critical“The providers/registered managers failed to operate an effective quality assurance system to ensure they assess, monitor and improve the quality and safety of the services provided. This is a breach of Regulation 17”
record keeping
1 finding
moderate“All the five care records we looked at did not have the initial assessment carried out which informed the development of the care plan.”
care planning
1 finding
moderate“The risk assessments failed to identify people's specific health and care needs, their mental health needs and medicines management.”
staff training
1 finding
moderate“Staff were not supported through individual one to one supervision meetings...supervisions had not happened as stated in their policy.”
supervision appraisal
1 finding
moderate“The provider's policy clearly stated, 'Every employee will be invited to a supervision session with their line manager or supervisor at least four times each year'. However, this had not been implemented.”
staff competency
1 finding
moderate“Robust recruitment procedures had not been followed to make sure that only suitable staff were employed. There were gaps in documentations as some files had no MOT or car insurance and no education histories.”
incident learning
1 finding
moderate“There were no audits of calls times carried out to ensure that people were getting the care and support they were assessed for.”
medication management
1 finding
moderate“Checks were not being carried out to ensure that medicines were administered appropriately, and that care staff signed medicines administration records.”