During an assessment under our new approach
Date of assessment: 7 to 22 April 2026. This assessment was prompted due the length of time since the last assessment and in part due to concerns raised regarding not notifying appropriately. Since the last assessment the provider has changed.
The provider was in breach of 6 legal regulations related to person-centred care, consent to care and treatment, safe care and treatment, safeguarding, good governance, and safe and effective staffing.
The provider did not always ensure all potential risks to people were understood and managed. People’s care plans lacked guidance in relation to the potential risks associated with their diagnosed medical conditions. People’s records were not always up to date, complete or contemporaneous. Medicines were not always managed safely. Guidance was not always available to support staff with the safe management of medicines.
Where people lacked mental capacity to consent to their care and treatment, mental capacity assessments and best interest decisions had not been completed in accordance with the Mental Capacity Act 2005.
Risks associated with the environment had not always been safely managed. There was no robust oversight of delegated tasks in relation to environmental risks. Systems to ensure that staff received all training relevant to their role were not effective. The provider failed to ensure recruitment processes were operated effectively and staff were employed in line with regulatory requirements.
The provider failed to operate effective checks of care quality and safety. The provider’s governance processes did not identify the issues we found during this assessment. Quality assurance systems and processes were not effectively implemented to ensure safety and drive improvement.
We have asked the provider for an action plan in response to concerns found at this assessment in relation to person centred care, need for consent, safeguarding, and safe and effective staffing.
In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.