minor“we found some instances where risk assessments did not always contain enough detail. For example, use of a profile bed. The risk assessment did not detail how this should be adjusted”
medication management
1 finding
minor“For one person staff were applying prescribed moisturising skin creams but no protocol was in place for staff to know how these should be applied.”
record keeping
1 finding
minor“Some care plans needed to provide more detail about people's preferences. Staff knew people very well...and this meant less detail had been put into the plans.”
governance
1 finding
moderate“The provider had not always had good oversight of the service...The registered manager used an electronic system for auditing, but this did not have enough detail to support quality improvement.”
staff competency
1 finding
minor“when the registered manager had taken on staff they knew from a previous role they had failed to get a previous employers reference for these individuals because they knew them.”