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

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 inspection in July 2021 we rated this key question good. At this inspection, the rating has changed to requires improvement. This meant the service was not consistently managed and well-led. Leaders and the culture they created did not always promote safe and effective care.

This service scored 54 (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 staff about the shared direction and culture of the service. Some staff felt the provider was not doing all they could to foster this. One member of staff told us, “There's A lack of clear direction, and staff concerns are not always addressed in a timely manner.” Despite, these concerns many staff and manager demonstrated a shared goal to improve the quality of care and therapy being provided. One member of staff told us, “We really want British Home to be an outstanding example of care for people with neuro-disability. We have a lot to do to achieve this but I think we can get there.”

The provider had carried out a range of meetings and focus groups within the home to connect staff and ensure good communication across different teams. Staff focus groups had been conducted to gather feedback from staff and find solutions to some of the ongoing issues with quality and safety. The provider had also revisited their mission statement by consulting with staff and people who received care.

Staff did not feel leaders were always capable and compassionate. Comments from staff included, “The leadership and management needs to improve. They need to ensure adequate staffing levels and offer better psychological support for residents and staff” and “They need to offer better emotional support to staff.”

The registered manager had recently left and the provider was in the process of recruiting a range of senior staff including a replacement for the registered manager. At the time of the assessment the service was being managed by an interim service manager with support from the director of care. Despite the shortfalls we found during this assessment we found senior leaders took action to address poor performance when this was identified. The provider also told us they were in the process of changing the governance structure of the home to improve the oversight of safe and effective care.

Staff felt able to raise concerns, however, they did not feel senior managers always listened and/or took the necessary action when issues were raised. We received comments such as, “If I had concerns about safety I would tell the nurse in charge” and “We do share suggestions during meetings, but they are rarely considered or implemented, which can be disheartening” and “Although managers are present, they aren’t consistently approachable or open to discussing concerns.”

There were a range of meetings and forums in place to ensure staff had the opportunity to speak up, raise concerns and suggest areas of improvement. Staff meetings were used to remind staff of their responsibility to raise concerns to senior staff.

The service employed a diverse workforce and valued diversity and inclusion. Staff received equality and diversity training. Staff surveys were used to gather feedback from staff about their experience of equality and inclusion. When staff gave negative feedback about equality and diversion plans were put in place to address these concerns.

There were diversity and equality champions in place to help support staff and build a culture of inclusion. The activities and events organised within the home reflected the diverse cultural backgrounds of the workforce and people who received care. The provider made reasonable adjustments for staff with disabilities so that they could be supported to fulfil all aspects of their role.

Feedback from staff was mixed, but in general staff told us improvements were needed to the management of the service. Staff were not confident that senior managers listened to them and took the necessary action to improve things. Comments from staff included, “The service is not well led. There's a lack of clear direction, and staff concerns are not always addressed in a timely manner.”

There was a system of audits and checks but these were not always effective. The checks on the environment, medicines and care records had not identified all the issues we found with infection control and environmental hazards. The regular checks of care plans and risk assessments had not identified/resolved the shortfalls we found. Staff conducted regular medicine audits, however, these audits failed to identify the concerns related to medicines management and storage we found during the inspection. There was no process of reviewing call bell records to analyse how long people were kept waiting when they called for assistance. Before we carried out this assessment the provider had recognised there were issues with the governance and management of the home and had commissioned external consultants to carry out audits with the aim of identifying shortfalls and helping drive improvements. The provider had formulated plans to improve the governance and oversight of the service. The provider has also submitted a detailed action plan based on our feedback and the findings of their own quality assurance processes.

Many people and their relatives did not feel consulted about their care and many people told us they had not been asked to give feedback. Comments included, No one has ever asked me if I am happy with my care” and “They don’t ask me what I think about [family member’s] care.” Despite a range of meetings regularly being held for people and their relatives some people were not aware these were taking place which showed communication was not always effective. Comments included, “I’m not aware that there are any meetings for relatives or residents.”

Staff told us they worked with a range of external partners including, volunteers, external health and social care professionals and commissioners. Staff told us the home was well supported by external partners.

In general partners who worked with the service spoke highly of the way staff and leaders worked in partnership with them and other external partners. Comments included, “I am aware that the organisation is committed to providing high standards of care and treatment. I also understand the director of care has already taken steps to work towards this aim” and “Engagement with staff has recently improved thanks to good partnership working with senior staff.” Another professional told us, “There is an action plan in place to support the staff working there to manage the patients with confidence and competence, and that action plan has been developed in partnership with our colleagues at the home.”

There were processes in place to ensure partnership working was effective. Senior leaders and staff worked collaboratively with a range of external partners. There were regular meetings at the home which were attended by external health and social care professionals.

Despite the shortfalls we found senior leaders showed an ambition to learn and improve the standard of care being delivered. Senior leaders and staff acknowledged the shortfalls we found and started to make some immediate improvements when we raised our concerns. Staff told us there were plans in place to build on the range of therapies available in the home.

Due to the issues we found, we could not be assured the processes in place to learn, improve and innovate had always been effective. Despite some ambitions to introduce innovations, feedback we received from people indicated basic standards of care needed to improve. The systems and process for learning and improving after incidents was also not consistently applied to drive improvements. The provider has acknowledged the shortfalls we raised and put an improvement plan in place and taken some immediate actions to address some of the serious shortfalls.