critical“Care records did not always contain the relevant information, guidance or support for staff to follow. Medical / health conditions were often recorded, however there was little or no information about the surrounding risks”
governance
1 finding
critical“Quality monitoring and governance measures were not always effectively in place. This was a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
missed or late visits
1 finding
moderate“People had not received support at the agreed times and the system did not have the ability to identify and monitor variations in call times.”
medication management
1 finding
moderate“We identified one medication administration concern; we were not assured that medication administration instructions had been followed safely.”
record keeping
1 finding
moderate“The majority of care records contained personalised information...however, the level of information was not always consistent across all care records we reviewed.”
incident learning
1 finding
moderate“The areas of risk and quality performance we identified during the inspection had not been identified during any quality reviews the provider had conducted.”
consent capacity
1 finding
minor“We did identify one care record where the person had not provided the necessary consent. This was brought to the attention of the manager at the time of the inspection.”