critical“One person had seizures which may require emergency medication. However, the procedures for administering this were not clear.”
moderate“An alert was not acted upon when they did not receive their tablet. The provider acknowledged the alert system was not really being monitored.”
record keeping
1 finding
moderate“We continued to find some gaps in staff and other records. Staff training records were not always clear to show who was providing training to staff.”
governance
1 finding
moderate“Although the provider had an audit system including one for medication, this was not always effective in identifying gaps in records or ensuring areas identified were acted upon.”
staff training
1 finding
minor“The induction record did not demonstrate what staff had covered and whether the provider had checked staff knowledge following completion.”
incident learning
1 finding
minor“There was no action plan in place at the time of the inspection to indicate what the provider's response had been or would be.”