About the service The British Home and Hospital for Incurables (which is known as The British Home) is a nursing home providing personal and nursing care to 77 people with physical disabilities at the time of inspection. The service can support up to 127 people in one large adapted building over three floors.
People’s experience of using this service and what we found
Although medicines were managed well, PRN (as and when required medicines) protocols were not always filled in or authorisation documented. Staff files in place did not always document their full employment history. The registered manager devised risk management plans to keep people safe. Safeguarding concerns were reported in line with legislation. People were protected against cross contamination as there were robust risk management plans in place.
Staff did not always receive regular supervisions. Staff received a wide range of training to enhance their knowledge. People were supported to access food and drink that met their dietary needs. People received a holistic approach to managing and monitoring their health and well-being.
People told us that not all the staff were kind and caring. Staff were aware of the importance of supporting people to meet their faith needs. People’s independence levels were regularly monitored to ensure the care provided reflected their needs. People were encouraged where possible to make decisions about the care and support they received.
The service had a culture that was not always conducive for positive staff morale. Records were not always easily accessible, and audits did not always identify issues we found during the inspection. Staff spoke highly of the registered manager and said he was approachable, supportive and hands on. Records confirmed the service worked in partnership with stakeholders to drive improvements.
Care plans gave staff clear guidance on how to meet people’s health, medical and physical needs. People were aware of the provider’s complaints procedure and complaints were managed in line with the provider’s policy. The service were in the process of reaccreditation for the Gold Standards Framework. People’s end of life wishes were documented.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 3 May 2019).
Why we inspected
The inspection was prompted in part due to concerns received about accident management, transparency of the management team and the culture of staff at the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the caring, responsive and well-led sections of this full report.
Enforcement
Since the last inspection we recognised that the provider had failed to display their inspection rating. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.
During this inspection we found breaches in relation to dignity and respect and good governance.
Full information about CQC's regulatory response to the more serious concerns found during inspections is
added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.