Last updated: 10 February 2026
"Mixed staff feedback on culture, but poor leadership oversight, unsafe recruitment with friend references, and major safety risks hold it back."
The service was in breach of the legal regulations in relation to people’s safe care and treatment, the way people’s medicines were managed safely, risks relating to the environment, safe and effective staffing and recruitment.
Staff provided mixed feedback about the management of the service. One staff told us they felt meetings were only called if something had gone wrong and carers were blamed and not listened to.
The provider did not make sure there were enough qualified, skilled and experienced staff. Staff were not recruited safely. Records showed some staff references were from their friends rather than previous employers.
Some of the staff we spoke with had a poor understanding of safeguarding people. They could not describe how to recognise neglect or abuse or who to escalate any concerns to outside of the service.
Leaders did not have the skills, knowledge, experience and credibility to lead effectively. The service had not sustained any significant improvement, and people did not receive safe care and treatment.
1 person told us they were told staff would support them to go out and do activities outside of the service, but this had not happened since they had moved in.
Managers fail to oversee the home properly and miss major problems like unsafe care.
The provider’s oversight of the service was poor; audits and checks did not identify any of the significant concerns we found at this inspection which left people at risk of harm.
Staff get hired without proper checks, using references from friends and missing criminal record proof.
Staff were not recruited safely. Records showed some staff references were from their friends rather than previous employers, identification and right to works checks were out of date, and DBS checks were stated as having been competed but there was no evidence of the result of the checks.
Safety is poor with unsafe medicine use like sedatives without plans and unmanaged risks like wounds and constipation.
There was no PRN protocol or guidance for staff to instruct them when this medicine should be administered... Some people had wounds but there were no care plans or risk assessments in place... Some people were at risk of constipation.
AI Generated
Last inspected: September 2025
Management Quality
Well-led: Inadequate
Direct feedback from current and former employees

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