British Home & Hospital for Incurables Also known as The British Home

On this page

• 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 inspection in July 2021 we rated this key question good. At this inspection, the rating has changed to requires improvement. This meant people’s outcomes were not consistently good, and people’s feedback confirmed this.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Many people and their relatives told us they did not remember being involved in initial assessments or consulted when care plans were written or reviewed. We received comments such as, “I haven’t had discussions about the care plan” and “They have not consulted me about [family member’s] care needs.”

Staff told us they liaised with other professionals to gather information about people's needs. Comments from staff included, “We do the care plan but sometimes people come with a care plan already depending on where they are coming from” and “We review care plans every month there is also an option of creating personalised care plans.”

Despite positive feedback from staff we found people’s needs were not always assessed promptly when they entered the service. We saw some people who were missing several elements of their needs assessment despite being in the service for some time. We discussed this with the provider who told us staff were not always working in a consistent way resulting in some assessments being completed on paper and some being recorded electronically. The lack of consistency resulted in potential gaps in people’s care plans.

Some relatives were not confident people were being given food in a way that they needed. Comments included, I have noticed that they have sometimes put his breakfast by his side and left it, without cutting up his food. Everything like sausages and toast need to be cut up” and “Spicy food upsets his stomach, so it has been made clear that he should not have it; but he still gets offered it. There was mixed comments about the choice of food but most people thought it was healthy and nutritious. Comments included, “The food is very nice and they make a lovely omelette if I don’t like what’s on offer. The fruit salad is especially nice” and “There is fruit on offer during the day.” Most people receiving care told us staff always ensured they had plenty to drink. Comments included, “There’s always a drink by my side.” However, some relatives did not think staff were always being diligent in this regard. One relative told us, “[Family member] needs to drink plenty, but I notice when I come, the jug is almost always full as is the cup, which suggests they are not encouraging [family member] to drink regularly.”

Most staff demonstrated a good understanding of people’s eating and drinking guidelines. Staff told us people’s individual dietary needs were being met. One member of staff said, “There are a lot of different dietary needs here but we know them all and meet everyone’s needs. If people do not want what is on offer they can always choose something else. The chef is very flexible and will make something else.”

Although we did not identify anyone that had experienced inadequate fluid intake. The systems and processes in place to ensure people received adequate fluids were not robust. One person had a catheter and their care plan said they were at risk of developing a urinary tract infection (UTI) if they did not drink adequate fluid in a day. Despite this identified risk there was no daily fluid target set for this person and the fluid charts showed the person’s average daily fluid intake was well below the recommended daily intake. This placed them at risk of dehydration and increased risk of a UTI. Another person’s eating and drinking care plan stated they were at risk of dehydration due to a cognitive impairment. Despite this risk there was no daily fluid target in place for this person to ensure they received adequate fluids. The fluid charts for this person showed 18 days in 1 month when no fluids had been recorded. This placed them at risk of dehydration. There were no audits of the fluid monitoring records being conducted so these shortfalls had not been identified.

We received mixed feedback from people about how staff teams worked together. Many people told us they had access to in-house therapy and external healthcare as and when they needed it. However, some relatives did not know whether their family member was receiving any input from the rehabilitation team and others told us they had requested rehabilitation but this had not been put in place. Comments included, “My [family member] has no rehab. I think that would be good for her and I have had meetings about it, but nothing has happened” and I think he’s supposed to have physiotherapy, but I’ve never been around when it happens.” Not all people at the service were being funded to receive rehabilitation therapy. When people were receiving input from the rehabilitation team they were very positive about the care they received. Positive comments included, “I feel well supported overall. The physio and care workers are patient with me” and “At first mum was very anxious here, but the combination of psychology and medication has helped.”

Staff and the manager liaised with other healthcare professionals. They told us they had a good relationship with the GP and other external health and social care professionals. One member of staff told us, “We refer to other professionals such as the GP, tissue viability nurses, palliative team and podiatrists.”

We received positive feedback from external professionals who worked with the service. Professionals told us there had been concerns about the competency of staff and management of risks but through partnership working and regular meetings things had recently improved. One professional told us, “We have had a range of concerns and recently initiated some urgent training sessions as part of the make safe plan. Things have definitely started to improve. We have found the director of care to be fully onboard and instrumental in better staff engagement.” Other positive feedback included, “Yes, we receive appropriate referrals for general podiatry care and foot wounds and foot pressure sores.”

The in-house therapy team consisted of occupational therapists, speech and language therapists, physiotherapists, and a music therapists. The therapy team worked in partnership with other staff to design and deliver therapy programmes for people. There was evidence of good liaison with external professionals to make sure people's needs were assessed and monitored. There were regular multidisciplinary meetings at the home which were attended by a range of external health practitioners. Staff and external partners were positive that the systems and process supported good clinical and therapeutic care. Staff were also able to access specialist palliative care advice from staff at a local hospice.

Most people were satisfied their health was being supported and they had good access to the relevant healthcare. Comments included, “My [family member] has a brain injury, but I am confident in the way they support him and I have confidence in the carers” and “I was getting a bit down and wasn’t sure what it was, so they made sure the doctor saw me.”

Despite our concerns with the quality of some care records. The staff we spoke with had a good understanding of people's individual healthcare needs and knew who to contact if they needed additional support. Staff also told us they were well supported by the GP and other healthcare teams who visited the service. One member of staff told us, “We are fortunate as the GP is very supportive and visits regularly. If we have any concerns about someone they will see them.”

In general, assessments and care plans contained a good level of information about people’s overall health and medical conditions and how these affected them. Staff recorded when people had medical appointments and these records showed people had access to the external healthcare services they needed. Staff handovers were also used to update staff on any significant changes to people’s health.

People were positive about the care they received to improve when they were getting input from the in-house therapy team. People told us, the input had meant there physical and mental health and improved. One person told us, “The therapy team and the care staff have really supported me to regain some of strength and mobility back. You wouldn’t recognise me from how I was when I came here. They have performed miracles.”

Staff spoke highly of the work being done to improve people’s outcomes. One member of staff told us, “We are improving the therapy services we provide. We create SMART goals and monitor progress to support people to achieve good outcomes where possible. We are also building on the different types of therapy we can provide within the home.”

Not all monitoring process were being carried out effectively. For example, staff were monitoring people diabetes blood sugar levels. However, staff were not completing quality assurance checks on the blood glucose testing kits as per the manufacturer’s instructions. This meant that the provider could not be assured the blood glucose readings were always accurate. The quality assurance process in place had failed to identify the shortfalls with monitoring processes we found. When people had input from the in-house therapy team there were good systems in place to support people’s rehabilitation goals.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The provider was not always working in line with the MCA. We identified one person who was being deprived of their liberty due to the risk of them leaving the service unattended. Due to the risks they were being supervised at all times by a member of staff. Despite this restriction being in place the provider had not assessed the person’s capacity to consent to their care and had not made a deprivation of liberty (DOLs) application. People told us staff asked for their consent before delivering care. One person told us, “They always ask permission before they help me, and call me by name.”

Staff did not get regular Mental Capacity Act training and we found some staff did not have a full understanding of the MCA and their responsibilities under this. They did not know if there were DoLS authorisations in place for people and did not know whether conditions had been imposed as part of these. More senior staff had a better understanding of their responsibilities and the DoLs authorisations that were in place. Comments included, “People have right to refuse personal care if they have capacity to make this choice” and “Sometimes we have to have best interest meetings if people are not able to make choices for themselves.”

The provider had a process for recording when people had consented to their care. However, this process was not always been followed. The care plans we reviewed had not been signed by people and no best interest meetings had taken place when people could not make decisions for themselves. The provider has acknowledged the shortfalls we found and recognised the urgent need to provide MCA training to all staff.