Last updated: 10 February 2026
"Staff feel supported with engaging activities from volunteers, but leadership failings, staffing shortages and training gaps hold it back."
Risks to people were not mitigated, including infection control risks. Safe medicine practices were not promoted.
Staff told us they felt supported. Supervision of staff was taking place but not at the frequency determined by the provider.
Sufficient staff were not provided to meet people's needs. This is a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff were not suitably trained, skilled and supported in their roles. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The registered manager had failed to meet their regulatory responsibilities in relation to meeting regulations to provide a safe and effective service for people.
The service used volunteers who supported people with one-to-one activities. During the inspection we saw a person involved in an art session.
No permanent manager providing strong oversight, with serious leadership failings leaving staff without proper direction.
The registered manager had failed to meet their regulatory responsibilities in relation to meeting regulations to provide a safe and effective service for people.
Not enough staff to meet needs, with long 14 to 15 hour shifts, sleep-ins, and agency workers sometimes used.
The service had not reviewed if staffing levels were appropriate to meet people's needs. As a result, staff were not suitably deployed to ensure people's needs could be met.
Big gaps in staff training and checks on skills for tasks like feeding tubes and stoma care.
The service had no record of which staff were trained and had their competencies assessed to undertake the tasks associated with stoma care, PEG feeds and flushes.
AI Generated
Last inspected: May 2023
Management Quality
Well-led: Inadequate
Direct feedback from current and former employees

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