Note29 Jul 2023
The provider and management team formally informed CQC of notifiable incidents as required.
Note29 Jul 2023
Records of complaints included actions taken and how they were used to drive improvement.
Note29 Jul 2023
There were risk assessments in people's care records which identified how risks were to be mitigated.
Note29 Jul 2023
Safeguarding concerns were reported to the local authority safeguarding team when abuse was suspected.
Note29 Jul 2023
Staff received training in infection control and sufficient PPE was provided.
Note29 Jul 2023
Records showed staff were recruited safely, including DBS checks.
Note29 Jul 2023
Staff received training in the safe handling of medicines and their competency was checked.
Note29 Jul 2023
Medicine audits demonstrated checks were undertaken and where errors identified, actions were taken to reduce risks to people.
moderateleadership29 Jul 2023
There was no registered manager in post. The last registered manager deregistered in March 2023.
minorincident_learning29 Jul 2023
the oversight in the service needed improvement to ensure all actions taken were recorded.
moderatemedication_management29 Jul 2023
some records were contradictory regarding who supported people with their medicines... prompts on the electronic system for what creams were to be administered, this was not in the main body of the ca…
moderatecare_planning29 Jul 2023
there were 2 care plans being used for people... a risk that staff may not always read the 2 sets of care records and potentially miss information of how to keep people safe.
moderatecommunication_with_families29 Jul 2023
One person said they received, 'Zero,' contact from the office, 'The only time I speak to anyone from the office is when I call them.'
moderateperson_centred_care29 Jul 2023
The language and ways of describing the support provided used in some daily records was not always person centred or respectful.
moderatesupervision_appraisal29 Jul 2023
not all of the staff files included 1 to 1 staff supervision and appraisals and where these were in place, they had not followed up on the shortfalls identified in spot checks
criticalrecord_keeping29 Jul 2023
Care plans were not always kept up to date and current... one part stated there were no medical conditions recorded, and in another part listed the person's conditions.
criticalgovernance29 Jul 2023
Governance systems in place were not robust enough to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.
moderatestaff_competency29 Jul 2023
staff who undertook visits did not always know how to support them. People said they were spending the time they should be receiving care explaining to staff how to provide care
criticalstaffing_levels29 Jul 2023
67% of visits had no travel time between each visit... 11% of visits were less than half the planned duration and 41% of visits were between 50% and 90% of the planned length