critical“We found the monitoring system for calls to be ineffective as no late or missed calls had been recorded even though we had been notified by people of recent occurrences.”
governance
1 finding
critical“The systems for governance were not sufficiently robust to monitor and to have identified the issues we found on inspection.”
incident learning
1 finding
moderate“No incident reports had been recorded regarding late or missed calls even though we had been notified of recent occurrences. This meant the provider did not learn when things go wrong.”
care planning
1 finding
moderate“We found the care plans were generic. They did not always contain sufficient information and guidance to make sure that care was provided in a consistent way.”
person centred care
1 finding
minor“The care plans were not presented in different ways to reflect differences in people's abilities, for example, font size, symbols or pictures.”
medication management
1 finding
moderate“My worry is about the timing, given on occasions care workers are late or are not staying for the duration of call.”