critical“There was no environmental risk assessment in place. This person's care records included an environmental risk assessment template but we noted that this was not completed.”
minor“We looked at a sample of these and noted that there was a lack of detail recorded in these daily notes.”
care planning
1 finding
critical“This person was diabetic and used a walking stick due to limited mobility. However, there was no risk assessment to help manage the associated risks related to their diabetes or mobility.”
staff training
1 finding
critical
“The lack of training programme and lack of formal induction is a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
supervision appraisal
1 finding
minor“Appraisals were not due at the time of the inspection. The nominated individual confirmed that these would be carried out in due course.”
governance
1 finding
moderate“Management were in the process of formalising checks and audits...the majority of these had not yet been fully implemented and established yet.”
incident learning
1 finding
minor“The template did not include a section for recording details about any follow up actions and lessons to be learnt.”
staffing levels
1 finding
moderate“It was not clear who had provided references for newly recruited staff...There was a lack of evidence to confirm how references had been verified to check their authenticity.”