14 April 2023 & 20 April 2023
During an inspection looking at part of the service
Our rating of this service improved. We rated it as requires improvement because:
We carried out a focused follow up inspection of Safe, Effective and Well led domains to check compliance with concerns identified in conditions imposed in February 2023 and warning notice imposed in March 2023. At this inspection we found:
- Although the provider had taken action to comply with the provisions of Regulation 12: Safe Care and Treatment, and Regulation 17: Good Governance, there were still some areas of poor practice.
- The service did not always control infection risk well. Staff did not always use equipment and control measures to protect patients, themselves and others from infection.
- The design, maintenance and use of facilities, premises and equipment did not wholly keep people safe.
- The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
- Leaders did not fully manage the priorities and issues the service faced. They did not always identify and escalate relevant risks and issues. There was no formal written strategy to turn the vision of the service into action. Not all staff could access systems to find the data they needed to understand performance, make decisions and improvements.
However:
- The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse. Staff assessed risks to patients, acted on them and kept good care records.
- The service had recently implemented systems to monitor the effectiveness of the service and made sure staff were competent.
- Leaders were visible and approachable in the service for patients and staff. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.