Archived: Floron Residential Home for the Elderly

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.

Floron Residential Home for the Elderly is a residential care home providing accommodation and personal care support to older people and people living with dementia. The service can accommodate up to 16 people and at the time of the inspection, 16 people were living at the service. The service provided a mix of single and shared bedrooms.

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

People were supported by staff who were trained in medicines administration. However, staff’s medicines competency assessments were not recorded. Some people and staff were not satisfied with the staffing levels at nights and over weekends. Staff rotas were not clear and easy to follow. We have made a recommendation in relation to planning and deployment of staffing.

People were not always 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 always support this practice.

People’s accommodation was not always adapted to meet their care and privacy needs. People living with dementia were not offered a choice that met their needs and abilities. We have made a recommendation in relation to specialist support to meet people’s dietary needs. The provider’s quality assurance systems were not always effective.

People and relatives told us they felt safe with staff. People were supported by staff who understood risks associated with their healthcare needs. People’s risk assessments informed staff on how to provide safe care. People were safeguarded from the risk of harm, abuse and the spread of infection.

People’s needs were assessed before they moved to the service. People were supported to access ongoing healthcare services. People were supported by staff who were provided with training and supervision.

People's care plans were comprehensive, and staff knew people’s likes and dislikes. People and relatives told us staff were caring and treated them with respect. People were supported by staff to remain as independent as possible. People and relatives were satisfied with the complaints process.

People, relatives and staff told us they found the management approachable. Relatives told us they would recommend the service. The provider worked with healthcare professionals and local authorities to improve people’s wellbeing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to need for consent at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service provides accommodation and support with personal care to older people. Some of whom were living with dementia. They are registered to provide support to a maximum of 16 people and 14 people were using the service at the time of our inspection. The service provided a mix of shared and single bedrooms.

The service had a registered manager in place. 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.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place and people told us they felt safe using the service. Risk assessments provided information about how to support people in a safe manner. Medicines were managed safely.

Staff undertook an induction training programme on commencing work at the service and received on-going training after that. People were able to make choices for themselves where they had the capacity to do so and the service operated within the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

People’s needs were assessed before they began using the service. Care plans were in place which set out how to meet people’s individual needs. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the registered manager. Systems were in place to seek the views of people on the running of the service.

People who used the service said that they were happy with the variety and quality of food provided. People said they were able to make choices and staff did a good job.

The menu plan was varied and offered people a healthy balanced diet. Staff told us that although there was no alternative meal recorded on the menu plan, people were able to have something different if they did not want what was planned. Staff demonstrated a good understanding of what constituted a nutritious balanced diet and were knowledgeable about people's individual needs and preferences in relation to food and drink.

We observed staff supporting people and responding to their needs in the preparation for and during the main meal of the day.

The home was clean, tidy and adequately maintained.

Care plans viewed detailed people's care and support needs, however not all records were complete or available for inspection. Daily notes demonstrated that staff delivered care in line with the care plan.

We observed staff responding to people's needs and people that used the service told us that there were enough staff to meet their needs.

Staff were knowledgeable about the safe handling of people's medication however not all records were accurate.

The complaints procedure was adequate but would benefit from review.

Not all records were available for inspection or accurate.

There was documentary evidence that people's needs were assessed to determine their care and support needs. There was evidence risk assessments were undertaken to ensure the safety and welfare of people who used the service was maintained.

We found the provider had arrangements in place to deal with foreseeable emergencies. Staff had first aid training and were aware of the steps they should take in the event of an emergency or accident in the home.

Staff were seen interacting appropriately with people that used the service and were respectful when talking about and to people.

The provider/manager had made most of the changes which had been required from the last inspection and were working towards others. We saw records that evidenced the provider/registered manager had implemented regular quality monitoring and staff said they felt supported.

We did not assess compliance with 'care and welfare'.