑time information, ensuring people benefitted from care that was not only safe and effective, but continually evolving in direct response to their outcomes.

The provider had transitioned to new digital dashboards for clinical governance and health and safety, ensuring real‑time oversight of indicators such as falls, urinary tract infections, accidents and safeguarding. The registered manager monitored daily dashboards to identify overdue actions, while weekly and monthly audits scrutinised areas including nutrition, hygiene, wounds, pain checks, infection prevention and control, call bell response times and dignified care standards. These processes led to timely action, for example implementing additional safety measures or arranging a review by a healthcare professional.

Outcome monitoring consistently translated into meaningful and measurable improvements for people. We saw numerous examples where the provider used high‑quality data and reflective analysis to inform decision‑making, resulting in enhanced independence, emotional wellbeing and physical health. Care reviews clearly demonstrated sustained progress against enablement goals, and the service used detailed case studies to track and evidence people’s achievements over time.

For example, one person who was being nursed in bed, became noticeably more alert and actively engaged in daily life after staff supported them to increase participation in communal activities through well‑judged, positive risk‑taking. This illustrated how the service’s outcome‑focused monitoring not only identified opportunities for improvement but directly enriched people’s quality of life and promoted greater confidence, connection and wellbeing.

Healthcare professionals consistently confirmed that people’s needs were met and that care planning supported progress. One stated the home “risk assess and manage those risks with attention to a patient’s detail… information is passed on to team members accurately,” reflecting how monitoring processes ensured consistent, safe practice.

Feedback from relatives and people demonstrated noticeable improvements in wellbeing. One relative shared that their family member “has even been to the circus and the seaside” and experienced activities they would not have engaged in previously, showing that the provider’s monitoring translated into meaningful opportunities. The provider used outcome data not only to maintain standards but to innovate. They participated in numerous pilots, as mentioned previously in the report, all designed to enhance clinical accuracy and wellbeing outcomes. These projects reflected a culture of learning that prioritised measurable positive change for people.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider sought and recorded people’s consent in line with legal requirements and ensured staff understood the Mental Capacity Act 2005 (MCA). People were supported to make their own decisions wherever possible, and when they could not do so, staff followed appropriate best‑interest processes. Evidence showed the service took a person‑centred and lawful approach to gaining consent.

We saw clear processes for assessing mental capacity and documenting best‑interest decisions. Where people lacked capacity, decisions were recorded thoroughly. For example, best‑interest documentation was completed for those receiving covert medicines, and these decisions were reviewed by the registered manager, GP and people’s representatives. Care records showed covert medicines were managed in line with MCA and duly recorded and reviewed, demonstrating appropriate application of consent frameworks.

People and relatives confirmed their involvement in decisions about care. One relative described being kept fully informed and included in care planning, stating, “I have a copy of the paperwork and feel included in the planning of her care.” They also noted confidence in the home’s respect for privacy and dignity during personal care.