We carried out a review of the data available to us about Florence House 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 House, you can give feedback on this service.
Florence House is a residential care home providing personal care to up to 36 people, some of whom may be living with dementia, a sensory impairment or mental ill health. The service accommodates people in a single adapted building, over two floors. At the time of the inspection 29 people were living at the service.
People’s experience of using this service and what we found
Some care records needed reviewing to ensure they were up to date and contained the most accurate information about people’s assessed needs. Care plan audits needed to be completed more frequently.
There were however other systems in place to measure and monitor the quality and safety of the service and other audits had been completed regularly. There was a clear staff structure in place and staff understood their roles and responsibilities. Staff felt valued by the management team and told us Florence House was a good place to work.
Since the last inspection, risk management had improved, and people had risk assessments in place. Staff understood how to recognise and respond to concerns of abuse and supported people to keep safe. There were enough staff to support people and there was an on-going recruitment drive. Medicines were managed in a safe way. There were effective infection prevention control measures in place. The management had improved systems and practices, demonstrating they were able to learn lessons when things went wrong and improve care for people living at Florence House.
People had their needs assessed and planned for and were supported by staff who were suitably trained to meet people’s needs. 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. Staff worked alongside other agencies and professionals to ensure people had access to healthcare as required. People had their dietary needs met.
Staff supported people in a dignified way and upheld people’s privacy. People were supported to remain as independent as possible.
People’s likes and dislikes were considered, and activities were tailored to people’s preferences. There was a complaints process in place and people and their relatives knew how to make a complaint. People were supported at the end of their life.
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 26 November 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
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 carried out an unannounced comprehensive inspection of this service on 19 October 2020. 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. The provider was required to send us monthly updates as per the conditions on their registration, which we imposed due to the breaches of legal requirements.
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Florence House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Florence House is a residential care home providing personal care and accommodation to 31 people aged
50 and over at the time of the inspection, some of which were living with dementia, a physical disability,
sensory impairment or needed support with their mental health. The service can support up to 36 people in
a single adapted building.
People’s experience of using this service and what we found
Systems were not effective at identifying areas that needed improving in a timely manner. Risks were not
always assessed, planned for and mitigated to keep people safe as assessments were not always
personalised.
The registered manager failed to ensure that people’s care records were accurate and up to date. The registered manager did not undertake audits of people’s care records.
Systems were not in place to manage medicines safely. Medication audits had been completed, however, they failed to highlight issues that were found during the inspection.
Ineffective quality assurance systems meant that the provider could not always continuously learn, improve and innovate. We found the registered manager did not complete any audits that focused on accidents and incidents in the service.
The service was clean and free of malodour. There were a number of personal protective equipment (PPE) stations positioned throughout the home and staff wore appropriate PPE.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The rating at the last inspection was requires improvement (report was published on 22 August 2019). You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Florence House on our website at www.cqc.org.uk.
Why we inspected
We received concerns in relation to people's personal care and how the service was promoting people's
safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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
remained the same.
Follow up
We identified concerns at this inspection. We will therefore aim to re-inspect this service within the published time scale for services rated requires improvement. We will continue to monitor the service through the information we receive.
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 two breaches. Regulation 12 the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely and the registered person failed to ensure the proper and safe management of medicines. Regulation 17 The registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.
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 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.
Florence House is a residential care home providing personal care and accommodation to 28 people aged 65 and over at the time of the inspection, some of which were living with dementia, a physical disability, sensory impairment or needed support with their mental health. The service can support up to 36 people in a single adapted building.
People’s experience of using this service and what we found
Systems were not effective at identifying areas that needed improving in a timely manner. Risks were not always assessed, planned for and mitigated to keep people safe as assessments were not always personalised. Medicines were not always managed safely. People were protected from the risk of cross infection, although there could on occasion be unpleasant odours. Lessons had not always been learned.
People were supported to be independent but there was mixed feedback about people’s involvement in their care. Staff did receive training, although this was in the process of being refreshed again to ensure it was consistent for all staff. People were supported to have adequate amounts of food and drink, although the lunch time experience could be more dignified for people. People had their mental capacity assessed when necessary and staff did generally ask for people’s consent. People had their needs assessed but this did not always lead to a personalised plan, but work was being undertaken to remedy this. People had access to other health professionals.
Staff were not always effectively deployed, although staff were recruited safely. People were protected from the risk of abuse by staff who understood their safeguarding responsibilities. People were not always appropriately supported with their communication needs, although plans were in place.
People were able to access some activities, but improvements were required. People were not always given the opportunity to discuss their diverse needs. People were supported at the end of their life. People and relatives felt able to complain and an appropriate procedure was in place.
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 15 February 2017). It is now rated as requires improvement, so care and support had deteriorated since our last inspection.
Why we inspected
This was a planned inspection based partly on concerns raised by the local authority and also on the previous rating. We have found evidence that the provider needs to make improvements. Please see all of the sections of the full report.
Enforcement
We have identified breaches in relation to medicines, risk management and governance systems which were not effective at identifying areas that needed improvement.
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.
Florence House provides support to older people and to older people living with dementia. The service accommodates a maximum of 36 people. On the day of our visit, 35 people lived in the home.
The home has a registered manager. 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 2014 about how the service is run.
There were enough staff on duty to meet people's needs. Staff had the skills, knowledge and experience to work well with people who lived at the home. This was due to an effective induction and on-going staff training.
Staff understood safeguarding policies and procedures, and followed people’s individual risk assessments to ensure they minimised any identified risks to people’s health and social care. Checks were carried out prior to staff starting work at Florence House to ensure their suitability to work with people in the home.
Medicines were managed well to ensure people received their prescribed medicines at the right time. Systems were in place to ensure medicines were ordered on time and stored safely in the home.
Staff respected and acted upon people’s decisions. Where people did not have capacity to make informed decisions, ‘best interest’ decisions were taken on the person’s behalf. This meant the service was adhering to the Mental Capacity Act 2005.
The registered manager met the requirements of the Deprivation of Liberty Safeguards (DoLS). The provider had referred people to the local authority for an assessment when they thought the person’s freedom was restricted and when they had been assessed as not having capacity to consent to this.
People were provided with sufficient to eat and drink and people’s individual nutrition needs were well supported. People enjoyed the food provided. Where changes in people’s health were identified, they were referred promptly to other healthcare professionals.
There were two activity workers who supported people with a range of group and individual activities. The service supported people who lived with dementia well.
People and visitors to the home were positive about the care provided by staff. During our visit we saw staff being caring to people, and supported people’s privacy and dignity.
People who lived at Florence House, their relatives, and staff, felt able to speak with management and share their views about the service. No written complaints had been received, although 12 written compliments had.
The premises and equipment people used was safe and well-maintained.
The registered manager was passionate and committed to ensuring people who lived at the home received good care and support. She was well respected by her staff team. Both people and staff felt able to go to her with any concerns or issues.
During the inspection we spoke with people who used the service who told us that they were happy with the care provided. One person we spoke with told us, "Its beautiful here they take care of you". Another person we spoke with told us, 'I've found the service to be impeccable".
We observed people being cared for in a respectful and compassionate way. People told us that staff respected their individual choices. One person told us, "We are offered the opportunity to take part in activities but they respect our rights to choose not to".
The provider had recruitment systems in place but not all of the checks required to ensure that staff were suitable to provide support to vulnerable people were within the records we looked at or had been obtained. Potentially placing people at risk of harm.
People told us that staff were caring and understood their needs. Staff told us that they received an induction and felt supported by their manager. We saw that training needs for staff were identified and systems were in place to ensure staff received regular meetings, supervision and appraisal of their performance.
People we spoke with told us they had no complaints about the care they received. The manager was able evidence that any complaints were taken seriously and investigated within agreed timescales. This meant that complaints management arrangements were satisfactory.