critical“one person was at risk of skin breakdown. There was no guidance in place for staff to follow to inform them what to do if the person's skin became sore or red”
moderate“person's care plan did not contain manual handling guidance for staff. There was no falls risk assessment to advise staff how to support them, and no skin integrity care plan.”
record keeping
1 finding
critical“The provider failed to maintain accurate records in respect of each service user. This was a breach of Regulation 17 of the Health and Social Care Act 2008”
governance
1 finding
critical
“The provider failed to monitor and mitigate the risks relating to the health, safety and welfare of service users. This was a breach of Regulation 17”