Flowerdown Care Home

Updated 21 May 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

The inspection was undertaken by a two inspectors, a specialist nurse advisor and an Expert by Experience. 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

Flowerdown Care Home 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. Flowerdown Care Home is a care home with 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 a registered manager in post, although they had recently stepped down from this role. A new manager had been appointed who had started the day before our inspection. In our report we refer to the new manager as the general manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. We used all of this information to plan our inspection.

We used the information the provider sent us in the provider information return (PIR). 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.

During the inspection

We spoke with eight people living in the home and 13 relatives. We also spoke with the registered manager, general manager, a senior general manager, a clinical development nurse, two registered nurses, the chef and six care workers. We also spoke with three healthcare professionals who worked closely with the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 21 May 2022

About the service

Flowerdown Care Home provides personal and nursing care to up to 53 people. The home is arranged over two floors and provides general nursing care but also has six beds which are commissioned by local health care services to provide end of life care to people. Some of the people using the service were living with dementia. There were 36 people using the service when we inspected.

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

Improvements were needed to ensure the safe and proper use of medicines and to the arrangements for keeping the premises clean and hygienic. There were not always sufficient staff deployed to meet people’s needs. Whilst there was no evidence that this had caused any harm, there was an inconsistent approach to managing some of the risks to people’s health and wellbeing. Staff understood their responsibility to raise concerns and report safety related incidents. People told us they felt safe at Flowerdown Care Home and the provider had appropriate policies and procedures which ensured staff had clear guidance about what they must do if they suspected abuse was taking place.

The interior of the home was not maintained or decorated to an acceptable standard. Whilst there was evidence that the provider had a suitable induction programme that prepared staff for their role, this had not always been followed in practice. Completion rates of the provider's mandatory training programme were good. Feedback about the food was generally positive and the new chef had a number of further improvements planned. Staff sought the specialist advice of a range of health care professionals and people had experienced positive outcomes regarding their health.

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 support this practice.

Overall people told us staff were kind, caring and friendly and we observed interactions where staff engaged with people in a cheerful and positive manner. People were able to attend meetings to hear about developments within the service and to share their thoughts about the care they received. Some people told us that at times they struggled to understand staff and felt that this impacted upon their ability to develop or maintain positive relationships with the care team.

To help prevent social isolation, more needed to be done to ensure each person had access to regular and meaningful activities. People and their relatives expressed confidence that they could raise any issues or concerns with the registered manager and that these would be addressed. The registered nursing team worked with local health care professionals to ensure that people had a comfortable and pain free death. The feedback about the end of life care continued to be very positive.

The inspection highlighted a number of areas where the safety of people’s care had been compromised. Records relating to people’s care and treatment were not always sufficiently personalised, complete, legible, accurate or up to date. The governance systems in place were not being effective at ensuring compliance with the fundamental standards. Whilst voicing some challenges, staff understood the values of the service and spoke of a positive culture and of the importance of providing people with person-centred care.

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

Rating at last inspection

This service was registered with us on 7 April 2020 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 28 March 2018.

Why we inspected

This was a planned inspection in order to give the service a rating under the current provider.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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, premises and equipment and good governance.

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 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.