critical“Risks to people were not always identified, assessed, and documented. Staff did not always have access to detailed risk management information.”
medication management
1 finding
critical“Medication administration records (MAR) did not include all medicines that were being given by staff, and care plans did not always provide clear guidance.”
staff training
1 finding
critical“The provider failed to ensure staff received training relevant to their roles. A number of staff were working without the necessary training.”
governance
1 finding
critical“The provider did not always operate effective systems and processes to assess and monitor the quality and safety of the service.”
safeguarding
1 finding
moderate“Not all staff had received training in safeguarding vulnerable adults. The training matrix showed that 4 staff had not completed training in safeguarding.”
staff competency
1 finding
moderate“Medication competency assessments had been completed, although there were no records available at the time of the inspection to evidence this.”
record keeping
1 finding
moderate“People's consent to care was not recorded... Official records of lasting power of attorney were not available within care plans.”
consent capacity
1 finding
moderate“Not all staff had received training in the Mental Capacity Act. The training matrix showed that 13 staff had not completed training on the Mental Capacity Act.”
supervision appraisal
1 finding
minor“We were told regular supervisions had taken place to provide support to staff, although these had not always been recorded.”