Note30 Oct 2021
Clean environment with good infection control practices observed
Note30 Oct 2021
Complaints handled effectively in line with provider policy
Note30 Oct 2021
Discharge to Assess model reduced average stays from 55 to 23 days, promoting independence and timely hospital discharge
Note30 Oct 2021
Strong, open and approachable management team with a clear vision for service development
Note30 Oct 2021
DoLS appropriately applied for and authorised
Note30 Oct 2021
People's dignity, privacy and diverse needs were respected
Note30 Oct 2021
Staff demonstrated warmth and caring interactions; people and relatives consistently praised staff
Note30 Oct 2021
Care plans were complete, regularly reviewed and gave clear guidance to staff
Note30 Oct 2021
People received timely access to healthcare services
Note30 Oct 2021
Safe recruitment practices including DBS checks and references
Note30 Oct 2021
Sufficient staffing levels with low staff turnover resulting in an experienced team who knew people well
Note30 Oct 2021
Excellent multidisciplinary working with social workers, mental health team, occupational therapists, physiotherapists, district nurses and GPs
minorconsent_capacity30 Oct 2021
Staff did not always complete written capacity assessments or document best interest decisions.
moderategovernance30 Oct 2021
medicines audits contained a 'check competencies' section, which was always recorded as being 'complete'. However, staff who had made medicine errors had not always had their competencies reassessed.
moderateincident_learning30 Oct 2021
information was not effectively collated to allow effective identification of trends. This could mean that causes of accidents would not be known and addressed to prevent further occurrences.
moderaterecord_keeping30 Oct 2021
daily records did not always include these details...one person's daily record contained the entry, 'Lower body care cream applied'. This person was prescribed three different topical medicines.
moderatemedication_management30 Oct 2021
the temperature in the medication room frequently exceeded the maximum temperature for safe medicines storage
criticalmedication_management30 Oct 2021
Thickening agents were not stored securely...kept in an unlocked kitchen cupboard...people could access the thickening agent
criticalmedication_management30 Oct 2021
a member of staff had made five errors between October 2016 and November 2017, and had continued to administer medications with no additional training or competency assessments
criticalmedication_management30 Oct 2021
on four occasions in November 2017, as required (PRN) medicines prescribed to treat pain, were not administered to a person requiring them due to an absence of suitably trained staff