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 assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership did not always provide consistent oversight to support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 61 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Improvements had been made to ‘open’ the culture so people and staff could speak up, and people were the main focus of care delivery. However further improvements were needed to obtain people’s preferences, choices and feedback and to help ensure person-centred care was provided.

New staff received support and training which helped them to demonstrate the provider’s values in their daily work with people. Staff members said they now worked as a team and morale was much improved. Their comments included, “I think the culture is okay, staff have said that it is better”.

However, further progress was needed to embed a culture of accountability, particularly regarding how care records were updated and how guidance was implemented consistently across the staff team.

Staff described a more positive working environment. One team member said, “The culture is so much better now. There is a real emphasis on people's wellbeing and happiness, everyone just wants people to be happy.”

During our visit, we observed a noticeable shift in the service’s culture compared to the previous assessment. The atmosphere was calm and welcoming, with staff taking time to support people in a relaxed and engaging manner.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation.

Feedback about leaders was mixed. Staff described senior managers as approachable, supportive, and responsive to feedback. However, despite this positive leadership approach there were missed opportunities to learn and improve the service.

Staff were complimentary about the senior manager. One staff member said, “[My line manager] is great, when I started here, they are involved and they’re approachable.” Another said, “[senior nurse] is nice, very caring and there if you need them”. And another staff member told us, “When I have had struggles, I have gone higher, and they have dealt with it.”

Whilst there was no evidence of any harm to anyone living at the service, as at the previous assessment, checks and audits were not always consistently effective in identifying where improvements needed. This meant leaders did not always have accurate oversight of quality and risk, and opportunities to drive timely improvement.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider has a “speak out” policy in place. Records from team meetings and staff discussions show that guidance to staff focused on raising concerns internally, including through team meetings, supervision, and discussions with the manager or care director.

People, relatives and staff told us they felt confident to raise concerns with the senior manager and these would be listened to and acted upon.

Staff were aware of who they could contact, if they did raise a concern and felt they had not been listened to.

The provider had a clear whistle blowing policy. Staff could raise concerns, and written information was available of how to do this.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider’s recruitment process was equality monitored to ensure it was fair for potential candidates. The provider had systems in place to support staff and promote equality, including access to mentoring where required.

The provider was committed to diversity, equality, and inclusion. Staff from diverse backgrounds said they were happy working at the service and felt valued and supported.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

At our last assessment the governance systems were ineffective as they failed to identify shortfalls within the service. At this assessment the governance systems remained ineffective. Shortfalls had not always been identified or addressed.

The provider had established a new electronic system and processes to check the safety and quality of the service. We reviewed various audits that had been completed consistently by the care manager, nurses, and senior managers. These were not always effective. We found shortfalls with these audits as we identified several issues that had not been detected through their internal audits for example we found gaps in consent documentation, incomplete records relating to care and risk plans and the Mental Capacity Act 2005 (MCA) assessments and medicines management.

We also found audits did not always state the actions needed to address the identified gaps and issues. Where the provider had identified improvements were needed, actions had not been appropriately taken to resolve or learn from them.

We discussed some of these shortfalls with the provider who said they were committed to improving the service and were following a service improvement plan. They told us this would be amended as necessary to include issues raised at our assessment. The provider updated their records throughout the assessment process and changes were witnessed. It was too early to determine if these changes were sustainable.

Staff expressed generally positive views about the service. One team member commented, “I think it has room for improvement as every service should but as the director is doing quite well, things getting better, and people live the best they possibly can.”

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Systems were in place to work with other health and social care professionals. During the assessment a visit from the GP occurred and records showed there were regular visits from the district nurses. The service also reached out to other specialist services run by the provider to gain knowledge on areas they were less confident. For example, seeking training for staff on supporting people with Injuries.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Although systems were in place to support learning and continuous improvement, these were not effective. Internal audits and other processes did not consistently result in timely action to address identified concerns, which meant improvements were not embedded and risks remained.

While the provider had a service improvement plan in place and was engaging with the local authority, staffing pressures affected the pace at which improvements could be implemented. This meant changes were not yet embedded, and systems introduced were too early to demonstrate sustained improvement.