critical“Medicine care plans for two people were incomplete or not started. This put people at risk of being administered the wrong medication.”
staffing levels
1 finding
critical“Staff were not always recruited in line with safer recruitment practices. One person had started work before their DBS was received and without a risk assessment.”
care planning
1 finding
critical“People did not always have care plans developed before support was provided, this meant they were at risk of receiving poor support.”
governance
1 finding
critical“The registered manager completed quality checks, audits, and supervisions but when issues were identified no actions were taken to address these.”
record keeping
1 finding
moderate“One person had been given information about another person in their care plan.”
staff training
1 finding
moderate“Several staff had not completed their refresher training for some of their training in line with company policy.”
incident learning
1 finding
moderate“The manager had recorded that one member of staff was wearing PPE incorrectly but there was no evidence that there had been an attempt to rectify this.”
communication with families
1 finding
moderate“Because English was not always the first language of carers, there was at times a difficulty in accurate communication.”
person centred care
1 finding
moderate“Staff we spoke to could not tell us what person-centred care was, despite them having attended training.”
leadership
1 finding
critical“The registered manager had not always sent appropriate notifications to the CQC. Failure to send notifications to the CQC is a breach of Regulation 18.”