About the service: The British Home and Hospital for Incurables (which is known as The British Home) is a nursing home. The British Home provides nursing care for up to 127 adults with physical disabilities.

People’s experience of using this service:

¿ People continued to be protected against the risk of avoidable harm and abuse as the registered manager had robust risk management plans in place that were reviewed regularly to reflect people’s changing needs. Staff were aware of how to identify, respond to and escalate suspected abuse.

¿ Sufficient numbers of staff were deployed to keep people safe. The registered manager carried out robust pre-employment checks to ensure staff were suitable to work at the service.

¿ People’s medicines were managed in line with good practice and administered as intended by the prescribing Pharmacist.

¿ People continued to be protected against the risk of cross contamination as the registered manager had robust infection control measures in place.

¿ People received care and support from a service that was well-led. People, their relatives and staff spoke positively about the registered manager and the rest of the management team.

¿ Audits were regularly carried out at the service to monitor the service provision. Issues identified during the audits were responded to swiftly to minimise the impact on people.

¿ People’s views were sought regularly to drive improvements through regular house meetings, quality assurance questionnaires and daily discussions.

¿ The registered manager encouraged partnership working with other healthcare professionals to monitor the service provision and enhance people’s lives.

Rating at last inspection: The service was previously inspection on 1 September 2017 and rated Good overall and Requires Improvement in the key question, is the service effective?

Why we inspected: Prior to this inspection we were made aware of issues that placed people at risk.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced inspection took place on 1and 15 September 2017. The British Home and Hospitals for Incurables [also known as The British Home] is a large nursing care service for up to 127 adults who have physical disabilities and require nursing care. At the time of the inspection there were 74 people using the service. The service is situated in the London borough of Lambeth.

At the last inspection on 16 June 2016 the service was rated Good.

The service has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People did not always receive care and support from staff that had undergone regular training to meet their needs. Since the inspection the provider has submitted a training schedule with upcoming training. We are satisfied with the action the provider has taken.

People were protected against the risk of unsafe medicine management. Records confirmed people received their medicines as prescribed. Storage, recording and administration of medicines was undertaken by staff competent to do so.

People were protected against the risk of abuse. Staff had sufficient understanding of how to identify, report and escalate concerns around suspected abuse. Risk management plans in place gave staff guidance on how to manage identified risks.

The service had comprehensive health and safety plans in place to ensure the safety of the premises. Accidents and incidents were monitored and reviewed to learn from and enhance people’s safety.

The service employed adequate numbers of staff to keep people safe. Staffing levels were monitored and adjusted in line with people’s changing needs.

People’s consent to care and treatment was sought. People’s decisions were respected, recorded in their care plans and implemented in the delivery of care they received.

The service ensured people received sufficient food and drink to meet their dietary needs and requirements. People’s dietary needs were monitored regularly to identify any concerns and issues shared with healthcare professionals in a timely manner. People were supported to access a wide range of healthcare services.

People told us staff were considerate, compassionate and treated them with dignity and respect. Staff ensured people’s confidentiality was maintained with only authorised personnel having access to confidential information.

People received personalised care that was tailored to their individual needs and preferences. Care plans were devised with people and their relative’s input and reviewed regularly in line with people’s changing needs. People were encouraged to participate in a wide range of activities of their choice.

Concerns and complaints were fully investigated and managed to seek a positive resolution, in line with the provider’s policy. Complaints were shared with the relevant healthcare professional bodies.

The registered manager was highly thought of by people, their relatives, staff and healthcare professionals. People confirmed he was supportive, approachable and listened to people’s ideas and suggestions.

Regular audits of documents relating to the management of the service were undertaken. Issues identified where then acted upon swiftly.

The British Home and Hospital for Incurables (which is known as The British Home) provides nursing care for up to 127 adults with physical disabilities. When we visited the home 70 people were living there. The last inspection of the service was in September 2014 when we found the regulations we inspected were met.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received their medicines as prescribed and followed clear procedures in relation to recording administration of medicines. People were able to see health professionals to assist with their specialist needs.

Staff were knowledgeable about abuse and issues which raised concerns about people’s safety were referred to the safeguarding authority for investigation. The manager was familiar with how they should support people in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and further training was to be provided for staff. The provider had safe arrangements for the recruitment of staff and they were trained for their roles.

People said staff had a caring and kind approach. They took account of people’s views about how they wished to be cared for. Staff protected people’s privacy and maintained their dignity when caring for them.

People were involved in planning their care and their individual needs were addressed. People could choose meals which took account of their nutritional, cultural and religious needs. The provider had systems for people to give their feedback about the home through meetings and surveys. The manager investigated complaints and took action to ensure concerns were addressed.

Management systems were in place to audit and check the safety and quality of the service provided and action was taken to make improvements when necessary.

Two inspectors carried out this inspection. This inspection focussed on staffing levels at the home. At our inspection on 15 April 2014 we raised concerns that there were not enough staff to meet people’s needs.

Below is a summary of what we found. The summary describes what people using the service told us, what staff told us, what we observed and the records we looked at. During this inspection we spoke with; 12 people that used the service, two friends of people that used the service, the interim manager of the home, 5 nurses, 13 health care assistants and an activity co-ordinator.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

At our last inspection on 15 April 2014 we found there were not enough qualified, skilled and experienced staff to meet people’s needs. At this inspection we found improvements had been made and on the whole there were sufficient staffing levels to meet people’s needs.

The interim manager had reviewed processes regarding staffing and new systems were in place to review staffing levels daily to ensure adequate staff were deployed at the service to meet people’s needs, and to review arrangements to cover staff annual leave and sickness.

Two units at the service had seen an increase in staffing numbers allocated and the service was in the process of recruiting further nurses and health care assistants.

Is the service effective?

Not reviewed during this inspection

Is the service caring?

Not reviewed during this inspection

Is the service responsive to people’s needs?

Not reviewed during this inspection

Is the service well-led?

At our last inspection on 15 April 2014 we found the provider failed to notify the Care Quality Commission about an event which they were required to by regulation. We found at this inspection that notifications had been made as required so that, where needed, action could be taken.

Our inspection team was made up of two inspectors, a nursing care and end of life care specialist and a member of our management team. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, speaking with the staff and from looking at records. We requested information from the provider and spoke with five community based health care professionals who visited the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. When people were at risk staff followed risk management procedures to protect them. Systems were in place to make sure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

A member of the management team was available on call in case of emergencies. Staff had received training to meet the needs of the people living at the home. However, we were concerned that current staffing levels were insufficient to meet people’s identified needs and at times when they have increased need. People using the service told us "the staff are nice but they don't have time. They are always rushing about" and "sometimes I get lonely".

Is the service effective?

People’s health and care needs were assessed with their involvement or that of a relative or friend. Areas of the support required for each person had been identified in care plans. Records, our observations and discussions with staff confirmed that this support was provided, but not always quickly enough. People had the aids and adaptations to maintain their independence.

Is the service caring?

People were supported by kind and attentive staff. But the staff did not have the time to show consideration and kindness as much as they wanted to because they were too busy. Our discussions with staff on duty and our observations of the care and support provided confirmed this. We saw that care workers showed patience and gave encouragement when supporting people but people were left for long periods with little or no staff interaction. A person using the service told us "the staff are caring and kind."

Is the service responsive?

The staffing levels were not high enough for the service to be as responsive as it should be. Although people’s basic care needs were being met they were often not met in a timely manner and there was no time for staff to spend talking with people and responding when they need more attention than usual. However, the service responded quickly when people needed extra support from their health professionals. People had requested a different range of leisure activities and the service responded by arranging them. People knew how to make a complaint if they were unhappy and had been frequently asked for their views of the service. We saw that the provider used this feedback to improve the service. People could therefore be assured that their views were taken into consideration in regards to the running of the service.

Is the service well-led?

The service was well- led. The manager was registered and had been in post for many years. The provider visited the service often and followed up on any quality issues identified. The service worked well with other agencies and services to make sure people received their care in a joined up way.

People’s privacy, dignity and independence were respected and their views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person using the service told us "I like to do as much as possible for myself and the staff support me where needed”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A person using the service told us “Staff keep my skin intact by moisturising it and changing my position regularly". A relative told us "I can't fault the care the staff provide here".

People were protected from the risks of inadequate nutrition and dehydration.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had safe and effective arrangements in place for the management of medicines.

There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by 2 CQC inspectors, joined by a practicing professional.

We used a number of different methods to help us understand the experiences of people using the service. A number of the people using the service had complex needs, which meant they were not always able to communicate verbally with us in a meaningful way. During breakfast and lunch we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us that the service was flexible, focused on their individual needs, and they were not rushed. People told us that they received the care and help they needed at the time that it was required especially at meals.

A visiting relative spoke of her confidence in the service, "I find that staff are kind and courteous, there are always plenty of staff on duty and I feel my sibling is well cared for and safe".

People said that mealtimes were enjoyable; they felt that they received the support and encouragement they required with eating. A person told us how much they enjoyed their meals; they said “I feel like a lady, my food is cut up so that I can manage to eat the meal myself".

People told us that they are encouraged to do as much as possible for themselves and that the environment facilitated this. The bedrooms, communal areas and garden were wheelchair accessible.