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Inspection report

Date of Inspection: 20, 24 June 2013
Date of Publication: 20 August 2013
Inspection Report published 20 August 2013 PDF


Inspection carried out on 20, 24 June 2013

During a routine inspection

We spoke with two people who use the service and both were informed about their care and treatment choices. Care records showed that people were involved with planning their care as far as they were able to be. We looked at the care records for six people who used the service. For four of those people we found that care plans and risk assessments were in place. These reflected people�s needs at the time they were produced. However, there had been no review of these care plans since July and December 2012. For two people we found no care plans were in place.

In one person�s care file we found body charts had been completed. These charts showed that the person had sustained several injuries that could not be explained. The staff had not made any notes about these injuries in the daily notes. There was no evidence that any investigation had taken place to establish how the injuries happened.

Whilst staff had been trained to safely administer people's medicines, we found gaps in recording on the medication charts and issues regarding administration and disposal of medicines, that gave us cause for concern.

We saw evidence that recruitment procedures had not been effective and that people were not always cared for, or supported by, suitably skilled and experienced or appropriate staff.

The provider's quality monitoring process was not effective and had not picked up all the areas of concern we identified during our inspection visit.