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 assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed

The provider was previously in breach of the legal regulation in relation to safety. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 59 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Since the last assessment, the provider had implemented a range of systems and processes in response to the concerns we raised. However, some key areas still required attention. Care plans were not always updated to reflect people’s current risks and support needs were not consistently recorded.

Accidents and incidents were recorded and reviewed so any trends or patterns were identified.

We were informed managers investigated safety concerns and events and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe. However, we found processes to learn from incidents were not always followed up or embedded. For example, we reviewed an incident that was notified to CQC in 2025. We found that although actions and lessens were identified and reported by the service provider, the actions had not been undertaken or learnings not implemented.

We discussed this concern with the provider who was open and honest about the areas needed for improvement and they had an action plan in place which included robust reviewing and implementing lessons learned going forward.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

In circumstances where a person moved between healthcare provisions, for example to hospital, information via a hospital passport was shared. This ensured the person received continuous care and support. However, we found limited information on communication needs for people with complex needs. For example, Individualised guidance for staff on how to communicate effectively when delivering care and support was not always supported to communicate effectively, increasing the risk that people’s needs were not fully understood or met.

There were an admissions process and policy in place. This meant pre-admission assessments were completed before people moved into The British Home and staff had information about how to meet people’s needs. Staff made referrals and worked with other agencies to make sure different aspects of people’s health and wellbeing were considered by the appropriate health professionals.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe with the staff and the care provided. A person said, “I do feel safe because they are all very good to me.” And another person told us, “Staff are around and I feel safe living here.”

Relatives told us they felt the service was safe. A relative told us, “My [Relative] is looked after and kept safe because of the staff.” A relative said. “[Relative] is safe with the staff here.”

Staff received safeguarding training and understood their responsibility to keep people safe and how to report concerns. There was a safeguarding policy in place. Staff had completed safeguarding training and were able to tell us the action they would take if they had concerns. A staff member told us, “I would report concerns to senior staff.”

Another staff member said “I can go to the manager to report [concerns] if needed. They will look into these, and I am confident to escalate to the local safeguarding team if needed and not taken addressed.”

The service had processes in place to monitor Deprivation of Liberty Safeguards (DoLS). Staff had completed training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty

Safeguarding information and policies were accessible to all staff, and management ensured these were kept up to date.

Where incidents had been identified these had been appropriately reported to the local authority and to CQC.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The electronic care planning system provided space for mandatory risk assessments such as choking, epilepsy, multifactorial falls assessment and waterlow assessment. We found these were not being updated monthly for every person.

Where people had specific health needs which placed them at risk of harm, such as epilepsy, risk assessments had not always been completed and the risks relating to the condition had not been fully considered. For example, 1 person had a diagnosis of epilepsy and whilst this was well managed with medicines, there was no care plan or risk assessment in place for this condition to provide staff with information, guidance or advice on how to monitor, support and escalate concerns should the person become unwell or experience a seizure.

Risk assessments and care plans had been reviewed with some improvement since our last assessment however, many still needed more detail to assist staff to support people safely.

We were not assured people at risk of developing pressure injuries had been repositioned in-line with their assessed need. We found some people were not always repositioned within the agreed time to ensure their skin remained intact. We reviewed a person’s repositioning records for a period and identified they had not always been repositioned as described. We found the monitoring section records on positioning for people were not regularly in completed This meant that we could not tell if people were being repositioned as recommended.

We discussed these issues with the management team who acknowledged that information was not being reviewed effectively. People were placed at risk of experiencing skin damage.

In addition, we identified additional further risks presented to people. We observed that throughout 2 days on site we found the sluice doors on all floors were kept unlocked. We highlighted this to the management team.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Equipment was serviced to help ensure it was safe to use, and windows were fitted with restrictors if there was a risk of falling from them. Regular servicing checks of the building had been completed, these included gas safety, electrical installation and fire systems. Certificates of any works completed were readily available.

People had access to call bell alarms. These helped ensure people could summon assistance if they needed.

People had the equipment they needed to keep them safe. Bedrooms were personalised according to people’s preference.

The provider had established improved systems to ensure staff had received training in infection prevention and Control.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff were recruited safely and received training. However, the provider did not always make sure staff received effective support in that the staff did not benefit from frequent structured supervision, feedback or lessons learned discussion. This would support staff to reflect on practice and to develop and embed their approach to providing person centred care.

People and relatives told us there were staff available. One relative said, “Staff are very respectful, there seems to be plenty of them. They are always around if we need them.”

Staff worked well together to deliver care that met people’s individual needs.

Staff told us staffing levels had improved since the last assessment. One staff member said, “There are enough staff on duty. In the past, there weren’t enough. Now we have more time to carry out tasks with people.”

The provider used a dependency tool to determine appropriate staffing levels. This tool helps assess people’s needs and calculate the minimum number of staff required to support them safely.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People spoke positively about the cleanliness of the service. One relative stated, “The home is always clean and tidy when I visit.’’ Personal Protective Equipment (PPE) was available for staff to use, and we saw staff used this as required.

The provider had an infection prevention policy in place and infection control audits were completed regularly.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Time critical medicines, such as medicines to manage Parkinson’s disease, were not always administered as prescribed. For example, we found 1 person had been administered their Parkinson’s medication over an hour late on 8 occasions within 9 days. Similar to our previous assessment, staff did not have access to detailed instructions when medicines were administered differently from medicine’s manufacturer guidance, such as via enteral feeding tubes. Staff were unclear on where to find this information, increasing the risk of incorrect administration. However, we saw that the service had provided training to staff around managing enteral feeding tubes within the past year.

Care plans were not always up to date. For example, 1 person’s care plan indicated monitoring for a high-risk medicine that was not listed on their medicine administration record. It was unclear whether the medicine had been stopped by the prescriber or missed by the pharmacy due to little information on the care plan. This created a risk of staff acting on outdated information. Care plans for management of seizures for people with epilepsy did not have detailed information, posing a risk that staff may not have recognised or responded safely to seizures.

Not all care plans for people with diabetes had enough detailed information about how to manage this condition. We could not be assured staff could have access to relevant information about people’s to safely manage their diabetes needs.

Controlled drugs were not always managed safely. Whilst we saw that they were kept securely and stock counts were completed regularly, we saw on 2 occasions that expired medicines in liquid form had been administered to a person within the past 2 months.

Staff supported people with their PRN (when required) medicines. However, PRN protocols did not always contain person-centred information. There was a risk that staff unfamiliar with people did not have access to information which would support them to administer medicines safely.

Medicines were stored securely, and access was restricted to authorised staff. Staff were supported in their role and received regular medicine related training. We saw people’s allergies were recorded on their medicine’s records. We saw that staff gave medicines to people in a caring and dignified manner. Staff had their competencies assessed; however, this was not always fully documented.