Last updated: 9 February 2026
"Enough staff and a positive culture, but serious medicines safety gaps and lack of management audits are major concerns."
Medicines management and administration was not always safe. One person had a prescribed medicine that was not listed on the medicines administration records (MAR)... One person had been given an ointment that was out of the manufacture's expiry date... The registered persons had failed to ensure there was proper and safe management of medicines. This is a breach of Regulation 12.
Staff told us that the service was a good place to work and that there was a positive culture. Staff told us they found the management team approachable and helpful.
People, relatives and staff told us there were enough staff. The registered provider completed a dependency tool to inform on staffing numbers needed.
The registered provider and registered manager did not complete regular audits on the service to ensure it was safe and identify any areas for improvement. There was a lack of oversight for areas highlighted within this report including medicines, accident and incidents management, weights management and reviewing and updating care plans.
One relative told us they were happy with the activities on offer, 'I come during the day and they have a lot of entertainment and people doing stuff. They have a lot of it here it's a big positive... various things that I've seen them do'.
Safety checks on medication and infection control have serious gaps like missing medicine records and wrong bins for waste, putting people at risk.
One person had a prescribed medicine that was not listed on the medicines administration records (MAR). The administering staff member did not know if the person should have the medicine or not... Used PPE had been discarded in open bins, or swing bins. This increased the risk of infection.
Managers are not doing regular audits or checks, so problems with records and risks go unnoticed.
The registered provider and registered manager did not complete regular audits on the service to ensure it was safe and identify any areas for improvement. There was a lack of oversight for areas highlighted within this report including medicines, accident and incidents management.
Activities sound basic like entertainment and events with no sign of a dedicated coordinator or special programmes to make shifts more interesting.
One relative told us they were happy with the activities on offer, 'I come during the day and they have a lot of entertainment and people doing stuff. They have a lot of it here it's a big positive regardless if you want to join in or not. There are various things that I've seen them do'.
AI Generated
Last inspected: February 2023
Management Quality
Well-led: Requires improvement
Direct feedback from current and former employees

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