The Business Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant people were not safe and not protected from avoidable harm.
The provider was in continued breach of the legal regulations relating to medicines.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety.

People were not kept safe. We identified missed calls, calls where staff were in the wrong location, and calls that were shorter than the assessed time. We also found calls where calls had been missed. The provider had not identified these issues, leaving people at risk of neglect due to missed care.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not have effective oversight of medicines management. The provider failed to make sufficient improvements to meet the requirements of the CQC warning notice served in April 2025. That warning notice stated that people did not always receive their medicines as prescribed and on time. We found a lack of accuracy in the recording of medicines and a lack of systems to ensure calls were made in a timely manner meant we were not assured there were adequate systems to ensure safe delivery of medicines.

The warning notice also stated a failure to provide accurate information and documentation for a person who was administered “as and when required” PRN medicines. During this inspection we found a PRN protocol and the care plan contained no information on what the medicines are used for or how often they can be used. There was a risk that medicines were not being administered in line with prescribed instructions placing people at harm.

The warning notice served on 2 April 2025 found the provider failed to ensure all staff had the relevant skills and competence to carry out theirroles safely. During this inspection we found sufficient improvements had not been made and concerns remained. Staff who had not had training in medicines were administering medicines and this increased the risk to people through poorly managed medicines.

The warning notice served to you on 2 April 2025 identified the providers medicines policy was not sufficient to ensure the safe management of medicines and did not contain the guidance and information for staff on applying topical creams. During this inspection we found that the medicines policy has not been suitably updated and concerns remained over the detail and accuracy of the medicines policy. We reviewed further call information from the provider for November 2025, and this continued to show inconsistencies in call times and length of calls as well as calls that do not have any record of staff attending. People continued to be at risk of not receiving their medicines,

The provider had failed to make adequate improvements with medicines continuing to be poorly managed and people continued to be exposing people to ongoing risk of harm.