moderate“The provider's oversight of the service had not identified some improvement was required in their risk assessments for people using paraffin based creams, protocols for 'as required' medicines”
record keeping
1 finding
moderate“Systems had not identified some care plans, located in the office, had not been updated and signed to reflect recent amendments contained in the care plans at people's homes.”
incident learning
1 finding
moderate“We found there were two incidents not notified to the CQC. We discussed these with the registered manager... they were not aware these two incidents should have been reported to us.”
medication management
1 finding
minor“Protocols were in place for medication prescribed to be taken on an 'as required' basis. Some additional detail was needed to make sure it reflected people's communication needs.”
care planning
1 finding
minor“Appropriate assessments had not been made for people who smoked... there was limited guidance for staff on how to support the person safely.”
staff training
1 finding
minor“Two of the staff training records we looked at had not been signed 'as completed'. For example, when the staff member had completed their induction, their first shadow review or their start date.”