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

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. 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 were not always safe and protected from avoidable harm.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people about how the provider responded when things went wrong. Some people were not satisfied that necessary improvements were made after incidents or concerns were raised. Comments included, “I don’t feel the management side is prepared to listen or accept criticism” and “I have complained about [family member] being left in their pads instead of staff taking them to the toilet. I told the manager, but there’s been no change.” Despite this, some people told us they were satisfied with the response they received when issues were raised. One relative told us, “If I have any problems I call them up and it gets sorted straight away.”

Staff told us they discussed incidents, accidents and things that went wrong during meetings and handovers. However, some staff felt the process for responding and learning from incidents was not very robust. One member of staff told us, “When complaints are raised, management tends to be reactive rather than proactive, which sometimes delays necessary action to ensure the safety of the residents.”

There were a range of processes in place to learn from previous incidents, however, we were not assured the process was effective. Suitably robust actions were not always taken in response to concerns raised and lessons were not always learned or applied in practice. We found some shortfalls had been identified through the provider’s own checks and audits but had not been resolved. We also found some issues of concern about standards of care at night had been raised and discussed in March 2024 but despite some attempts to address these concerns, the actions taken had not been robust. There were no night-time audits conducted after concerns were raised to monitor staff and no investigations into the allegations raised. The feedback from people we received during the assessment showed many people were unhappy with the care delivered at night.

We received mixed feedback from people about the systems and processes in place to manage risks. The majority of people receiving care told us they felt safe, however, relatives were not confident staff were always keeping people safe. Negative comments included, “When I’m there, no one goes in to check on [family member] even though they don’t know I’m there” and “My emotions when I leave, depend on which staff will be caring for my [family member]. Despite this, many people were confident about the systems and processes. Positive comments included, “I feel safe here, because everyone knows what they are doing to look after us well” and “In terms of my [family member’s] care, I would say he is safe and won’t come to harm.”

Staff told us there was a process in place to assess risks to people when they entered the home. However, some staff told us the system did not effectively alert staff when risk assessments were due to be reviewed. This meant there was a risk that some information about risk management was not up to date or accurate. Comments from staff included, “We complete the risk assessments once people are admitted to the home” and “The system doesn’t alert us when risk assessments are overdue.”

We received mixed feedback from partners about the systems in place to manage risks. Positive comments included, “Risks are managed appropriately by staff” and “I believe people are getting safe and effective care.” However, some professionals told us there had been concerns about the management of some risks. One professional told us, “There have been ongoing concerns about the management of some risks but things have really started to improve. Communication with staff is much better now and we are working together to help drive improvements.”

Despite good examples of working in partnership with external partners the provider did not always operate effective systems and processes to manage and mitigate risks to people. Personal emergency evacuation plans (PEEPs) were either not in place or not completed accurately. One person’s PEEP did not contain any information about how to support them to leave the building in the event of a fire. The care plan for the person showed they had restricted mobility which meant staff would need a detailed and specific strategy to support them to evacuate safely. Another person’s PEEP contained inaccurate information about their ability to mobilise independently. The lack of a personalised plans placed people at risk of harm in the event of a fire in the building. One person had a diagnosis of epilepsy but did not have a care plan in place guiding staff on how to support them if they had a seizure. This placed them at risk of receiving inappropriate care from staff if they were to experience a seizure.

People did not feel they were always protected from the risk of neglect/poor care. During the inspection one person told us they had been neglected by night staff who had left them in an undignified situation and exposed them to the risk of harm. A relative of another person also told us, “I worry about [family member] every time I leave.” Another relative said, “[My family member] gets left in bed too often.”

We raised our concerns about the allegation of neglect and the provider has taken some immediate steps to ensure the ongoing safety of the person whilst they investigate the allegations. Staff told us they received safeguarding training and understood their responsibilities to protect people from harm and raise concerns when needed. One member of staff told us, “The most useful training has been in safeguarding, as it has significantly helped with improving residents' safety and comfort.”

Despite the concerns raised we did not observe any neglectful practices during our visit to the home.

The provider’s systems and processes were not always effective. Concerns about the conduct of night-staff were raised in March 2024 but the there was no formal investigation conducted to determine the cause of the neglect and ensure the standard of care would improve. The provider is investigating the specific allegations raised.

We received mixed feedback about the management of risks. Most people felt the staff were managing the risks to their health and wellbeing. However, some people felt less confident about the safety of care when temporary staff were on duty. One person said, “I only get anxious when I have an agency staff member with me.” Positive comments included, “Most of the time I feel very well looked after, which gives a feeling of security and safety and “I feel safe here, because everyone knows what they are doing to look after us well.”

In general, staff told us they thought the process for managing risks was robust. Positive comments included, “Yes, I regularly go through the care plans and risk assessments, and I find them accurate and up to date.” However, when we shared our concerns about the shortfalls we found with managers, who acknowledged improvements were needed.

We saw staff support people who were distressed in a calm and empathetic manner which helped reduce their anxiety and distress. Staff explained what they were doing, encouraged people to make choices in their preferred communication method and did not rush them.

The provider did not ensure the process for managing risks to people’s health and wellbeing were robust. The risk of skin breakdown was not always thoroughly assessed and staff did not always follow the care plans. One person who did not have a skin integrity assessment in place despite them being at considerable risk of skin breakdown due to their health and restricted mobility. We also found measures in place to mitigate the risk were not always clear or followed correctly. For example many people at high risk of skin breakdown and care plans stated staff should support them to reposition at regular intervals. However, we found large gaps in repositioning charts which meant the provider could not be assured people were being repositioned regularly in line with their plan. We shared our concerns about these shortfalls and the provider has taken immediate action to resolve some of the issues we found.

We received mixed feedback from people about the safety of the home environment. Some people were not satisfied with the overall management of the maintenance of the home. Comments included, “I am not happy with [family member’s] bathroom. Tiles have already fallen off the wall and it’s been like that for a whole year. I’m concerned that there’s always a chance one could fall off on them” and “The building itself isn’t ideal. It’s a bit of a creepy place, not a warm or comfortable setting.” Despite this some people we spoke with told us that they felt the home was clean and well decorated. Comments included, “The room has been redecorated and [family member] likes it” and “This place is all right. It’s clean and welcoming.”

We shared our concerns with the safety of the environment and the provider told us they were not aware of all the issues we found. After we raised our concerns the provider has put a plan in place to resolve the issues we found .

During the inspection we found a range of hazards, maintenance issues and poor practices in relation to the safety of the environment. Many doors that were meant to be locked or closed were open or unlocked. We saw doors to sluice rooms, clinical waste rooms, storerooms and linen rooms were unlocked when they should be securely locked. This meant they were easily opened and accessible to people. Many communal areas were being used to store moving and handling equipment. We also saw communal bathrooms were in a poor state of repair. One bathroom had ceiling tiles missing and another had a broken toilet seat.

The systems and process in place were not effective in identifying all the issues we found with the safety of the environment. Risks to the environment had not always been assessed, monitored and managed effectively which placed people at risk of potential harm. The hazards we identified in relation to unlocked/open doors had not been identified through the provider’s audit processes. Despite these concerns we found examples of good practice in other areas. The service had a business continuity plan in place for managing the service in an emergency. There was an up-to-date Fire Evacuation Plan in place and fire drills were conducted every 6 months Routine maintenance certificates for fire safety, electricity, gas, Legionella prevention and lifting equipment were in place and up to date.

We received mixed feedback from people about safe and effective staffing. Many people were unhappy about staffing levels, the use of agency staff and the care delivered by night-time staff. Comments about staffing levels included, “I don’t feel there are enough carers, it’s not always easy to find someone to help out” and “There have been moments when I’ve been frustrated not being able to get a carer to me to help.” Comments about care at night included, “I am not happy with the situation with the night staff” and “The night staff just seem to want to disappear. They’re not easy to get hold of.” Negative comments about temporary staff included, “The agency staff are ‘shorter’ with him. They don’t understand that [my family member’s] condition” and “Some have a very poor grasp of English, so can’t understand instructions.” Despite this some people were positive about how the staff responded when they called for assistance. Positive comments included, “The call bell is near me, so I can easily alert carers” and “They get to me pretty quickly.”

Staff also told us there were not always sufficient number of staff on duty to meet people’s needs safely and effectively and agency staff were not always suitably skilled. Comments from staff included, “We are short of staff on shift” and “At times there are not enough staff so we use agency staff. The agency staff that come to work my floor do not stay as they do not know what to do, how to use the equipment, sliding sheet, hoists, I have to show them. I get tired as we are doing all the work on shift.” Despite these concerns staff felt they received adequate training and supervision. Positive comments included, “Yes, I have received adequate training. For example, the moving and handling training and safeguarding has been particularly useful and I do have supervision sessions.”

During the assessment there were many occasions when it was not easy to find a member of staff as they were busy delivering care in people’s rooms. We also saw the lunchtime service was extremely busy on 1 floor due to insufficient staff being on duty. We also saw some staff take a task focused approach when delivering care, indicating they did not have time to sit and interact with people.

Staff were not deployed effectively within the home. The provider used a dependency tool to determine staffing levels. However, we found this was not always a robust way of determining staffing levels as it did not always show when some people required 1-2-1 support. Analysis of staff rotas showed numerous occasions when the minimum staffing levels set by the dependency tool was not achieved. The provider also did not have an effective process for analysing call bell waiting times so they could not be sure how long people waited when they called for assistance. The provider was not ensuring staff were qualified, competent and skilled to provide the duties they were employed to perform. Training records showed that attainment levels for refresher training were far below the expected target of 95% which was stipulated by the provider’s training policy. Staff were not supported through regular supervisions and appraisals, in line with the provider’s supervision/appraisal policy. This meant the provider could not be assured that staff received adequate support and monitoring to ensure their performance was effective. Overall safe recruitment practices were being followed; however, we found the process for ensuring references were legitimate was not always robust. References from previous employers were from unverifiable email accounts without any company stamp or headed paper and the provider had not taken any further steps to verify their legitimacy. The provider has acknowledged the staff deployment has not been very efficient and they are taking steps to address this and the shortfalls with staff training.

We received mixed feedback from people and their relatives about the infection control procedures and standards of hygiene within the home. One person told us, “I don’t feel they clean [family member] up that well and there are splashes on the wall, from his milk for example.” However, many people told us the home was kept clean and staff used appropriate personal protective equipment (PPE). We received comments such as, “The room is clean, tidy and with no odour” and “They wear PPE when they undertake tasks with [family member].”

The provider has accepted the shortfalls we found and told us they would resolve these issues as soon as possible. They told us the former registered manager who had recently left had been the infection prevention control lead and following their departure another staff member had been allocated to take on this role.

Infection prevention and control (IPC) of the home was not appropriately managed. The environment was visibly unclean and unhygienic in places and some bedrooms/bathrooms and communal bathrooms had unpleasant odours. We saw toilet brushes in bathrooms were old, worn and not clean. People’s private bathrooms and communal bathrooms were not always clean. Some floors were sticky and littered with pieces of toilet roll. A shower room was unclean and had a pungent smell but staff did not seem to notice and could not identify where the smell was coming from. At lunch time we saw a pantry kitchen had breakfast dishes piled in sink and had not been washed up after breakfast. A staff member told us the breakfast dishes should have been washed after breakfast and the pantry left clean prior to lunch, however, they were unable to identify the member of staff who had been assigned this duty. We also observed a staff member putting food in a unclean microwave without a plate. Despite these observations we saw staff were wearing appropriate PPE and people and relatives confirmed this was standard practice.

IPC audits were conducted but these had not been effective in improving standards of hygiene within the home. The IPC audits showed infection prevention compliance levels were deteriorating, not improving. The most recent audits conducted in August 2024 identified a range of shortfalls but these had not all been resolved by the time of our visit in September 2024

We received mixed feedback from people about the management of their medicines. Not all people were satisfied their medicines were being managed well. One person had recently raised a complaint due to repeated issues with the supply of their medicines. They told us, “My main concern is the fact that I found that some of the medication prescribed by the GP, was not given to me. The whole medication thing is erratic and I’ve spoken to others who say they’ve had problems too.” At the time of the inspection the person had not received the response to their complaint, although the provider had made improvements. Despite this, some people were satisfied their medicines were being managed appropriately. Positive comments included, “I get my medication as I should” and “I have insulin injections, which are done regularly.”

Staff told us that they had sufficient time to complete medicines rounds. Staff had a system for managing medicines related incidents and told us they would seek GP/pharmacy advice as required. Staff demonstrated an open and transparent culture in relation to the management of medicines incidents. There had been ongoing discussions about the previous issues with obtaining medicines supplies in a timely fashion. As a result, meetings had been held with the GP practice and the community pharmacist. Staff reported that these issues had improved as a result of these meetings.

Medicines were not always managed and stored safely. During our visit we saw one of the medicine rooms contained medicines for disposal and these were not safely segregated from other medicines. Topical creams were being stored in people’s bedrooms and this had not been considered in people’s risk assessments. Staff did not record which part of the body topical medicines should be applied to so there was risk they would not be applied correctly. Staff did not always have access to detailed information on medicines administration when they were given in a way that differed from the manufacturer’s instructions. For example, medicines given covertly (disguised in food or drink), or medicines given via enteral feeding tubes. Staff conducted monthly medicines audits to identify issues and shortfalls, however, the audits had not identified all the issues we found with the storage and management of medicines. Despite the shortfalls we found, we also found some examples of good practice. Medicines records were securely maintained. People’s allergies were accurately recorded on their medicine records. Staff were given training and had their competency assessed before they were able to manage people’s medicines. We saw that staff gave medicines to people in a caring and dignified manner.