moderate“There were no written protocols in place...no guidance for staff to follow in relation to when and where these creams should be administered.”
moderate“Medication administration records (MARs) were not fully completed...it was not recorded if it had been offered to the person and if the person had taken it.”
consent capacity
2 findings
moderate“There was no documentation in place to record capacity assessments and best interest decisions.”
moderate“Staff told us they had received training in the MCA, they could give us little detail on what this meant to them and how it applied to people.”
governance
2 findings
moderate“Audits took place, they failed to pick up areas for improvement...systems had not identified that the management of medicines required strengthening.”
moderate“The safeguarding policy used by the provider was not based upon the most recent local interagency policy.”
safeguarding
1 finding
critical“During the inspection a safeguarding was raised, as the inspector identified potential abuse could be occurring.”
incident learning
1 finding
minor“The provider informed us that there had been no incidents or accidents since the last inspection nor had there been any complaints, so there were no lessons that had been learned.”