Florence House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to the need for consent.

This service scored 29 (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’s care and treatment were effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

The service did not consistently ensure assessments fully reflected people’s individual needs. We found not all needs were identified and plans put in place to meet them. For one person whose diabetes was controlled by insulin, there was no care plan in place for this and staff did not have access to the information they needed to effectively support that person’s needs

We also identified a number of people with learning disabilities where this had not been identified in their care records, how this impacted on them or the support they needed. Furthermore, people and their relatives told us they were not involved in reviewing their care needs.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

There was a lack of reference to guidance to ensure people received the correct support and care. We identified several people with learning disabilities but there was no consideration of the CQC’s Right Care, Right Support and Right Culture guidance.

Staff were not familiar with such tools as Malnutrition Universal Screening Tool (MUST) for use with people who have unplanned weight loss.

NICE guidelines for Violence and aggression: short-term management in mental health, health and community settings (NG10) had not been considered in relation to staff training for de-escalation and use of PRN medication.

NICE guidelines for managing medicines in care homes (SC1) had not been considered in relation to ensuring appropriate systems in place for people who self-administered their medication, as there was a lack of medication care plan detailing how this was being managed.

The provider did not always work well across teams and services to support people. There had been a quick turn over of managers with 3 in the last year. This had impacted on how staff and teams worked together, leading to a poor culture and low staff morale. This had been identified, and the provider was undertaking a review of the senior carers role looking at their training needs and their role and filter this down to other staff.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

We found there was a lack of guidance and person-centred information in people’s care plans and risk assessments on promoting them to live healthier lives and to manage pre-existing conditions which could impact on their health. We identified people who were diabetic or pre-diabetic with a lack of guidance on how this impacted, how staff could support them, including what healthier food options were available for the person. There was a lack of weight monitoring, as the record of weights for this year had been lost, so any concerns about people’s weight was not being monitored. There was a lack of having care plans and risk assessments for such things as smoking cessation support, pressure care monitoring and continence.

The provider did not routinely monitor people’s care and treatment to continuously improve it. We found there was a lack of monitoring of people’s health and support needs.

For example, there was no effective system in place to monitor people’s weight, and we saw that staff did not have the information they needed to support people to manage this risk. For other people whose care plans stated an assessment tool must be used to understand and analyse their behaviour, we saw these had not been consistently completed as required and where they had, they failed to provide the relevant information for analysis. In addition, for one person we saw that the provider had assessed they required increased fluid intake and that medical assistance was required; there was no evidence these actions had been completed. Furthermore, we identified that daily notes were task focused and did not provide enough detailed information to effectively monitor people’s health, wellbeing and safety.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. We found there was a lack of mental capacity assessments under the Mental Capacity Act taking place.

The mental capacity assessments in place were poor without a defined question for the decision to be based on. For example, for one person on covert medication, the decision stated, ‘medication administration’, and their capacity assessment did not cover the fact their medication was being covertly administered. Some of the answers to the functional questions were generic, talking about how their impairment impacted on them but not based on a conversation about the decision to be made.

When people lacked capacity there were no best interest’s decision in place. There was no record of who had been consulted as part of the assessment process.

Staff knew to ask people’s permission before entering their room or providing them with personal care.