critical“care plans and risk assessments were inconsistent and did not always contain clear guidance for staff to ensure they understood how to mitigate known risks.”
record keeping
1 finding
moderate“one person's home safety checklist showed a walk-in shower had been provided. However, the personal hygiene part of the care plan still stated staff should support the person with a strip wash.”
medication management
1 finding
moderate“medicines support described in care plans were not in line with current best practice guidance... 'prompting' as a category of medicine support so we could not be sure whether the prompting was part of a self-management plan”
staff competency
1 finding
moderate“Some staff we spoke with told us they had not received MCA training and they could not describe how they applied the principles of MCA in their day to day role.”
governance
1 finding
moderate“quality assurance processes in place but these were not always effective as they had not identified the issues with risk assessments and recruitment checks that we found.”
staff training
1 finding
moderate“training matrix showed that all staff had received MCA training the gaps in the staff knowledge showed the training had not been effective and further support and training was required.”
other
1 finding
critical“provider did not follow safe recruitment processes as they had not obtained a full employment history when recruiting new staff and gaps in employment were not explained.”