8 December 2021
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 Care Act 2014.
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.
The inspection was carried out by one inspector on the first day and two inspectors on the second day.
Service and service type
The Flowers is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and the safety of the care provided.
Notice of inspection
The first day of the inspection was unannounced. The second day of the inspection was planned.
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 spoke with one person who used the service, four relatives of people who used the service and a health care professional. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and one relative about their experience of the care provided. We spoke with six members of staff including the registered manager, deputy manager, senior care workers and a care worker. 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 reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. We also reviewed a variety of records relating to the management of the service, including policies and procedures.
After the inspection
We met with the local authority and continued to seek clarification from the provider to validate evidence found.
8 December 2021
About the service
The Flowers Care Home is a residential care home providing accommodation and personal care to 23 people including people living with dementia. On the first day of the inspection there were 17 people living at the home. On the second day of the inspection there were 16 people living at the home.
People’s experience of using this service and what we found
People were not safe. They were at risk of harm because risks to their health and safety were not managed effectively. Medicines were not managed safely. People’s nutritional needs were not always met. Government guidance on the prevention and control of infection was not always followed which meant people were put at increased risk. Staff were not carrying out regular testing for COVID-19.
There were not always enough staff to keep people safe. We saw staff were kind and compassionate, but they were rushed, and routines were often task orientated. Staff were not always able to respond quickly where people needed care, support or comfort.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Most people and relatives felt people were safe and described staff as being kind and helpful.
The home and grounds were accessible.
Staff received induction, training and supervision to carry out their role. The staff team was consistent and experienced, and they knew people well and we observed warm and caring interactions. Recruitment was managed safely.
Systems to assess, monitor and improve the service had not been effective and there was a lack of management oversight to monitor day to day events and the safety of care. Audits and checks had not identified shortfalls. Opportunities to learn lessons and make improvements to the service had not been taken. Staff and relatives spoke positively about the registered manager and said they were approachable and supportive.
The provider was responsive to inspection findings and responded during and after the inspection.
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 the service was requires improvement (published 23 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
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 improvement. Please see the safe, effective 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.
The provider has taken action to mitigate the risk. They completed an action plan the day after the inspection and took immediate action to safeguard people, including increasing the staffing levels on an afternoon and night shift.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Flowers Care Home on our website at www.cqc.org.uk.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, consent to care, nutrition, staffing and good governance.
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.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.