We carried out a review of the data available to us about Florence Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Florence Nursing Home, you can give feedback on this service.
People’s experience of using this service and what we found
Risks to people were assessed and staff were aware of the action to take to minimise risks where they had been identified. The provider had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people’s care and support needs. Medicines were managed safely. The provider had systems for monitoring, investigating and learning from incidents and accidents. The service had procedures in place to reduce the risk of infections and COVID 19.
The registered manager recognised the importance of regularly monitoring the quality of the service. They worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people’s views into account through satisfaction surveys and spot checks and feedback from these was used to improve the service. Staff said they received good support from the registered manager and nursing team.
Rating at last inspection and update: The last rating for this service was requires improvement (7 October 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
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. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Florence Nursing Home on our website at www.cqc.org.uk.
Florence Nursing Home is a care home accommodating up to 30 older people, some of whom may be living with dementia, in one adapted building. At the time of the inspection 20 people were using the service.
People’s experience of using this service and what we found
Some risks in relation to the premises were not always identified or safely managed. The provider’s system to manage the quality and safety of the service was not consistently effective. Staff had received training, but they did not always have appropriate guidance to refer to on how to manage some possible risks in relation to Covid 19. Records of people’s care were not always accurate and up to date.
The registered manager took swift action to address the issues we found with the premises and records. They told us they would take action to address other areas of concern found.
People’s relatives told us they thought their family members were safe and well looked after. People were protected from abuse and neglect. There were enough staff to meet people’s needs and medicines were managed safely. Risks in relation to people’s health care were assessed and plans were in place to reduce risks.
We saw staff had received training on infection control, wore appropriate PPE and supported people to socially distance as far as possible. There was guidance displayed on how to manage visitors safely during the pandemic.
Staff received regular training and support to carry out their roles. 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. People’s nutritional needs were supported, and they had access to appropriate advice from health professionals.
Relatives told us they were happy with the way the home was run. However, they told us they would like more communication from the home during the pandemic, when visits were limited.
The registered manager understood their responsibilities as registered manager. Staff told us they felt well supported and worked well as a team. The provider sought people’s and their families views about the service, although meetings had not been held for some time due to the restrictions of the pandemic.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good report published (5 December 2019).
Why we inspected.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We undertook this 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 people’s nursing care needs. A decision was made for us to inspect and examine those risks.
We inspected and found areas of concern had been acted on but there was a concern with some risks in relation to the premises, the provider’s system to manage the quality and safety, and people’s records. So, we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Effective 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 coronavirus and other infection outbreaks effectively.
We have found evidence that the provider needs to make some improvements.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Florence Nursing Home on our website at www.cqc.org.uk.
Enforcement
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 assessing some risks within the premises, and aspects of the systems to monitor and review the quality and safety of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service and what we found
The home had safeguarding procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people’s care and support needs. Risks to people had been assessed to ensure their needs were safely met. People’s medicines were managed safely. The service had procedures in place to reduce the risk of infections.
People’s care and support needs were assessed when they moved into the home. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training, regular supervision and annual appraisals of their work performance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them. The registered manager was in the process of improving the environment for people living with dementia.
People and their relatives had been consulted about their care and support needs. People were supported to take part in activities that met their needs. The home had a complaints procedure in place and people and their relatives said they were confident their complaints would be listened to and acted on. There were procedures in place to make sure people had access to end of life care and support when it was required.
The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people and their relatives views into account through satisfaction surveys and meetings. There were systems in place to monitor the quality and safety of the service and any learning was identified and acted on. Staff enjoyed working at the home and said they received good support from the registered manager and deputy manager.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection.
The last rating for this service was ‘Good’ (published 18 July 2017).
Why we inspected:
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager also managed another care home run by the registered provider. The provider was in the process of recruiting a full time registered manager to run the home.
There were appropriate safeguarding adults and whistle-blowing procedures in place and staff had a clear understanding of these procedures. Procedures were in place to support people where risks to their health and welfare had been identified. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs. Medicines were managed, administered and stored safely.
The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service and supervision. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.
People’s privacy was respected. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. Care plans and risk assessments provided guidance for staff on how to support people with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.
There were appropriate arrangements in place for monitoring the quality and safety of the service that people received. The provider took into account the views of people using the service, relatives and staff through surveys. The results were analysed and action was taken to make improvements for people living at the home. The provider carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from the registered manager and the provider.