CQC report explained · a residential care home
What the CQC found at Florence House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risk assessments, staffing, medicines and infection control had improved. Inspectors found enough staff and said staff understood how to recognise and respond to abuse and other safety concerns.
- Effective?
- Good
- People's needs were assessed and staff had suitable training. People received support with food, drink and healthcare, although some care plans needed updating.
- Caring?
- Good
- People and relatives spoke positively about the care. Staff supported people's dignity, privacy, independence, choices and preferred routines.
- Responsive?
- Good
- Care was tailored to people's likes, dislikes and needs. Activities reflected people's interests, visiting was supported and there was a complaints process.
- Well-led?
- Requires improvement
- Managers had improved the service and staff understood their roles, but care plan audits were not always completed. This meant some inaccurate or outdated information was not identified promptly.
What inspectors found, May 2022
Rated Good overall; inspectors found safe, kind care, but the home was not always well-led and care records needed improvement.
Inspectors carried out an unannounced comprehensive follow-up inspection on 12 April 2022. They spoke with two people living in the home, seven relatives and nine staff. They also checked care records, medicines, recruitment files and management records.
The overall rating was Good. Safe, Effective, Caring and Responsive were all rated Good. Inspectors found improvements since the previous inspection, including better risk management, safer medicines systems, enough staff and stronger infection control.
Well-led was rated Requires Improvement. Some care records were not up to date or contained incorrect details, and care plan audits were not completed often enough to find these problems. The issues were corrected during and after the inspection, but the home still needed to make further improvements.
Improved safety
Risk management had improved since the previous inspection. People had risk assessments and staff knew how to keep them safe.
“People did have specific risk assessments in place and care plans did contain information for staff to support people in an effective way.” from the report
Safe medicines
Medicines were stored, recorded and disposed of safely. Stock levels matched the administration records and there were clear instructions for medicines given when needed.
“Medicine stock levels corresponded with Medication Administration Records (MAR) and medicines were stored and disposed of in a safe way.” from the report
Kind and respectful care
People and relatives described positive relationships with staff. Staff respected privacy and dignity and encouraged people to remain independent.
“Staff told us how they respected people's dignity and promoted their independence.” from the report
Personalised activities and care
Care and activities reflected people's preferences. People were encouraged to maintain relationships and take part in activities they enjoyed.
“People received personalised care which was specific and tailored to each individual living at Florence House.” from the report
Learning from mistakes
The management had introduced processes to improve care and shared learning when things went wrong.
“When things had gone wrong, actions were taken, and learning was shared with management and staff to improve knowledge and prevent the likelihood of a reoccurrence.” from the report
Care records were not always accurate
needs fixingSome care records contained incorrect or outdated information about people's needs. Managers corrected the issues promptly, but regular checks had not always found them.
“Some care records needed reviewing to ensure they were up to date and contained the most accurate information about people's assessed needs.” from the report
Care plan audits were not frequent enough
needs fixingCare plan audits had not always been completed. As a result, they did not identify the record problems found by inspectors.
“Audits of care plans had not always been completed and therefore did not identify the shortfalls we found.” from the report
Leadership systems still needed improvement
needs fixingThe home had made substantial progress, but inspectors found that management and leadership were still inconsistent. Further improvement was needed to make sure care was always properly monitored.
“The service management and leadership was inconsistent.” from the report
- 01How often are each person's care plans reviewed, and who checks that the information is accurate?
- 02What has changed since the inspection to make sure care plan audits are completed regularly?
- 03How will you monitor the remaining improvements needed in leadership and governance?
- 04How do you make sure staff follow each person's current risk assessments, preferences and care instructions?
- 05What activities are currently available for people with different interests, communication needs or levels of independence?
This was an unannounced comprehensive follow-up inspection covering all five key questions, with particular attention to infection prevention and control and improvements required after the previous inspection. This explanation was written from the published report of 14 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2021
Rated Requires Improvement overall, with an Inadequate well-led rating and serious gaps in risk management, medicines and quality checks.
This was an unannounced focused inspection on 19 October 2020. Inspectors spoke with people, staff, relatives and the manager. They observed care and checked care records, risk assessments, medicines, accidents and incidents, training and other information.
The home was rated Requires Improvement for Safe. Inspectors found that some risks were not assessed or managed properly, care plans were out of date, and medicines were not always recorded or managed safely. There were enough staff during the visit, and the home was clean.
The home was rated Inadequate for Well-led. Managers did not have effective systems to check care quality, learn from incidents or keep records accurate. The overall rating stayed at Requires Improvement, which was also the rating at the previous inspection. The home remained in breach of Regulations 12 and 17.
Enough staff
Inspectors found enough staff to respond to people promptly and support them with meals, walking and going to the toilet.
“We found that people were supported by a sufficient number of staff.” from the report
Clean environment
The home was clean and did not have unpleasant smells. Staff were using appropriate protective equipment during the pandemic.
“The service was clean and free of malodour.” from the report
Respectful medicines support
Although medicines were not managed safely overall, inspectors saw staff supporting people respectfully when medicines were given.
“Staff supported people to take their medicines in a respectful way. Staff ensured that people's dignity was maintained when administering medication.” from the report
Risks and care plans
seriousSome care plans and risk assessments were out of date or not personal enough. This meant staff might not understand people's current needs or how to support them safely.
“People were at risk of been supported by staff who did not understand their care needs.” from the report
Weak quality monitoring
seriousThe manager and provider did not have effective checks covering care records, medicines, accidents, incidents or staff training. Problems found at the previous inspection were still present.
“Most of these areas had not been addressed and we found the same issues were ongoing.” from the report
Training gaps
needs fixingTraining was not up to date for some staff, including safeguarding and dementia awareness. The report says this meant some people were supported by staff who were not trained effectively to meet their needs.
“The providers training matrix highlighted that staff training was not up to date.” from the report
Limited feedback from people
needs fixingThe manager had not sought feedback from people about the service since the previous inspection. Relatives gave some positive feedback about communication, but this was not documented for service development.
“The registered manager told us they had not gained feedback from people since the previous inspection.” from the report
- 01What has changed since the inspection to make care plans and risk assessments accurate, personalised and up to date?
- 02How do you now check that covert medicines, refused medicines and topical creams are given, recorded and disposed of safely?
- 03What action has been taken to meet the condition imposed under Regulation 17?
- 04How do you review accidents and incidents now, and how do you make sure lessons are added to people's risk assessments?
- 05Which staff still need safeguarding, dementia awareness or other training, and when will this be completed?
This was an unannounced focused inspection of Safe and Well-led only; the other question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 2 March 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Florence House
4 rated inspections over 5 years: the service has held its Good rating throughout.
- May 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- August 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2013
Report published without a new overall rating.
- May 2012
Registered with the Care Quality Commission on 28 May 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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