Last updated: 10 February 2026
"Good training and a positive culture with supportive leaders, but poor medicines management and weak safety oversight hold it back."
concerns around the management of people's medicines and the ways in which people were involved to manage risks. We also found accidents and incidents were not effectively investigated, reported thoroughly or lessons learnt to reduce risk of recurrence
Staff were confident the registered manager had the skills, knowledge and experience to perform their role... Comments included, “[Registered manager] is a good leader” and “You get a balance between [registered manager] and [deputy manager], she is a bit more sensitive... [Deputy manager] is like a mother to us
People reported that overall, there were usually enough staff, that knew them well, available to meet their needs. Staff reported appropriate staffing levels. Comments included, “Yes generally [Enough staff] sometimes if people want to go out that can leave us short”
Overall, staff received training appropriate and relevant to their role, this included training in areas such as learning disability and autism and mental health. Staff received supervision every 2 to 3 months
The registered manager and provider had failed to adequately assess and monitor the safety and quality of care being provided. Insufficient improvements had been made following our last inspection
The registered manager described how people were supported to develop their independence... They had introduced a yoga class and transformed a room in the service into a yoga studio. Cooking classes had been introduced
Medication errors and poor accident follow-up make shifts riskier and more stressful
we continued to find concerns with the temperature monitoring of medicines, protocols for ‘when required’ (PRN) or variable dose medicines and with the disposal of medicines. When staff administered variable dose medicines, they were not recording the actual number administered
Leaders miss safety issues and fail to improve on past problems
The registered manager and provider had failed to adequately assess and monitor the safety and quality of care being provided. Insufficient improvements had been made following our last inspection to ensure medicines were safely managed
Staffing is usually enough but gets stretched for outings and nothing extra
Most of the time ok, sometime maybe not enough, can't always meet the spontaneous requests to go out. But we always make a plan.”
AI Generated
Last inspected: March 2024
Management Quality
Well-led: Requires improvement
Direct feedback from current and former employees

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