CQC report explained · a residential care home
What the CQC found at HSN Care (Bricket Wood)
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed, incidents were investigated and lessons were shared. There were enough staff to meet assessed needs, although the home was under staffing pressure after five staff resigned.
- Effective?
- Good
- People's health, nutrition and communication needs were assessed and reviewed. Staff had received training for people's specific needs, but relatives felt newer staff would benefit from more shadowing.
- Caring?
- Good
- Relatives described care as compassionate and kind. Staff respected privacy and dignity, involved people and families in decisions, and encouraged independence.
- Responsive?
- Good
- Communication plans helped staff understand people's expressions, gestures and other ways of communicating. People received personalised support and meaningful activities, although some activities such as sailing, hydrotherapy and horse riding had not yet resumed.
- Well-led?
- Good
- Leadership and governance had improved since the previous inspection. Audits, meetings and feedback systems were used to monitor care, and relatives and staff described an open and supportive culture.
What inspectors found, August 2021
Rated Good; inspectors found safe, kind and well-led care, with some plans and staffing arrangements still being developed.
This was an unannounced comprehensive inspection of the home. Inspectors observed care, met all 12 residents, spoke with managers and staff, reviewed care, medicines, recruitment and training records, and received feedback from seven relatives.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were safe, treated with kindness and supported by staff who understood their needs. The home also supported communication, family contact, activities and access to healthcare.
The rating improved from Requires improvement at the previous inspection in May 2019. The earlier breach had been addressed, and the home was no longer in breach of regulations. Inspectors noted some areas still being improved, including support for newer staff, guidance for some medicines, end of life plans and the return of activities restricted during the pandemic.
Improved safety culture
Relatives and staff reported that safety had improved. Incidents were investigated, and learning was shared to reduce the chance of problems happening again.
“The culture has changed completely since the last inspection and a good, open and safe culture is now embedded.” from the report
Person-centred support
Support plans covered people's health needs, routines, beliefs and preferences. Staff used individual communication methods to help people make choices.
“The service was person centred and developed specifically for people to be closer to their families.” from the report
Kind and respectful care
Inspectors saw staff supporting people patiently and respectfully. Staff promoted dignity, privacy and independence in everyday activities.
“Staff were considerate of people 's dignity and privacy and knew how to ensure this was maintained.” from the report
Good family involvement
Relatives received regular updates and could contribute to care reviews and service decisions. The home also had a relative consultative committee.
“Parental involvement is fully embedded into all parts of service delivery.” from the report
Strong infection control during the pandemic
Inspectors found appropriate protective measures, testing and risk assessments. The report says no resident contracted COVID-19 during the pandemic measures described.
“During the pandemic, measures taken by staff had ensured no person contracted COVID-19.” from the report
Staffing pressure
needs fixingFive staff had resigned because they refused the COVID-19 vaccine. Managers were covering gaps and recruitment was continuing, although inspectors saw shifts covered at the assessed levels.
“The service was experiencing pressures on their staffing levels.” from the report
New staff experience
needs fixingRelatives said newer staff needed more support and shadowing before working alone. The manager said the induction process would be reviewed.
“I feel that new staff would benefit for more shadowing before being left on their own.” from the report
When-needed medicines guidance
minorGuidance for medicines given only when needed was in place, but inspectors said it needed more person-centred detail. The manager was updating it.
“People had guidelines in place for staff to safely support them with 'when required' medicines, although some further development of these to ensure they are person centred is required.” from the report
End of life plans
needs fixingNo one was receiving end of life care during the inspection. Plans existed but were not fully developed, and the manager said they would be reviewed with residents and relatives.
“End of life care plans were in place but not fully developed.” from the report
- 01How many staff are currently working at the home, and are all shifts still covered at the assessed staffing levels?
- 02What extra shadowing and supervision do new staff receive before they work alone with residents?
- 03Have the 'when required' medicines guidelines now been updated to make them person-centred?
- 04What is now recorded in each resident's end of life care plan, and how are families involved?
- 05Which activities outside the home, including sailing, hydrotherapy and horse riding, have resumed?
This was an unannounced comprehensive inspection covering all five CQC questions, with the report giving both 10 August 2021 and 04 August 2021 as the inspection date. 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, May 2019
Rated Requires Improvement; care had become safer, but management, records, consent and person-centred support still needed work.
Inspectors made an unannounced comprehensive inspection visit on six days in March and April 2019. They spoke with staff, relatives and health professionals, observed care, and reviewed care and management records.
The home had improved since its previous Inadequate rating. Medicines, safeguarding, staffing, training and responses to complaints had improved. People were treated with kindness and dignity, and relatives said safety and care were better.
However, care was still often task focused rather than centred on each person. Records did not always fully describe people's needs, consent checks were incomplete, and activities and social contact were not always meaningful.
The overall rating was Requires Improvement. The home was no longer in special measures, but it breached Regulation 17 because its systems had not ensured that improvements were completed and records were comprehensive.
Improved safety
Safeguarding processes, incident reporting and learning from mistakes had improved greatly since the previous inspection. There was one open safeguarding concern compared with more than 20 previously.
“The number of safeguarding concerns reported to the local authority and CQC had significantly reduced between the last inspection to this inspection.” from the report
Safer medicines
Medicines were administered by trained staff and records were accurate. Errors were identified and followed up, although stock reconciliation still needed improvement.
“At this inspection this had improved and was no longer a breach of regulations.” from the report
Kind and respectful care
Inspectors saw staff treating people with compassion, dignity and respect. Staff understood people's preferences and ways of communicating.
“People were treated in a compassionate manner by staff who were caring and respectful to them.” from the report
Better involvement of relatives
Relatives felt more able to raise concerns and take part in discussions about improvements. The keyworker system also helped some people build more consistent relationships with staff.
“Relatives now were a very powerful voice both within the service and also with external stakeholders.” from the report
Improved health support
Staff followed professional guidance for eating and drinking, made referrals when needs changed and worked with health professionals. Staff had also been trained in areas such as autism, choking and pressure care.
“All people had been reviewed by a dietician or speech and language therapist, [SALT].” from the report
Weak management systems
seriousThe home had experienced repeated management changes and did not have a CQC-registered manager at the inspection. Improvement actions from the previous inspection were still outstanding, and care records were not comprehensive enough.
“There continued to be ongoing improvements required in relation to the management of the service, and not fulfilling the actions identified from the previous inspection.” from the report
Incomplete consent checks
needs fixingNot all mental capacity assessments and best-interest decisions had been completed. Managers were also unaware of conditions attached to two people's DoLS authorisations.
“At this inspection, although some assessments had been completed, the interim manager told us they were not all in place.” from the report
Care not always personalised
needs fixingRecords did not give enough guidance about communication, and some care was focused on completing tasks rather than people's experience and outcomes. Activities and family contact were not always meaningful or consistent.
“Overall, care was found to be task focused, and not centred on the person or their positive outcomes.” from the report
Environment and monitoring
minorSome communal areas were bland, and parts of the home needed decoration, repairs and cleaning. Weight monitoring was not always completed as often as required.
“We saw that areas of each bungalow required maintenance.” from the report
- 01What action has been completed to make care records comprehensive and person centred?
- 02How do you now complete mental capacity assessments and best-interest decisions, and how do you track conditions on DoLS authorisations?
- 03How are meaningful activities, family contact and individual communication needs planned and recorded?
- 04Who is currently the registered manager, and how has management stability been maintained since this inspection?
- 05How do you check staffing levels and reduce reliance on agency staff while maintaining consistent support?
This was an unannounced comprehensive inspection covering all five key questions and following up concerns from the previous inspection. This explanation was written from the published report of 25 May 2019 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 HSN Care (Bricket Wood)
5 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- August 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2017Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2016
Registered with the Care Quality Commission on 11 February 2016.
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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