CQC report explained · a residential care home
What the CQC found at Bricket Wood Care Limited
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Staffing, safeguarding, infection control and medicines had improved. However, some risk assessments lacked enough detail, and the report said there was limited assurance about safety.
- Effective?
- Requires improvement
- People's care and support had become more focused on their goals and independence. Some needs had not been reassessed, and staff supervision and training still needed further development.
- Caring?
- Good
- This question was not inspected separately during this visit. Inspectors observed kind and compassionate interactions and said people and families described staff as kind.
- Responsive?
- Good
- This question was not inspected separately during this visit. The report described improvements in people's activities, choices, community access and longer-term plans.
- Well-led?
- Requires improvement
- The new management approach had improved the culture and people's quality of life. Governance was still developing because audits, action plans and learning from incidents were not always recorded or complete.
What inspectors found, February 2023
Rated Requires Improvement; care and independence had improved, but risk records and management checks were still not consistent, and the home had only recently left Special Measures.
Inspectors visited unannounced on 4 and 24 January 2023. They spoke with three people, one relative, four staff members and two visiting professionals. They reviewed care, medicine and staff records, training information and management records.
The home supported four people and could support up to six. Inspectors saw kind and calm support. People were helped to make choices, take part in household tasks, access the community and develop their independence. Medicines, staffing, safeguarding and infection control had improved since the previous inspection.
Some important systems were still developing. Risk assessments varied in quality, some people's needs had not been reassessed, and management audits and action records were incomplete. The ratings were Requires Improvement for Safe, Effective and Well-led. Caring and Responsive were not inspected separately in this visit.
Greater independence
People were supported to make choices, do household tasks, access the community and work towards longer-term goals.
“People were being supported by staff to be actively involved and engaged in cooking and completing their own household tasks.” from the report
Kind support
Inspectors saw staff supporting people calmly and compassionately. People and relatives also described staff as kind and supportive.
“We observed staff interacting with people in a kind and compassionate way and in a way that promoted people's independence.” from the report
Improved medicines practice
Staff received training and competency checks before giving medicines. Records were signed and regular medicine audits were carried out.
“Staff administered people's medicines following best practice guidelines. Medication, administration record (MAR) charts were signed after administering people's medicines.” from the report
Improved environment
The home was clean, fresh and refurbished. Adaptations included a ramp and new flooring.
“The home was clean and fresh.” from the report
Risk records were inconsistent
needs fixingRisk assessments were in place but varied in quality and detail. Some people's needs were not fully reflected in their records.
“These were variable in quality and detail but did capture the risk identified.” from the report
Management checks were incomplete
needs fixingThe home had introduced some audits, but not all areas were regularly monitored or documented. Incident analysis and action planning were incomplete.
“The manager had identified improvements but did not always document these and plan how to make those improvements in a timely way.” from the report
Staff development still needed work
needs fixingTraining had improved, but the training programme and supervision process were still being developed. Supervision did not yet consistently support reflection and development goals.
“However, supervision continued to require further development to ensure the process enabled staff to develop their knowledge, reflect on practise and set and review development goals.” from the report
- 01When will every person's risk assessment and care plan be fully reviewed and updated?
- 02How will you make sure actions from audits, incidents and staff meetings are recorded and followed up?
- 03What further training and supervision will staff receive for each person's specific support needs?
- 04How will you show that incident themes and trends are being analysed and used to prevent problems happening again?
- 05What is the current plan and timescale for completing the manager's registration process?
This was a focused inspection that looked at Safe, including infection prevention and control, while the other key question ratings were not inspected and carried over from the previous inspection. This explanation was written from the published report of 25 February 2023 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, June 2022
Bricket Wood Care Limited was rated Inadequate and placed in special measures; inspectors found serious safety, staffing and management failures.
Inspectors visited unannounced on 31 March and 7 April 2022. They spoke with people, a relative, staff and visiting professionals. They reviewed care, medicines, recruitment, training and management records.
The home was not always safe. Risk assessments were unclear or missing, staffing was sometimes too low, recruitment checks were incomplete and staff did not always recognise possible abuse. Fire safety checks, cleaning and use of protective equipment also needed improvement.
Some care was kind and people said they felt safe. Medicines were managed safely, people were supported with food and health care, and staff respected privacy and day-to-day choices. However, care plans did not always support people's individual goals, and management systems had not ensured that earlier problems were fixed.
The overall rating was Inadequate. Safe and well-led were rated Inadequate, while effective was rated Requires Improvement. Caring and responsive were not given ratings in this report. The home was placed in special measures and the provider was required to submit an action plan.
Kind interactions
Inspectors saw staff interacting with people in a kind and compassionate way. People's privacy was respected.
“We observed staff interacting with people in a kind and compassionate way. Staff protected and respected people's privacy.” from the report
Medicines
People were supported to make decisions about their medicines where possible. Staff followed systems for giving, recording and storing medicines.
“People were supported by staff who followed systems and processes to administer, record and store medicines safely.” from the report
Health and food
People had health action plans and were referred to health professionals when needed. They were involved in choosing food, shopping and planning meals.
“People were involved in choosing their food, shopping, and planning their meals.” from the report
Recent management improvement
People and staff said the recent management change had brought more stability and better support, although inspectors said improvement needed to be sustained.
“Change in management, has been so much better.” from the report
Risk and safeguarding
seriousStaff did not always recognise possible abuse or know how to reduce risks. Risk assessments did not consistently explain what staff should do, including for epilepsy and distress.
“People were not always kept safe from avoidable harm because staff were not always confident on what to look out for or recognise where people were put at risk of abuse.” from the report
Staffing and recruitment
seriousThere were times when staffing was not sufficient to support people safely. Recruitment files lacked some references, employment history and other checks.
“The service did not always have enough staff to support people safely.” from the report
Infection control and cleanliness
seriousStaff did not always wear masks as required. Inspectors also found a dirty, damaged shower tray and an earlier problem with rubbish outside.
“On the two occasions we visited the service we found staff were not wearing masks.” from the report
Person-centred care
seriousCare plans did not always reflect people's goals and aspirations. Staff sometimes completed tasks instead of encouraging independence, and respite arrangements did not always include care plans or risk assessments.
“The provider failed to ensure people had care that is person-centred and met their individual goals and aspirations.” from the report
Weak quality checks
seriousThe provider's checks did not identify several important problems, and improvement actions were not always recorded clearly or followed through.
“The manager and provider had fail to ensure the quality assurance systems were reliable and effective.” from the report
- 01What has been changed to make sure every person has a clear, current risk assessment, including for epilepsy, distress and behaviour that may put people at risk?
- 02How do you now make sure staffing levels are sufficient, including when someone is unwell or needs extra support?
- 03Have all recruitment files been completed with references, full employment histories and the required checks?
- 04How are care plans now linked to each person's goals, independence and long-term aspirations?
- 05How do you record improvement actions, check that they are completed and show that the problems found by CQC have been resolved?
This inspection focused on Right support, right care, right culture and rated Safe, Effective and Well-led; Caring and Responsive were not rated in this report. This explanation was written from the published report of 22 June 2022 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 Bricket Wood Care Limited
4 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2022Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- February 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2018GoodSafe: GoodEffective: GoodWell-led: Good
- June 2017
Registered with the Care Quality Commission on 26 June 2017.
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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At least 100 live-in carers within about an hour of Hertfordshire
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Most charge £980 to £1,300 a week. 82 can care for a couple. 12 years' experience on average.
“She handled the new situation in front of her with such professionalism and I felt I could trust her 100%.”
“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
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