moderate“Quality assurance checks completed by the provider were not always effective at identifying improvement or recognising shortfalls.”
care planning
1 finding
moderate“Care planning and risk assessments failed to include guidance on the signs and symptoms that the PEG site might be infected or blocked.”
staff training
1 finding
moderate“not all staff had receiving training on these key topics. Therefore, in the event of a staff member being unable to cover a care call, alternative staff had not received training”
person centred care
1 finding
minor“regular reviews of these logs failed to identify that the language used by staff was often task oriented and not person centred. For example... 'fed' and 'changed their nappy.'”
record keeping
1 finding
minor“Further work was required to ensure documentation clearly reflected the actions taken by staff to keep people safe.”