Last updated: 10 February 2026
"Staff feel supported with strong team spirit and good training, but poor governance and incomplete risk assessments undermine safety."
Involving people to manage risks Score:1 'systems were not always effective in assessing and managing risks... no risk assessment to cover [medical condition]... risk assessments were not comprehensive... no clear guidance of when staff needed to call for an ambulance [for seizures]'
Shared direction and culture Score:3 'Staff were very complimentary about the service... A staff told us, “Everybody works well together, the communication between the team and with management works well.”'
Safe and effective staffing Score:3 'There were enough staff employed by the service to ensure the needs of people were met and they were supported safely. People and their relatives felt there were enough staff'
Per 2022 comprehensive inspection: 'The provider had a training programme for all staff to complete... Records showed that staff had received training in a number of key areas relevant to their roles'
Governance, management and sustainability Score:1 'Robust good governance systems were not in place to ensure management had oversight of the home... provider’s systems and processes had failed to ensure risks were always identified'
Per 2022 comprehensive inspection: 'There was an activities timetable in place... two activity coordinators... people who used the service went on a trip to Southend... two birthday parties arranged recently'
Risk assessments are incomplete for things like seizures and medical conditions, leaving staff without clear guidance on keeping people safe.
We found not all risks about people’s safety were assessed... one person had a medical condition which could cause them harm... no clear guidance of when staff needed to call for an ambulance [for seizures]
No effective oversight systems, so problems like missing care plan details for epilepsy and diabetes slip through.
Robust good governance systems were not in place... provider’s systems and processes had failed to ensure risks were always identified... vital information in peoples’ care plans and risk assessment were missing regarding their epilepsy and diabetes
Staffing is just adequate with enough people on shift, but nothing extra like low agency use or easy workloads.
There were enough staff employed by the service to ensure the needs of people were met... Per 2022: 'They do have quite a lot of agency staff working in there'
AI Generated
Last inspected: July 2025
Management Quality
Well-led: Requires improvement
Direct feedback from current and former employees

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