About the service:

HSN Care [Bricket Wood] is a residential care home that was providing residential care for 11 people with learning disabilities or autistic spectrum disorder.

People’s experience of using this service:

Some of the previous breaches had now been met. This meant that people now experienced a better quality of care that was safely delivered and managed. However, further work continued to be needed to ensure that people's records were fully person centred and completed, and actions arising from the previous inspection were addressed. A breach of regulations continued to be found in relation to the management of the service. The interim manager had an action plan to address these areas.

Consent continued to require improvement to ensure it was obtained in line with legal requirements. People’s social needs and interests were an area that required improvement to ensure they were meaningful. Overall, care was found to be task focused, and not centred on the person or their positive outcomes. The provider was aware of this and was developing new approaches to deliver care in this manner.

People’s relatives told us safety and care had improved and people experienced a better standard of care. One person’s relative said, “It’s much better, much safer than before. A lot of work has gone into training staff, listening to the relatives. It’s not there yet, but I do feel I can leave [Person] in their care and they will come to no harm.”

People were kept safe from harm because assessments identified the key risks to their health and well-being. Plans were in place to respond to people’s needs and staff were aware of how to respond.

Staff received the information that they needed to provide people with care and support. Staff were aware of people’s nutritional needs.

People were supported by a sufficient number of staff who had been trained to keep people safe. Staffing was being reviewed by the interim manager to ensure people could have greater choice and control around how they spend their time to make it meaningful and purposeful.

People’s medicines were now safely managed and administered as the prescriber intended. Errors were quickly identified and lessons were now learned.

People were cared for in a dignified manner. People’s confidential information was stored securely.

People were involved in the review and development of their care.

Concerns and complaints were now responded to. People and relatives were confident to raise concerns when necessary.

People using the service and their relatives told us that the interim manager and staff were approachable and could be contacted at any time.

Governance systems were now in place to monitor the quality of care provided. Leadership was now visible across the service, and staff, health professionals and relatives were all positive about the improvements.

Rating at last inspection: Inadequate. The inspection was carried out on 01 August 2018 and the report was published on 17 October 2018. The service was placed in special measures and CQC took enforcement action. At this inspection the rating has improved and the service is no longer in special measures.

Why we inspected: This comprehensive inspection was planned based upon the findings from our previous inspection. At that inspection we found six breaches of regulations, rated the service inadequate and placed the service in special measures.

Follow up: The service is no longer in special measures. However, we will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly. We will request a copy of an action plan and will regularly review this with the management team. CQC will meet with the provider as the service has not reached a rating of ‘Good’. This will be to receive further assurance regarding the improvements and will form part of our inspection planning. We will meet with the local aut

This inspection was carried out on 01, 02 and 09 August 2018 and was unannounced. At their last inspection on 7 December 2017, the provider was found to not be meeting the standards we inspected. We rated the service overall as requires improvement. These areas of improvement were in relation to safe care and treatment, and leadership and governance. At this inspection we found that improvements had not been made and there were additional areas that continued to not meet the standards. We found breaches of regulations in relation to providing safe care, safeguarding people from harm or abuse, supporting staff, involving people in their care and overall management and governance of the service.

HSN Care (Bricket Wood) is a ‘Care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 12 people. At the time of this inspection there were 11 people living there.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service could not live as ordinary a life as any

citizen.

The service had three managers who were registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. Following the inspection the provider was intending to remove two of the registered managers as they did not manage the regulated activity.

People were not consistently supported in a safe manner. Staff were not consistently aware of how to mitigate some risks to people’s well-being. Staff were not aware of how or when to report concerns to people’s safety and not all staff were able to describe how they would identify when a person was at risk of harm or abuse. Lessons learned were not shared to reduce the likelihood of people experiencing harm of poor care. People were not consistently supported by sufficient numbers of staff, although staff recruited were of good character. People’s medicines were not managed or administered safely. Although people lived in a clean environment, care practises left people at risk of cross contamination.

Staff had received basic training however had not had training specific to the needs of people using the service. Staff told us they felt supported in their role, and some people’s relatives felt staff were sufficiently skilled. People were not consistently supported in accordance with the principles of the Mental Capacity Act 2005, and people’s verbal consent was not always sought. Staff were not consistently aware of people’s nutritional needs, and people experienced a delay in being referred for specialist healthcare support, however when referred people saw the relevant professional when needed.

People were not consistently supported by staff in a respectful and kind manner. People’s relatives felt neither they or the person using the service was central to the care they received. People’s confidential personal information was not always secure.

People were provided with limited activities that did little to support their individual hobbies, interests or preferences. There was a complaint’s process which people and their relatives knew how to use. However, people's relatives had not been confident that their concerns would be responded to.

There were systems in place to monitor the quality of the home, these were disorganised and did not effectively review the whole home in terms of the safety and quali

2-4 The Kestrels is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation for up to twelve people with a learning and or a physical disability. At the time of our inspection there were twelve people using the service.

At the last inspection on 9 March 2017 we rated the service as 'requires improvement'. At this inspection we found that the service was still rated as requires improvement under the safe and well led domain.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We received mixed feedback about how the service operated and was managed. Some feedback was extremely positive while other was less so and raised a number of concerns relating to issues across the service from the overall management, staffing, activities, food and security.

People who used the service were unable to communicate with us due to their complex medical conditions. We observed staff to support people safely during our observations and staff told us they knew how to keep people safe from risks both at the service and when they supported people out in the community. Staff received appropriate on-going training and were supported by the management team to help them carry out their roles safely and effectively.

People had detailed care plans in place and risks were assessed and kept under regular review to help ensure that risks to people’s safety were mitigated where possible.

Medicines were not consistently managed safely by staff although they had been trained. We found that staff did not always follow the correct process for administering and record keeping around medicines.

People were protected from the risk of infections by staff who ensured the environment people lived in was clean and infection control measures were in place. Staff told us they used personal protective equipment when providing personal care.

People were cared for by adequate numbers of staff who met people’s needs in a timely way. Recruitment processes were undertaken through a recruitment agency and pre-employment checks were completed by them. We found that some of the staff who worked at the service did not have a full command of the English language which made their communication with people who used the service difficult.

People's family members were involved in planning and reviewing the support they needed. People were unable to sign their own care plans to consent to their care and we saw that family members had signed them on their behalf where it was appropriate to do so. The management and some staff were aware of mental capacity assessments and how MCA principles applied in their day to day care and support of people.

People were able to participate in a range of individual activities and pursue hobbies that were of interest to them.

People's families were asked for their feedback about the service people received. Although some of the people who provided feedback told us they did not feel much changed as a result of their feedback others said that they felt 'listened to'.

People's family members and staff told us they were mostly happy with how the home was managed but some told us they felt things needed to be improved.

The registered manager and the provider carried out regular audits of the service and undertook quality assurance checks to help ensure the quality of the service was continually improved.

The inspection took place on 8 and 9 March 2017 and was unannounced.

HSN Care (Bricket Wood) is a residential care home consisting of three bungalows for 12 people with profound learning disabilities. At the time of this inspection there were seven people living at HSN Bricket Wood.

There was a manager in post who was in the process of registering with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This was the first inspection since the service was registered. We found that the service had some good systems and processes in place. However improvements were required in relation to consistent staff induction and training and the overall management oversight of the organisation.

There were some systems and processes in place to regularly monitor the quality of the care and support provided for people who used the service. Where shortfalls were identified actions were in place to make the required improvements. We found that improvements were required in the overall management and governance of the service.

People were unable to communicate with us verbally due to their complex medical conditions. However we did receive feedback from people’s relatives who told us that overall they felt their family members were kept safe living at HSN Bricket Wood. Staff understood how to keep people safe and risks to people's safety and well-being were assessed and kept under regular review. People's medicines were managed safely by staff who had received training.

People had their needs met in a timely way and we observed there were sufficient numbers of staff to support people safely. The recruitment process was being reviewed to improve what was already in place. We found some inconsistencies in the way staff were recruited and in particular in relation to information recorded for agency staff who worked at the service. The provider and manager undertook to review these with a view to bringing them up to a consistent standard as detailed in the recruitment policy and procedure. This helped to ensure that staff who were employed at the service were suitable to work in this type of care setting.

Staff received regular support from their line managers which included one to one supervision and team meetings. Staff told us they felt well supported. However staff supervision records were generic and did not include any discussion about the people who lived at the service. There were no actions recorded where issues were identified.

People received the assistance they needed to eat and drink sufficient amounts to help keep them well. People were supported to maintain their physical and mental health and were also supported to access healthcare professionals when required.

We received mixed feedback about all aspects of the service from relatives of people who used the service. This was discussed with the manager and they accepted that there were improvements to be made and were realistic about timescales by which things would be implemented.

We observed staff to be kind and caring. Staff were knowledgeable about people’s individual requirements in relation to their care and support needs and preferences. People and or their relatives had been involved in the planning of their care where they were able to and where this was appropriate.

Visitors were welcomed to the home at all times and people who lived at HSN Bricket wood went home to stay with relatives for weekends and special occasions. The home was bright and airy and people's bedrooms were personalised. There was a cheerful ambience in the lounges of the home where people were observed to be engaging with staff.

People were supported to participate in a range of personalised activiti