critical“Some risk assessments had been in place for an extended period without being reviewed.”
minor“Staff made records about each visit, however these were often functional and lacking in information about peoples' overall well-being.”
care planning
1 finding
moderate“There was a lack of environmental risk assessments included in people's care plans.”
medication management
1 finding
moderate“There was a lack of information about medicines prescribed for 'as required' use.”
consent capacity
1 finding
moderate“Where care records were kept electronically there was not always strong evidence to show how people's consent to their care had been obtained.”
governance
1 finding
moderate“Some systems needed to be made more formal to ensure they were sufficiently robust should the service increase the number of people it supported.”
incident learning
1 finding
minor“The systems for ensuring lessons could be learnt were informal because the service was small and there were very few incidents.”
staff training
1 finding
moderate“There were no records of how competence and confidence had been assessed during this [induction] period.”
safeguarding
1 finding
minor“We talked with the manager about the need to improve staff confidence in this area [safeguarding awareness].”
end of life care
1 finding
minor“There was a lack of information relating to their preferences for the kind of care they wished to receive as they approached the end of their life.”