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Inspection Summary


Overall summary & rating

Good

Updated 24 January 2020

We rated The White House as good because

:

The White House is an independent hospital that provides treatment and care to male and female patients with eating disorders.

  • Staff completed and regularly updated risk assessments of the environment at the service. Staff knew how to keep patients safe. The service was clean, well maintained and well decorated.
  • Staff assessed the physical health of all patients on admission. They developed individual care plans which reflected patients’ needs and set clear goals. They provided a range of treatment and care for patients in line with the National Institute for Health and Care Excellence (NICE) about best practice.
  • The service had access to a full range of specialists within the multi-disciplinary team. They were discreet, respectful, and responsive to patients. Patients were supported to understand and manage their own care treatment or condition and staff supported access to other services if needed.
  • The service had an extensive admissions process. The provider liaised with services that would provide aftercare managing the discharge care pathway for patients. They understood the arrangements for working with teams both within the service and externally to meet the patients’ needs.
  • Managers at the service had the right skills and abilities to run a service providing quality care. Staff at the service knew what the vision was and demonstrated this in their day to day work, they felt respected, supported and valued. They were proud to work for the provider.

However:

  • The provider did not accurately record the administration of medicines. Staff undertook audits but the concerns we found had not been identified. Therefore, we were not assured that audit processes were effective in identifying errors; this could impact on patients’ safety.
  • Patient records did not show that individual risk assessment was reviewed regularly.
  • Incidents reported had no documented evidence of lessons learnt or feedback to staff from the investigation of these incidents. There was nowhere to record the closing dates of the incident. It was clear this was a documentation and recording issue at the service.
Inspection areas

Safe

Requires improvement

Updated 24 January 2020

We rated safe as requires improvement because

:

  • The provider did not accurately record the administration of medicines. There was a lack of robust practise in place; we found that several medicines had not been signed for and were not given in line with current best practice for safely recording medicines.

  • Patient records did not show that individual risk assessment were reviewed regularly.

  • Incidents reported at the service had no documented evidence of lessons learnt or feedback to staff from the investigation of the incidents. There was nowhere to record the closing dates of incidents. It was clear this was a documentation and recording issue at the service.

    However:

    Staff completed and regularly updated thorough environmental risk assessments of all areas at the service and removed or reduced any risks they identified. Staff knew about any potential ligature anchor points and mitigated the risks to keep patients safe. The service was clean, well maintained and well decorated.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • Staff could give clear examples of how to protect patients from harassment and discrimination. Staff knew how to recognise adults and children at risk of or suffering harm and worked with other agencies to protect them. Staff knew what incidents to report and how to report them. Staff told us they understood the duty of candour. They were open and transparent and would give patients and families a full explanation when things went wrong.

Effective

Good

Updated 24 January 2020

We rated effective as good because:

  • Staff assessed the physical health of all patients on admission. They developed individual care plans, these were extensive at this time and reflected patients’ needs including nutritional needs and setting of clear goals. Staff provided a range of treatment and care for patients in line with the National Institute for Health and Care Excellence (NICE) about best practice.

  • Staff met patients’ dietary needs and assessed those needing additional specialist care for nutrition and hydration. Patients were supported to live healthier lives.

  • The service had access to a full range of specialists within the multi-disciplinary team. Managers ensured staff had the right skills, qualifications and experience to meet the needs of the patients in their care.

  • Staff held regular multidisciplinary meetings to discuss patients and improve their care. Patients were fully involved, and all patients’ risks were considered.

Caring

Good

Updated 24 January 2020

We rated caring as good because

:

  • Staff were discreet, respectful, and responsive when caring for patients, and gave patients help, emotional support and advice when they needed it. Patients were supported to understand and manage their own care, treatment or condition and staff supported them to access those services if they needed help.

  • The service had an extensive admissions process in place. On admission patients would be orientated to the service and given a welcome pack with all relevant information.

  • The manager told us that staff supported, informed and involved families or carers by inviting them to attend multidisciplinary meetings, updating carers and families on patient care plans.

Responsive

Good

Updated 24 January 2020

We rated responsive as good because

:

  • The provider had an extensive admissions process to the service working with the patient and commissioners prior to admission. The provider liaised with services that would provide aftercare managing the discharge care pathway for patients.

  • The design, layout, and furnishings of the service supported patients’ treatment, privacy and dignity. All patients had their own bedroom, could personalise them and had a secure place to store personal possessions.

  • Staff supported patients with activities outside the service, such as work, education, attending recovery college and family relationships. Patients could access spiritual, religious and cultural support.

Well-led

Good

Updated 24 January 2020

We rated well-led as good because:

  • Managers at the service had the right skills and abilities to run a service providing good quality care.

  • Staff knew what the vision was for the service, which was ‘to support people to live healthy lives and be the best they can be’ and staff believed in this.

  • Staff felt respected, well supported and valued. They felt the service promoted equality and diversity and felt proud to work for this provider and the team. Staff morale at the service was high.

  • Staff at the service understood the arrangements for working within teams both within the service and externally to meet the patients’ needs. For example, we saw communication between staff and care coordinators in the community.

However:

  • There was no clear framework of what was to be discussed at meetings. Meeting minutes were brief and there was no evidence of discussion from previous meetings and of lessons learned shared with staff.

  • Staff undertook audits but the issues we found about medicines management had not been picked up. Therefore, we were not assured that the audit process and oversight were robust enough or effective in identifying errors; this could impact on patients’ safety.

Checks on specific services

Specialist eating disorder services

Good

Updated 24 January 2020

Other CQC inspections of services

Community & mental health inspection reports for The White House can be found at Brama Care Ltd.