The Flowers Care Home Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.
People’s care was not consistently delivered in a person-centred way. Care plans and risk assessments were frequently inaccurate, contradictory, or out of date, limiting staff ability to provide safe, individualised care. For example, some care records contained inconsistent information about pressure area management and repositioning schedules, while others had outdated guidance relating to pressure wounds. Inaccuracies were also observed in records relating to people’s mobility, with contradictions that could lead to inappropriate support or restrictions.
Clinical records sometimes included inaccurate or irrelevant information, such as a care plan incorrectly identifying a person as having a learning disability. Communication needs were also not consistently addressed, with essential strategies not implemented for some people, limiting their ability to express choices or preferences. Essential guidance for people cared for in bed was missing in some care plans, and there was contradictory information about the use of sensor equipment for monitoring, which impacted people’s privacy and autonomy.
Observations during the inspection showed a lack of person-centred practice. People who were able to walk were not consistently supported to maintain choice or independence, with sensor mats used routinely and all people being up early in the morning regardless of their preferences.
Care was delivered in a task-focused rather than individualised way, with limited consideration of people’s choices, routines, and specific needs.
 

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.
The provider admitted people with diagnosed mental health needs without ensuring staff had received sufficient training to care for them safely. As a result, there was limited assurance staff had the knowledge or skills required to meet these individuals’ specific needs. The provider also admitted people without agreeing their care band with the Commission in advance.
Record-keeping was insufficient to demonstrate how the service managed people’s increased or challenging behaviours. This meant the service was unable to provide commissioners with the information needed to request additional funding for one-to-one support, potentially compromising the safety of both the individuals concerned and others living in the service.
Partners and external professionals reported they did not feel the service consistently worked in an open or cohesive way, which further impacted collaborative care and oversight.
The provider did not always ensure care was planned, delivered, and recorded in a way that safely met people’s individual needs, particularly for those with complex health requirements.
 

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
People were not consistently provided with information in a format that met their individual needs. Care records were written in English and kept on site, with no evidence people or their representatives were supported to access them in their first language or in a way that they could understand. Some people and relatives required interpretation due to limited English proficiency, but there was no record of any attempts to provide translated care records or supporting information.
The provider did not make key documentation, leaflets, or policies available in different languages or accessible formats for people with specific needs. Pictorial menus were not available, despite provider audits indicating that “show plates” would be used to support meal choices. Some pictorial signage was in place within the service to identify rooms such as lounges and bathrooms, but this was limited and did not sufficiently support people’s understanding or choice.
People were not consistently supported to access information in a way that enabled them to understand their care, make choices, or participate in decisions about their daily lives.
 

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.
We were not assured the provider consistently listened to, or acted on, feedback from people, relatives, or staff. Inspectors requested evidence of resident or relative meetings, and feedback questionnaires, but none were provided during or after the assessment visits.
Some relatives told us they knew who to raise concerns with and had done so in the past. However, there was no systematic process to capture or respond to feedback, and we could not see evidence any concerns raised led to improvements in the service.
Some staff reported they did not feel confident raising concerns or making suggestions for improvement, as they feared reprimand from the registered manager. Although staff meetings were held monthly and minutes recorded, these did not demonstrate active involvement of staff in decision-making or show that feedback was sought or acted upon.
People, relatives, and staff were therefore not consistently engaged in discussions about the quality of care or service improvement, and the service did not have effective systems in place to ensure their views influenced care provision.
 

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.
The service was physically accessible to all people; however, safety within the building was not consistently maintained. People had unrestricted access to all areas of the service, including staircases and bedrooms, with no locks in place to mitigate risks.
The provider admitted a mixed group of people, including both younger and older adults, people living with dementia and people with diagnosed mental health needs. The service environment and staffing arrangements were not always effective in meeting the differing needs of these groups. In particular, younger adults were not consistently supported to maintain independence or skills, and opportunities for meaningful engagement were limited due to staff capacity and the layout of the service.
These factors demonstrate while the service was accessible, it was not always able to provide safe, appropriate, or equitable care tailored to different age groups or levels of independence.
 

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.
The provider did not consistently consider or meet people’s protected characteristics in the care and support provided. The service supported people with diagnosed mental health needs, but there were no provisions in place to ensure staff had the knowledge or training to manage these needs safely and effectively.
For people from ethnic minority backgrounds, there were no measures to ensure they could communicate their needs if they did not speak English. Their preferences were not consistently considered or respected, and we did not see culturally appropriate food or activities being provided to promote inclusion and meet their individual needs.
People who were cared for in bed were not provided with opportunities for one-to-one or meaningful interactions. The only time they were engaged with by staff was during personal care or mealtimes, which limited social interaction and meaningful engagement in their day.
Overall, the provider did not consistently provide care and support that recognised and responded to people’s individual characteristics, cultural needs, or personal preferences, which impacted their inclusion, wellbeing, and quality of life.
 

People were not consistently supported to plan for future care or to achieve their individual goals.
At the start of the assessment, the person in charge stated that there was no one on end-of-life care. However, two people were cared for in bed and had anticipatory medication in the service for use when required. Inspectors were not assured that staff were suitably trained to provide safe, personalised end-of-life care, as training records were not provided during or after the assessment. The service was not accredited by any recognised end-of-life scheme, and there was no evidence of individual end-of-life care plans in place.
Beyond end-of-life care, the service did not support people to identify or work towards personal goals. There was no documentation of skills for everyday living for people who had capacity and were able-bodied, and no evidence that people’s wishes or aspirations for the future had been discussed or recorded. This limited opportunities for people to maintain independence, develop new skills, or achieve outcomes meaningful to them.
The service did not consistently plan care or support in a way which considered people’s current or future needs, aspirations, or end-of-life preferences.