Florence House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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 leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance at the service.

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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

The nominated individual for the provider was not familiar with the values, vision or strategic goals for the service. Although there was a purpose, vision and values identified in their statement of purpose, this had not been shared with the managers or staff.

There was lack of identification of the needs of the people the service supported and ensuring there were measures in place to address these needs. Health care professionals told us they felt the service was more in lines of an elderly care home than a specialist mental health home. This was due to the lack of appropriate staff training, experience, lack of independence planning and goal setting for people.

The registration of the service did not reflect all the service user bands required. We identified there were people with learning disabilities who were not covered under the registration. This also meant their needs were not being identified and met.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders did not always fully understand the context in which the service delivered care, treatment and support. There had been a number of managers in the last year after the long-standing manager left. These managers lacked experience, skills and knowledge to support consistently with confidence and clarity. The oversight of day-to-day operations and risk management was affected. The provider failed to identify this and put measures in place to address the failings.

Staff had identified and expressed concerns for the leadership as they did not feel valued or supported. They did say they were feeling more supported by the deputy manager and the nominated individual for the provider as they were approachable and felt they were being listened to which had not been in place for a while.

People did not feel they could speak up and that their voice would be heard.

Staff did not always feel safe to speak up and, when they did, they did not always feel they were being listened to. This with poor leadership led to a poor culture where staff did not feel valued and lack of communication and poor team working.

Although feedback questionnaires had been sent out to staff and people who used the service there was no evidence information from these was taken forward to improve care or team working. No feedback had been sought from other stakeholders.

The provider did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff had not been well supported, valued or felt they could raise concerns. We received feedback from staff, whose English was not their first language. There was a need for a translator to help ensure they understood their role, what was being asked of them and to support them. However, this had not been put in place. This put them and people at risk as they were unable to complete their role safely and fully.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a total lack of oversight of day-to-day management of the service. Systems were not in place that were accurate and up to date to give managers reassurance. This included for such things as DoLs authorisations, incident management and safeguarding.

Audits were not being fully completed, when they were they did not identify and take actions for areas which needed addressing, which posed a risk to people and the care they received.

There was no identification of themes or trends relating to care provided to ensure people were being supported in the best ways and risks mitigated.

We identified areas, including environmentally and relating to medication, which the management were not aware of, so no steps had been taken to mitigate the risks this posed to people.

There was no regular review of how the service was performing by the manager or the provider.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

While the service did work with external partners, health care professionals said they had identified a deterioration in some aspects of the service over the last couple of years. This was in relation to medicines management and ensuring staff had specific training in mental health conditions, so they had the skills and knowledge to support people.

They also said the senior carers appeared to know people well and had relevant experience in providing personal care. They were helpful and followed instructions left for them.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The nominated individual for the provider was open and honest with us during the assessment. They were responsive to requests for information, documents and trying to resolve issues raised.

We were concerned about the role of the nominated individual for the provider covering 3 homes but were more reassured at the appointment of consultants to help turn the service round and support them in their role.