Archived: Florence House

Updated 20 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 11 February 2016. The inspection was carried out by three inspectors and an expert by experience (ExE). An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the visit we looked at notifications we had received. Providers tell us about important events relating to the care they provide using a notification. This enabled us to ensure we were addressing potential areas of concern. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we spoke with 13 people who used the service and seven relatives and visitors. Not everyone we met was able to tell us their experiences, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the registered manager, the provider, a nurse, the chef, the activity coordinator and six care staff. We looked at 7 people's care records, including records relating to medicines. We looked at a range of records about how the home was managed. We also spoke to the commissioners of the service.

During the inspection we spent time in the home and observed care practice and interactions between people and staff.

Updated 20 April 2016

This inspection took place on 10 and 11 February 2016 and was unannounced. Florence House is a care home providing nursing care for 30 people with a variety of conditions including people living with dementia. On the day of our inspection there were 26 people using the service.

The overall rating for this service is ‘Inadequate’ and the service is being placed into ‘Special measures’. Services in special measures will be kept under review and will be inspected again within six months.

There was 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.

We inspected the home on 22 and 29 May 2015 and followed up some of our concerns on 17 August 2015. We asked the provider to take action to make improvements in relation to the management of people's medicines, systems to protect people from harm, records relating to people who were unable to consent to care, supporting staff, quality assurance systems, security and accuracy of people's records. At this inspection we found improvements had been made in relation to the management of people's medicines, supporting people who were unable to consent to care, knowledge of staff relating to their responsibilities to identify and report concerns relating to safeguarding and support for staff.

However we found improvements had not been made in relation to the security of people's personal information, the accuracy of people's care records and systems to monitor and improve the service. We found additional concerns relating to the care and support people were receiving.

The service had not completed the actions stated on the action plan they sent to us following the May 2015 inspection. People's personal information was still stored in an unlocked office which visitors could enter freely throughout the day. People's care records contained information that did not reflect their current needs. Systems introduced to monitor the quality of people's care records had not identified these concerns.

People were not always fully assessed and care plans did not always contain accurate up to date information to ensure people's needs were met. Risk assessments were not always completed and where they were there were not always care plans in place that showed how the risks would be managed. People did not always receive care that met their needs and staff were not always clear about the specific care needs of some people. People had access to activities when the activity coordinator was on duty. However people spent long periods of time with no social interaction on the first day of our inspection when the activity coordinator had a day off.

Throughout the day we saw many caring interactions, however we found that people's rooms were not always personalised and did not have a homely feel. People's rooms were not always tidy and were left in a condition that did not promote a caring culture.

People and their relatives were positive about the registered manager and proprietor. Relatives told us they were approachable and supportive. However, there were no formal methods to communicate information to people and their relatives. The service did not have systems in place to enable people to provide feedback on the service.

Staff were supported and felt confident to raise any concerns with the registered manager or provider. Staff had regular one to one meetings with the registered manager and there were regular staff meetings where staff were encouraged to share ideas and raise any concerns.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.