Florence Mill Care Home

Florence Mill provides nursing and/or personal care for up to 150 older adults, some of whom were living with dementia, across four individual single-story units. At the time of our inspection 122 people were living in the home.

People’s experience of using this service and what we found

People's medicines were not always managed safely. We found that improvements had been made since the previous inspection however, further improvements were identified in relation to the safe management of people’s medicines.

Whilst governance systems had been effective at identifying areas of improvements needed, they had not always been robust enough to make the necessary improvements required. The provider and registered manager recognised the need for improvements to be made and continued to make changes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they felt safe living at the service. Clear procedures were in place for the reporting of incidents, accidents and safeguarding concerns to prevent further occurrences.

People spoke positively about the support they received from the staff team and that they were treated with dignity and respect. Effective procedures were in place for the safe recruitment of staff.

Risks to people's health and wellbeing had been assessed and guidance was available for staff to support people safely. Regular checks and maintenance of the service took place to provide a safe environment for people to live.

Staff felt supported in their role and regular meetings took place to share information and opinions about the service. The service worked in partnership with other external agencies and professionals to promote and meet the needs of people living at Florence Mill.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 August 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, although improvements had been made, we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 31 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Florence Mill Care Home on our website at www.cqc.org.uk.

We have identified breaches in relation to medicines management and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Florence Mill provides nursing and/or personal care for up to 150 older adults across four individual units; some of whom were living with dementia. At the time of our inspection 109 people were living in the home.

People's experience of using the service and what we found

People’s medicines were not always managed safely. We found concerns in relation medicines for two people with diabetes and four people had not received their prescribed medicines for at least three days due to no stock. We also found issues with records relating to the monitoring of some people’s identified risks. These concerns placed people at risk of avoidable harm.

The provider had recognised staffing issues that pre-dated them taking over the service and had completed a recent recruitment drive to address this. However, this meant many of the staff were new or agency staff resulting in people receiving care that was not always person-centred or meaningful.

Whilst governance systems had been effective at identifying issues, they had not been robust enough to make the necessary improvements needed. The provider and manager had recognised the need for improvements to be made and had been working hard to implement changes.

People’s needs had been assessed in line with best practice guidance. However, the issues relating to risk monitoring records and personal hygiene records meant we could not always be certain people were receiving the care they needed.

Risks to people’s health and wellbeing had been assessed and guidance was available for staff to follow in order to support people safely. Staff had received safeguarding training and people told us they felt safe living at Florence Mill.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We received mixed feedback from people and family members about the overall care and support people received. Some felt staff were kind and caring and interacted well whilst others felt interactions were limited and not meaningful.

Staff felt the overall service and the support they received had improved since the new provider had taken over and the new manager commenced in post. People and family members had also recognised improvements but felt further changes were needed.

Rating at the last inspection

This service was registered with us on 2 February 2022 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 21 July 2021.

Why we inspected

The inspection was prompted due to concerns received about the overall standard of care people received and the clinical oversight of the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medicines, risk monitoring records and governance systems.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.