26 March 2019
During a routine inspection
People’s experience of using this service:
• Systems and processes in place to protect people from risk of abuse were not robust.
• Risks to individuals were not always assessed or monitored.
• Medicines management was not based on current best practice and there was no systematic way of identifying and investigating errors in administration.
• The registered manager told us that they would organise further training for the medication officer and the introduction of auditing tools to improve medicine management.
• There were enough staff to meet people’s needs and people had regular care staff.
• There were procedures in place to help protect against employing staff who were unsuitable to work in the service.
• People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
• Care needs were not consistently assessed in people’s files.
• Staff had received the training they needed to carry out their roles. There was an induction programme in place for all new staff.
• The service worked with other healthcare professionals such as GP’s, district nurses and occupational therapists.
• People told us that the care staff were kind and caring. Staff knew people well which enabled them to provide consistent care.
• The service manager regularly rang people to review their care. However, it was not always clear in the files what had been updated as a result of these calls.
• People were supported with end of life care and staff received training as part of their induction.
• Systems and processes in place to monitor the quality of care were not robust.
• There was no system in place to support continuous improvement and learning from mistakes.
• Staff gave positive feedback about managers and said that they were open and approachable.
• The service worked well with the local community to support people’s care.
Rating at last inspection: At the last inspection the service was rated as good. (Report published 14 July 2016).
Why we inspected: This was a scheduled planned inspection based on the previous rating.
Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk