moderate“daily notes did not reflect the care delivered by staff. For example, a number of entries recorded care provided as 'personal care', this did not describe how and what care had been delivered”
governance
1 finding
critical“Systems to assess, monitor and mitigate risks to the health, safety and welfare of people using the service were not robust. This placed people at risk of harm. This was a breach of regulation 17”
staff competency
1 finding
critical“Staff DBS checks were for another employer...the provider had yet carried out their own criminal checks...This was a breach of Regulation 19 (Fit and proper persons employed)”
care planning
1 finding
moderate“risks related to the use of bedrails required more detail about the risk to the person should a staff member not be familiar with the person. This meant the person was at risk of harm”
safeguarding
1 finding
minor“not all staff understood whistleblowing procedures...due to the language barrier this may have been confused, they said they would review how training is delivered to staff”