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Archived: Florence House Inadequate

Reports


Inspection carried out on 10 February 2016

During a routine inspection

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 re

Inspection carried out on 17 August 2015

During an inspection to make sure that the improvements required had been made

We inspected Florence House on 17 August 2015. The home was providing a service to 26 people on the day of our visit.

We carried out an unannounced comprehensive inspection of this service on 22 and 29 May 2015. At the May inspection we found the provider was not meeting the legal requirements of five of the fundamental standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one of the standards of the CQC (Registration) Regulations 2009. After the comprehensive inspection, we took enforcement action and issued two warning notices to require the provider to meet the legal requirements of two of the fundamental standards (Regulation 11 and Regulation 12).

This inspection in August 2015 was to check they had met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to people's safe care and treatment and Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to consent to care and treatment. This report covers our findings in relation to these requirements. 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

Since May 2015 the provider had improved the system for the management of medicines. Medicine records were clear and detailed all medicines people were prescribed. However there were still improvements needed as medicines records were not always completed and balances of medicines did not always show people had received their medicines as prescribed.

Since May some staff had received training in the Mental Capacity Act 2005 (MCA) and had a clear understanding of how to support people who may lack capacity. The Mental Capacity Act 2005 protects people who can’t make some or all decisions for themselves. However, care plans did not always contain clear information relating to people's capacity and did not follow the principles of the MCA.  

We found two 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 this report.

Inspection carried out on 22 and 29 May 2015

During a routine inspection

We inspected Florence House on 22 and 29 of May 2015. Florence House provides nursing care for up to 30 older people with a range of conditions. At the time of our visit there were 22 people using the service. We carried out an unannounced visit.

People's medicines were not managed safely. Medicine records were not always accurate and there were no effective systems in place to monitor medicines coming into the home. This put people at risk of not receiving medicines as prescribed.

People's needs had been assessed and where risks were identified risk assessments were in place. However, staff were not always knowledgeable about people's needs and care was not always provided in line with care plans.

The provider was not always adhering to the principles of the Mental Capacity Act 2005 Code of Practice. The Mental Capacity Act 2005 ensures that where people lack the capacity to make decisions, any decisions made on the person's behalf are made in their best interest.

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

People and their representatives were complimentary about the care provided at the home. We saw some kind and caring interactions and people were given choice in relation to their care.

P

eople and their representatives spoke positively about the approachability of the registered manager and provider. However, there were no effective methods in place to enable the provider to gather feedback from people or their representatives. Quality assurance systems were not effective in making improvements to the service. 

Staff did not receive supervision or appraisals as required by the organisation's policy. However, staff were positive about the support they received from the management team and felt improvements were being made.

There were enough staff to meet people’s needs on the day of our inspection. People and staff had mixed views on whether there were always enough staff to meet people’s needs. The registered manager had no system to assess how many staff they needed to ensure people’s needs were met and the number of staff on duty often varied. We have made a recommendation about the assessment of staffing levels to meet people’s needs.

The provider was not always sending notifications to CQC as required by the conditions of their registration.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.