critical“Analysis of the ECM data showed persistent issues with lateness, unlogged visits, short visits, carers being logged in two locations at one time.”
medication management
1 finding
critical“Care plans contained conflicting information about the level of support people required to take their medicines.”
care planning
1 finding
moderate“Care plans contained conflicting information about people's risks and how these should be managed.”
consent capacity
1 finding
critical
“The provider had not conducted mental capacity assessments or followed a best interest process for these people in line with the MCA.”
governance
1 finding
critical“The provider did not have effective systems in place to monitor the safety and quality of the service as they had not identified the issues we found.”
staffing levels
1 finding
critical“The provider had failed to ensure that sufficient numbers of suitably qualified, skilled and experienced persons were deployed.”
staff training
1 finding
moderate“Not all staff had completed training to give them the necessary skills and knowledge to support people with a learning disability and autistic people.”
record keeping
1 finding
moderate“We were not assured that all documents we reviewed were an accurate representation of what was in place as most documents had been edited before sending.”
person centred care
1 finding
minor“Care plans did not always contain sufficient detail about people's individual food and drink preferences.”