critical“Care plans did not always provide accurate information on the person's current support needs...care plan indicated that care worker should provide support with hobbies and activities but there was no information on what the person's interests were”
medication management
1 finding
critical“The provider had not ensured guidance was provided for care workers to indicate when this medicine should be administered. This meant we were not assured the person was receiving PRN medicines as prescribed.”
consent capacity
1 finding
critical“The provider did not ensure a best interests decision had been recorded for each aspect of the care being provided...This was a breach of regulation 11 (Need for Consent)”
staff training
1 finding
critical“The provider could not always evidence care workers had completed the training identified as mandatory as up to date records were not maintained. This was a breach of regulation 17 (Good Governance)”
governance
1 finding
critical“The provider did not have effective and robust quality assurance processes to monitor, assess and improve the quality of services people received.”
staffing levels
1 finding
critical“The provider did not ensure the recruitment process was operated effectively. Regulation 19(2)”
supervision appraisal
1 finding
moderate“The registered manager explained they had regular supervision meetings with care workers but there were no records of these meetings.”
record keeping
1 finding
moderate“Care workers had described the person's experience in terms which were not appropriate. For example, a care worker had described the person as 'very naughty' when describing their behaviour during the day”
person centred care
1 finding
critical“Care plans had not been updated to reflect any information received from external organisations in relation to the support needs of the person.”
communication with families
1 finding
minor“The relative told us, 'I can get hold of the registered manager if I need to. If I don't call the office, I would not hear anything from them.'”
infection control
1 finding
moderate“A relative we spoke with told us when they had visited their family member's home, they saw the care workers did not always comply with best practice in relation to infection control by not always wearing masks.”