CQC report explained · a nursing home
What the CQC found at British Home & Hospital for Incurables
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, August 2021
British Home & Hospital for Incurables was rated Good; inspectors found safe, kind care and improved management, with some dignity issues still needing attention.
This was an unannounced, focused inspection on 27 July 2021. Inspectors spoke with 20 people, two relatives and 23 staff. They reviewed care plans, risk assessments, staff files and management records.
The home was rated Good for Safe, Caring and Well-led. Inspectors found people were protected from avoidable harm, medicines were managed safely, staffing levels were adequate and infection control measures were in place.
Care was generally kind and respectful. However, inspectors saw one staff member respond abruptly to a person, and a housekeeper cleaned around someone receiving intimate help with eating. Activities were also limited during lockdown.
The previous rating was Requires improvement, with breaches relating to dignity and respect and good governance. Inspectors found enough improvement had been made, so these breaches no longer applied. Effective and Responsive were not inspected during this visit, and their earlier ratings were used in the overall rating.
Safe medicines and staffing
Medicines records were completed and checked. Staffing levels were sufficient to meet people's needs.
“Records showed sufficient number of staff were deployed to meet people's needs.” from the report
Kind and personalised care
Most staff treated people with respect and compassion. Care plans were detailed, current and personalised, and people were involved in decisions about their care.
“People received person centred care and were able to express their views about the support they required.” from the report
Improved leadership
The home had strengthened its checks on care quality. Staff reported better communication, support and morale compared with the previous inspection.
“At this inspection we found the provider and registered manager had increased their oversight on monitoring the quality of care.” from the report
Infection control
The home had enough protective equipment, regular COVID-19 testing and checks for visitors. Inspectors found the premises visibly clean and hygienic.
“We were assured the provider was working within current guidance on good infection prevention and control guidelines in relation to the COVID-19 pandemic.” from the report
Inconsistent response from staff
needs fixingAlthough most care was kind, one staff member responded abruptly when a person tried to touch and kiss them. Inspectors said this showed poor understanding of the person's needs.
“This demonstrated a poor understanding of the person's disposition and needs.” from the report
Privacy during eating support
needs fixingA housekeeper cleaned in the room while a person received intimate help with eating because of their risk of aspiration. Inspectors said this made the process undignified.
“This meant a very personal process for this person was undignified because routine service was taking place around them.” from the report
Limited activities during lockdown
minorActivities were limited because of lockdown restrictions and limits on coordinators and volunteers. Recruitment was under way to provide more individual sessions.
“Activities provided for people were limited due to the lockdown as activities coordinators and volunteers were restricted.” from the report
- 01How do you make sure every staff member treats people respectfully during personal and intimate care?
- 02What action was taken after inspectors saw a staff member respond abruptly to a person?
- 03How do you protect privacy when someone needs help with eating or has a risk of aspiration?
- 04What activities and one-to-one sessions are now available, following the limits during lockdown?
- 05How are audits used now to check medicines, care records, staff support and recruitment?
This was a focused inspection of Safe, Caring and Well-led only; Effective and Responsive were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 25 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2020
British Home & Hospital for Incurables was rated Requires Improvement; care was generally safe and effective, but dignity, records and staff morale needed attention.
Inspectors visited on 6, 9 and 10 January 2020. The first visit was unannounced. They spoke with people, relatives, staff and a healthcare professional, and reviewed care, medicine, staff and management records.
The home was rated Good for Safe, Effective and Responsive. Medicines, staffing levels, infection control, healthcare support and personalised care were generally well managed. However, some people said staff were not always kind, and activities did not always match people's interests.
Caring and Well-led were rated Requires Improvement. Inspectors found poor staff morale, incomplete records and audits that had missed problems. The overall rating fell from Good at the previous inspection.
The home breached Regulation 10 on dignity and respect and Regulation 17 on good governance. The provider was asked for an action plan, and CQC said it would monitor progress and return for another inspection.
Safe medicines systems
People received their medicines as prescribed, and the inspection found no unexplained omitted doses in the records reviewed. Medicine stocks were monitored weekly after improvements since the previous inspection.
“We looked at 20 MAR charts and found no unexplained omitted doses in the recording of medicines administered” from the report
Good risk and infection controls
Risk plans covered areas such as mobility, eating, oral health and skin care. The home also had systems to reduce cross-contamination and provided protective equipment.
“People continued to be protected against infection, as the provider had systems in place to minimise the risk of cross contamination.” from the report
Personalised care planning
Care plans covered people's health, communication, preferences and personal needs. They were regularly reviewed and changes were shared with staff.
“Care plans were person-centred, reviewed regularly and gave staff robust guidance on how to meet people's needs in line with their preferences.” from the report
Access to healthcare
People were supported to see healthcare professionals, including doctors and therapy staff. The home used regular meetings to discuss concerns and agree actions.
“The service used a holistic approach to ensure people's health needs were regularly monitored and reviewed” from the report
Approachable registered manager
People, relatives and staff spoke positively about the registered manager. Inspectors also saw staff seeking guidance and support that was readily available.
“Throughout the inspection we observed staff approach the registered manager for guidance and support, which was readily available.” from the report
Dignity and kindness
seriousEight people gave negative feedback about the caring nature of some staff. Inspectors also saw a lack of communication and engagement at times.
“At times we observed staff appeared lacklustre, there was a lack of communication and engagement between some staff and people.” from the report
Incomplete management records
seriousRecords did not always show medicine authorisations, staff employment histories, supervision or complaint investigations. Audits did not consistently find these gaps.
“Records were not always complete and contemporaneous, therefore decisions taken in relation to care and treatment were not always clearly recorded.” from the report
Poor staff morale
needs fixingStaff described a culture in which they felt unsupported and alienated when raising concerns. Inspectors recommended immediate action to resolve conflicts.
“During the inspection we identified there was a systematic culture of poor morale amongst the staff members.” from the report
Activities did not suit everyone
needs fixingThere was a range of activities, but some people said these did not match their interests. Inspectors saw people in rooms with little or no stimulation.
“Although there were a wide range of daily in-house activities available to people, people confirmed these did not always reflect their interests” from the report
As-needed medicine protocols
needs fixingSome protocols for medicines given when needed were not completed or authorised consistently across the home.
“Sometimes the PRN (as and when needed) protocols were not filled in or authorised appropriately across all the units consistently.” from the report
- 01What has changed to make sure every member of staff treats people with kindness, dignity and respect?
- 02Have all staff received the supervision and appraisals promised by the end of January 2020?
- 03How are as-needed medicine protocols checked and authorised now?
- 04How do management audits identify incomplete care, medicine, staffing and complaints records?
- 05How are activities matched to each person's interests, including people who spend time in their rooms?
This was a three-day inspection covering all five CQC questions, prompted partly by concerns about accident management, management transparency and staff culture. This explanation was written from the published report of 12 February 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of British Home & Hospital for Incurables
5 rated inspections over 5 years: the service has held its Good rating throughout.
- August 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at British Home & Hospital for Incurables →
- February 2020Requires improvementdown from GoodSafe: GoodCaring: Requires improvementWell-led: Requires improvement
Read what inspectors found at British Home & Hospital for Incurables →
- May 2019Goodstayed GoodSafe: GoodWell-led: Good
- October 2017Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- May 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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