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 assessment we rated this key question requires improvement. At this assessment the rating has remained Requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to people’s safe care and treatment at the service.

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.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to moving to the service. The care plans developed were basic and they did not always contain the necessary information to instruct staff on what care and support to provide, for example, to manage risks of falling and skin integrity. Record keeping was not clear or consistent, and we were not assured people’s current needs were assessed and care plans reflected how staff were to meet their needs.

A new electronic care system had been introduced and implemented; People told us their care needs had been discussed with them when they first moved to the care home. A person said, “Usually 1 of the staff or [manager] will ask me if everything's ok with how staff support me, and so far, it’s been ok.” A relative said, “We've been involved in a meeting to review [Person name].”

However, care records did not always demonstrate people’s needs had been discussed with them. This was important as care plans should be developed collaboratively, focusing on what matters most to the person. We could not be assured reviews of care needs remained effective and relevant. The provider acknowledged any consultation with relatives were not always recorded.

Some care plans reviewed during our assessment, did not always contain detailed information about the specific support people might require. For example, people with epilepsy. This meant staff did not always have the information needed to provide consistent and safe support to minimise the risk to people’s wellbeing.

Although some people’s care records were reviewed frequently, assessments did not always reflect the complexity of their needs. This meant records did not always support staff to meet these needs effectively. Where people’s needs changed, records had not always been updated to reflect these changes.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service monitored care quality through audits, incident reviews, and feedback from people and professionals however we found where issues were identified changes were not always made to improve practice, such as having accurate and current people’s care records.

People living at The British Home had been affected by neuro-disability whether that is as result of accident or trauma, stroke, or a consequence of a degenerative condition or illness. The key medical issue for each person was not immediately evident from each resident’s care plan and there was no consistent information recorded about people’s preferences about how staff give them care, or foods they liked and disliked. This meant staff did not have access to required information to enable them to meet people’s needs. For example, we saw people had long term health conditions such as epilepsy and people with complex needs and there was no guidance for staff of the symptoms they may display if their health status changed, or the action staff should take.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Relatives confirmed the provider worked well with health professionals and communicated effectively. One relative said, “[My family member] has GP coming in, they let me know and always give me an update.”

Staff described improvements in teamwork and morale. One staff member said, “Staff morale is so good now, we work well as a team. We speak to a lot of visiting health professionals, it's important to make them welcome and listen to their advice.”

The leadership team had established systems and processes to support better communication to assist with oversight of risk. For example, staff meetings focused on the whole home, and there was a developing whole-home approach that encouraged collaboration across different roles, including care staff, nursing staff, and housekeeping. This approach helped to create a more joined-up way of working, although it was still becoming embedded in day-to-day practice.

While there was room for improvement in some areas, the overall approach to teamwork and partnership working supported positive outcomes for people.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Relatives told us the provider encouraged people to live healthier lives. One relative said, “They [staff] encourage [my family member] to stay as healthy as possible.”

Another family member said My [family member] had a brain injury, they staff support them and know his needs”.

Staff reported having more time to engage with people, supporting them to take part in activities which helped maintain mobility.

People and their relatives told us they were supported to attend routine health screening and vaccinations. Relatives also told us that staff kept them informed when their family member was unwell. People’s records also confirmed when they were by the GP or the district nurses. Records showed the provider monitored people’s health. However, some gaps were identified in monitoring documentation. The provider explained some people occasionally declined care tasks, such as being weighed. Although this was acknowledged, clearer documentation was needed to reflect the reasons. The provider addressed this with the staff.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

There had been some improvement since our last assessment. However, this was not the case for all documentation, such as recording when some people had been repositioned, care and risk plan recorded consent and following through actions identified from spot checks. While the provider responded promptly to this, systems and processes were not successful in identifying these gaps. Records were in place to monitor areas such as repositioning and diabetes however, these records did not always evidence people had been supported in line with their care plan or assessed needs.

We carried out observations at mealtimes. Staff were seen to be attentive in the dining areas lounge. We observed staff showing people plated up options of food to help them make an informed choice.

Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. Staff told us they helped people to make their meal choices if they needed it.

Relatives told us staff regularly monitored their family members. One relative said, “They monitor [my family member] and their mobility.”

Staff spoke about the importance of monitoring people closely and reporting any concerns promptly.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People’s capacity to make specific decisions was assessed and documented in their care plans. However, the provider was not working within the principles of the Mental Capacity Act 2005 (MCA). We found there was a lack of robust or effective mental capacity assessment in place for some people with complex needs. Records pertaining to best interests were not always completed robustly and did not ensure people or their relative had been consulted. For example, details of actions taken to support individuals to make their own decisions, including how information was presented to help them understand the decision, were not consistently recorded. This meant there was no clear evidence that people were always supported to make informed choices about their care and support.

We discussed this with the management team; they acknowledged the shortfalls within the MCA assessments and the potential impact on people’s rights. They said they would review and update all the capacity assessments in accordingly.

Safeguards and records demonstrated that staff did not understand their responsibility to obtain consent from people in line with the MCA.