critical“The provider's governance systems to record, assess and monitor the quality of service provided to people were ineffective.”
record keeping
1 finding
critical“Daily care notes were not being recorded. This meant there were no records to document the care and support being delivered to people using the service.”
leadership
1 finding
critical“In order to comply with regulatory requirements a registered manager was required to be in post. However, a registered manager had not been in place for over 12 months.”
care planning
1 finding
moderate“People's health conditions, which impacted upon their health and wellbeing, were not always clearly documented in care plans.”
staff training
1 finding
moderate“There were gaps in staff training such as autism and epilepsy training. In addition, some training had expired, therefore some staff required refresher training.”
supervision appraisal
1 finding
moderate“Formal supervisions were not taking place with staff, this meant there were no records evidencing staff were discussing concerns or reviewing their practice with the manager.”
medication management
1 finding
moderate“Medicines were administered by suitably trained staff, although we could not be assured medicine administration was being monitored.”
incident learning
1 finding
moderate“Incidents were documented, but incident analysis and staff debriefs were not recorded. This meant the provider could not demonstrate they were implementing strategies to support people.”
consent capacity
1 finding
moderate“One person required Lasting Power of Attorney (LPA) protections. However, their care plan did not detail who held this responsibility and there was no reference the LPA documentation had been viewed.”