moderate“audits did not always identify gaps in people's care related documents including care plans, consent to care forms, medicines administration record charts and daily care logs”
consent capacity
1 finding
moderate“consent to care forms were not always signed by the people and the reasons for people not signing the consent forms were not recorded”
end of life care
1 finding
minor“People's end of life care wishes were not discussed and staff were not trained in end of life care.”
governance
1 finding
moderate“they did not always keep records of MAR charts and daily care logs audits. Audits did not always identify gaps and errors”
medication management
1 finding
minor“we found a few gaps in the MAR charts...staff had forgotten to sign the MAR charts”
care planning
1 finding
minor“we found one person's care plan which although had been reviewed, did not reflect changes in their needs”