Archived: Floron Residential Home for the Elderly

Updated 24 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience who made calls to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Floron Residential Home for the Elderly is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Floron Residential Home for the Elderly is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed staff interaction with people during the site visit, including medicine administration and people’s mealtime experience. We spoke with the provider, deputy manager, team leader, technical liaison administrator assistant (responsible for audits and management of on-line records), four care staff, one domestic member of staff and the cook. We also spoke with eight people who lived at the service and seven relatives about people’s experience of living at the service. We reviewed documentation related to incidents and accidents, building safety checks, staff rotas, monthly menus, health and safety audits, policies and procedures, management action plan and information related to consent and deprivation of liberty safeguards (DoLS) authorisations.

Updated 24 August 2022

About the service

Floron Residential Home for the Elderly is a residential care home providing accommodation and personal care for up to 16 older people, including people living with dementia. At the time of the inspection 16 people were living at the service. The service is set in an adapted house over two floors.

People’s experience of using this service and what we found

We found concerns related to the management oversight of the service, recruitment, staffing levels, risk management, condition of the building, infection control and prevention person-centred care, dignity and respect and lack of activities. This put people at risk of harm and also had an impact on their quality of life and well-being. Records related to people who lived at the service and staff were not always accurate and up to date. This meant we were not assured care delivered was in line with people’s plan of care.

There was ineffective risk management and oversight of people's care. Infection prevention and control practices were not robustly implemented across the service, leaving people at risk. Risks were not always fully assessed, leaving people at risk of receiving inappropriate care. Daily care records lacked details about the care provided to people. There was a risk people may not receive consistent safe care due to low staff numbers and poor record keeping.

There were insufficient numbers of appropriately trained staff deployed to ensure people's safety and wellbeing. Records showed staffing levels were not sufficient to meet people’s needs. Relatives told us they felt the service would benefit from having more staff.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s preferences for care, privacy and dignity was not always respected.

The premises required several improvements to ensure the health and safety of people using the service. There was a lack of meaningful activities to maintain people’s health and wellbeing.

We received mixed feedback from people using the service and relatives about the quality of the service. Whilst most relatives felt the care provided to people was good and would recommend the service, others felt there were areas for improvement, such as the condition of the building and accommodating people’s choices.

Rating at last inspection

The last rating for this service was requires improvement (published 18 September 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that provider seek advice from a reputable source, in relation to planning staff rotas and deploying staff to meet people's needs safely and in relation to supporting the individual nutrition and hydration needs of people living with dementia. At this inspection we found the provider had not acted on all recommendations and improvements were required.

Why we inspected

We undertook a focused inspection to follow up on specific concerns which we had received about the service which included concerns about staffing level, governance and oversight, lack of activities, condition of the building and furniture, incident and accident reporting and poor record keeping. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with management oversight, staffing levels, disrepairs, notifications not submitted to CQC, lack of activities, person-centred care and dignity and respect when providing some care, so we widened the scope of the inspection to a comprehensive inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed

We have identified breaches in relation to safe care and treatment , staffing, recruitment, need for consent, person-centred care, dignity and respect, condition of the premises, and management oversight at this inspection. We have made recommendations in relation to staff supervision and training and supporting people with their nutritional needs and choices.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.