moderate“The registered manager did not have clear protocols in place for staff to follow when PRN medicines were needed.”
moderate“these audits did not identify that staff were not always using the correct codes for administering medicines.”
care planning
2 findings
moderate“People did not always have risks to their safety assessed and planned for... there was not enough information to mitigate the risk.”
moderate“on two occasions where risk assessments for specific conditions were not completed accurately. This meant staff did not have the information to care for people in a safe way.”
record keeping
2 findings
minor“the registered manager was not documenting this correctly. They told us, this was a recording error, and they would update their practice going forward.”
minor“Senior staff were completing spot-checks but they did not always record this work. The registered manager was aware of the need to record this information.”
governance
1 finding
moderate“The registered manager did not always have effective quality assurance systems in place to monitor service delivery as they had not identified the issues we found.”
supervision appraisal
1 finding
minor“There were some gaps in staff's supervisions, however, the registered manager was addressing this when we inspected.”