critical“One person's MAR showed they ran out of medicines over a 3 week period commencing mid-June 2023. This person had a health risk which they were prescribed medicines for.”
moderate“Staff received medication training, but did not have their competency checked. Medication audits were not being completed prior to our inspection.”
consent capacity
1 finding
critical“Capacity and consent had not been assessed and recorded. Best interests decisions were missing.”
care planning
1 finding
critical“Care plans had not been reviewed since April 2022 when services started.”
governance
1 finding
critical“Care plan audits and spot checks were said to have been carried out, but the provider did not have this evidence to show us.”
record keeping
1 finding
moderate“Contemporaneous care records had not been maintained. A mental health care plan for one person had not been completed.”
supervision appraisal
1 finding
moderate“The provider told us supervision support had not been provided to care workers.”
safeguarding
1 finding
critical“The provider discussed an allegation of abuse from late 2022 which was not reported to us.”
staff competency
1 finding
moderate“Staff received medication training, but did not have their competency checked. Annual competency checks are best practice.”
infection control
1 finding
minor“One staff member told us they were unsure if they were using the correct cleaning product for specific events.”