14 April 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
This was a focused inspection to check on a concern we had about the management of a specific risk associated with infection prevention and control.
This inspection was carried out by 1 inspector.
Service and service type
Florence Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Florence Court Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 4 people and 2 relatives; we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 12 staff members including the registered manager, deputy manager and 3 housekeeping staff, 5 care staff, head of maintenance and the provider’s clinical development nurse (south). We spoke with 4 external health and social care professionals.
We looked at the care records of 9 people and multiple medication records. A variety of records relating to the management of the service were reviewed. These included policies and procedures, records of accidents or incidents, staff training and quality assurance records. Following the inspection, the registered manager provided us with information and other documents to support our inspection.
14 April 2023
About the service
Florence Court Care Home (hereafter referred to as Florence Court) is a residential care home providing accommodation and personal care to up to 75 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 32 people using the service. The home provides purpose-built accommodation over 4 floors with 2 currently in use.
People’s experience of using this service and what we found
People and their relatives told us the service provided good care and people’s needs were met by caring staff.
Since October 2022 the home had experienced an infestation of flies, and this had posed risks to people’s health and wellbeing. We found these risks had not been robustly assessed and this had placed people at risk of harm.
Other risks to people’s health and wellbeing had not always been assessed to ensure action had been taken to mitigate these. Where action had been identified to support the management of risks, these had not always been completed.
Skin injuries had not always been recognised or investigated as incidents of possible abuse. Safeguarding incidents had not always been reported to the local authority or to CQC. We found no evidence that people had been abused, but the procedures in place to protect people from abuse were not robust.
People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible. However, it was not always evident decisions had been made in people's best interests in line with the Mental Capacity Act (MCA). We have made a recommendation about the application of the MCA.
The provider has acted to make improvements and was working with the local authority and others, including environmental health, to promote the safety of people using the service.
There were enough staff to meet people’s needs. People’s medicines were managed safely.
Quality assurance systems were in place but had not been effective in identifying the concerns we found. The governance approach to risk management had been limited and had not involved all stakeholders in a timely way. Decisions about people’s care when they lacked capacity were not always recorded to show their best interests had been considered. Whilst relatives we spoke with were happy with the care their relatives received, there was some dissatisfaction with the feedback from the service to concerns raised about the infestation. Not all serious incidents had been reported to the CQC as required.
The registered manager took action to address the shortfalls we found and is engaged in an improvement process, supported by the provider and local authority health and social care professionals.
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 good (published 23 December 2022).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about risks to people from infection prevention and control concerns. A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with the management of these risks, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
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.
Enforcement and Recommendations
We have identified breaches in relation to safeguarding, risk management, governance, and notification of incidents to CQC at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.