Henson Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider and management team fostered an open and transparent culture. Learning from incidents, concerns or when people’s anxieties were heightened was discussed constructively. One carer said about incident learning, “We sit together and help each other, we do it as a team. We read through what has been written. We discuss with manager and confirm the process and procedure. They do debriefs where the team leader will debrief at the end of the shift. Discuss what could be done differently.”

The provider had ensured that people’s relatives were informed of incidents and involved them in discussions about how to improve support. Staff were encouraged to contribute to Positive Behaviour Support (PBS) reviews and reflective practice sessions, ensuring lessons learned were shared across the team and used to improve people’s experiences and outcomes.

Training was tailored to the specific needs of the people living in the home, including communication approaches, positive behavior support and autism awareness. Staff told us they felt valued and listened to, and that the management team welcomed ideas for improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. This ensured that staff had timely access to specialist advice and reviews.

Staff made sure there was continuity of care, including when people moved between different services. The provider ensured that people had safe, structured transitions when they moved to the home. This involved assessing and observing the person in their home environment and planned visits to the home.

The home had effective and well-embedded systems and pathways in place to keep people safe while promoting their independence, rights, and choices. Staff understood the specific needs of people with learning disabilities and autistic people, and care pathways were designed to ensure support was personalised, consistent, and responsive.

The home had effective systems in place to protect people from the risk of abuse and neglect. Staff understood the specific safeguarding needs of people with learning disabilities and autistic people.

The provider had made improvements to its safeguarding processes since our previous inspection. The previous warning notice relating to safeguarding reporting had been fully met. Clear reporting pathways were now in place, and safeguarding concerns were being identified, recorded, and escalated appropriately, while information was being shared openly with relatives. One relative told us, “When there’s difficult times, he (manager) has made a point of calling me and talking things over. This gives me a lot of confidence in him.”

Staff demonstrated an understanding of their responsibilities, including how to recognise early signs of distress, respond to allegations, and report concerns both internally and to external agencies. Audits, incident reviews, and regular team discussions helped ensure learning was shared openly and consistently.

The home had effective systems in place to identify, assess, and manage risks to people’s health, safety, and wellbeing. Risk assessments were detailed, person-centred, and regularly reviewed to ensure they reflected people’s changing needs, communication styles, and preferences. Staff understood each person’s individual risks and worked to support them in a way that promoted safety while maximising independence.

Positive Behaviour Support (PBS) was well embedded across the home. Staff were trained in PBS principles and understood people’s individual triggers, early warning signs, and preferred de-escalation strategies. Behaviour support plans were clear, proactive, and focused on improving people’s quality of life rather than restricting it. This helped reduce distress, prevent incidents, and ensure responses were consistently calm, respectful, and least restrictive. One relative said, “They do this (PBS) very well. Recently he had the PBS plan and that was a joy to read because it was first thing I’ve read that was actually about (person). Yes, they know the triggers.” Another relative said of their loved ones PBS support, “The PBS team seem excellent as well. Their behaviour plans, I’m very impressed with the detail, the thought that goes into it and the expertise. They have great insight and ideas.”

Staff worked closely with families and external partners to ensure risk management plans were robust and informed by specialist guidance.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular maintenance checks of the environment were completed.

People had detailed personal evacuation plans in place. These informed staff of how to support people to evacuate the building in the event of an emergency that considered factors such as individual health needs, potential anxieties in the event of an emergency and control measures.

Layout, flooring and the general environment had been designed to support with flexibility and provide a safer and more personalised environment. Risks associated with the safety of the environment and equipment were identified and managed appropriately.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had assessed what staffing levels were required to keep people safe and to meet their individual needs, including those people who required one to one support. One professional said, “What really stood out was the great staffing level and how active everyone was.”

New staff completed a full induction and probationary period. Training had been identified and provided to staff according to the needs of the people living at Henson Court. One carer said, “We did a lot of training and shadowing. The training is very detailed. We completed Oliver McGowan training with an external trainer.” (The Oliver McGowan Mandatory Training on Learning Disability and Autism is the Government’s preferred and recommended training for health and social care staff to undertake).

Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The home had effective systems and processes in place to prevent and control infections, ensuring people lived in a clean, safe, and comfortable environment.

The home was modern, clean and hygienic throughout. Regular cleaning schedules were completed by day and night staff to ensure that the home remained consistently clean. Staff understood the importance of good infection control practices and were observed following guidance on hand hygiene, personal protective equipment (PPE), and safe food handling.

People’s care plans contained guidance for staff so that personal infections were minimised. This was done through, for example, regular health monitoring and effective application of prescribed creams. The home had procedures in place for managing outbreaks and responding to infection risks, including clear guidance for staff and regular audits to monitor compliance. Staff received up to date infection control training.

People in the home received their medicines safely and as prescribed. Staff followed clear policies procedures which ensured good practice.

Medicines were stored securely, while staff maintained safe and consistent oversight of them. The provider has assessed people’s capacity to manage their medicines and put safeguards in place when people lacked capacity. Staff encouraged people to be involved in their administration. For example, one person liked to apply their own creams and staff prompted them, and observed, so that they completed this correctly. Medicines were managed effectively when people visited their family homes. One relative said, “They gave a good system going on with recording. I’ve seen the record sheet which they have over, it’s quite rigorous.”

Staff had received training in medicines, and their competency was regularly assessed to ensure good practice and compliance. The provider focused on ensuring that medicines were prescribed and managed in line with their STOMP policy (STOMP, an initiative to support the reduction of overuse of psychotropic medication for people with learning disabilities, autism or both with psychotropic medicines). The management team held regular reviews with their PBS team to review restrictions (including medicines) and to reduce people’s need for these. One professional said, “Staff do not rely on medication to manage residents’ behaviour.” One relative told us about their loved one, “When he left home, he was addicted to (anxiety calming medication) and he’s now off of it. It was slowly reduced and that was another factor in (managing) his weight.”