Last updated: 10 February 2026
"Good staffing levels, positive staff morale and engaging activities, but unsafe medicines management and weak audits hold it back."
Medicines were not always managed safely. Records relating to safe medicines management were at times inaccurate or missing... Due to poor management of medicines, this was a breach of Regulation 12.
Staff told us they felt valued and listened to by the management team, and morale amongst staff members was positive. They said, 'The staff team are all positive. If new staff come in, we tell them to feel comfortable and they must always ask if they need help.'
Staffing levels were maintained at the assessed level to support people safely. We observed staff being available to support people as required. A staff member told us, 'There is a lot of staff, personally we feel very comfortable. The staffing levels are good.'
Staff received a mixture of mandatory training and service user specific training, but this did not cover all the required areas. We made a recommendation about this.
Quality monitoring and audits at the service were not effective or robust. These systems had not identified shortfalls in management of medicines or ensured areas of the home were safe.
There was an activities co-ordinator who visited the service 4 days a week. People were engaged in a range of activities including arts and crafts, card games, crosswords and puzzles, movie nights and ball games.
Medication records have errors and gaps like unaccounted doses and missing instructions on when or how to give them.
A record relating to the stock count of a controlled drug was inaccurate, meaning that a dose was unaccounted for. Recorded stock counts of other medicines did not always match the stock held at the service. On occasions, medication administration records (MARS) had missed entries.
Staff training misses required areas like learning disability and autism awareness.
Staff did not receive any training in learning disability and autism awareness, which is now a requirement for all care homes. We recommend the provider provides staff training in the areas of learning disability and autism awareness.
Quality checks and audits fail to spot safety problems like uneven floors or missing safety equipment.
Health and safety audits had failed to identify the uneven floor in the first-floor bathroom or the absence of a lap belt for the bath hoist... Medicines audits were being completed, but they had not identified the issues we found relating to medicines.
AI Generated
Last inspected: August 2023
Management Quality
Well-led: Requires improvement
Direct feedback from current and former employees

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