Florfield Home

Florfield Home is a residential care home providing accommodation for persons who require nursing or personal care to a maximum of 4 people. The service provides support to people with learning disabilities. At the time of our inspection 2 people lived at Florfield Home permanently and another was staying there for respite care.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care

Staff had not always assessed the risks people faced in their daily lives. Staff did not have access to the information they needed to ensure the safe administration of medicines. People’s needs were assessed and details of this were reflected in people’s care plans. People’s cultural needs were respected. People’s goals and aspirations were not always clearly captured and it was not always clear people had been involved in reviewing their care. No one living in the service was currently at the end of their life, but some work was required to improve planning in this area.

Right Culture

The quality assurance systems needed to be improved as they had failed to identify issues we found with the premises, medicines plans and risk assessments. The staff had developed an extremely caring culture which valued the people they supported highly. People clearly trusted their staff. Staff worked well with external agencies and health professionals. Processes were in place to safeguard people from abuse.

Right Support

People were supported by a big enough staff team who had been recruited in a safe way. Staff received the training they needed to perform their roles. The home was clean and tidy. People’s rooms were personalised and their sensory and physical needs were met by the layout of the premises. People were supported with their healthcare and nutrition needs. People were supported to maintain their relationships with their families, however, activities were limited.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 3 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

We have made recommendations about involving people in reviewing their care and ensuring they have access to activities that are socially and culturally meaningful to them.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager at the service at the time of our inspection. 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 felt safe and were protected from the risk of potential abuse. Staff were knowledgeable about safeguarding procedures and knew what to do if they had concerns about the service. The staff were suitable to work in the caring profession and were recruited appropriately.

People were protected from risks to their health and wellbeing because risk assessments to guide staff were accurate and provided sufficient detail for staff to know how to manage specific risks.

Medicines were well managed and the service conducted regular audits of medicine administration.

There were enough staff to meet people’s needs and they were suitable to work in the caring profession. Staff were trained to carry out their roles and newly appointed staff were supported in their role by a robust induction period. Staff developed caring relationships with people using the service and respected their diversity and dignity.

People were supported to get enough to eat and drink and people had access to healthcare professionals.

People and their relatives were involved in planning their care and care records included information about people's likes and dislikes and promoting their independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was a positive and open culture at the service. People using the service and their relatives felt they could raise concerns if necessary.

Is the service safe?

Safeguarding procedures were in place to keep people safe and minimise the risk of abuse. Medicines were effectively and safely managed and handled appropriately.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and report on what we find. The provider sought consent from people and or their relatives in relation to their care and was reviewing procedures under the Mental Capacity Act. The manager told us that they were aware of what constituted a deprivation of liberty and were in the process of considering what implications the new Supreme Court ruling had on people who lived at Florfield.

Is the service effective?

People's needs were assessed and individual care plans included how to support people with their care. People's needs were met in line with their individual plans. People were protected from the risks of inadequate nutrition and dehydration. Staff were knowledgeable about how to meet people's needs when caring for particular individuals. Staff received training, support and supervision to help them to carry out their roles more effectively.

Is the service caring?

Relatives and professionals involved in the care of people were positive about the behaviour and attitude of staff. People's diversity, values and human rights were respected. The provider consulted people and their representatives about individual needs and wishes. These were taken into account when planning their care.

Is the service responsive?

People's care needs were reviewed and their plans updated to ensure they received a service that met their current needs. Staff worked with and followed the advice of other professionals who were involved in people's care. Staff used assessment tools to monitor the health and wellbeing of people. The provider was responsive to addressing any issues raised by family members.

Is the service well led?

The provider had a registered manager in place to manage the service to ensure they shared the legal responsibility for meeting the requirements of the law with the provider. The provider undertook regular audits to check the quality of service, including the views of family members and professionals responsible for the care of people.

People using the service indicated they were happy at Florfield Home. One relative said, 'I'm very happy my relative is here. The staff are very good. I have peace of mind knowing my relative is safe.'

We saw that people were involved in their care planning and all written information was given in an easy to read format which included pictures. A relative told us, 'the staff make day-to-day decisions about my relative; they know what is best for them. I am always consulted about anything major.'

There were suitable arrangements in place to ensure people using the service were safeguarded against the risks of abuse.

Staff received appropriate professional development and further training relevant to their job.

There were quality monitoring processes in place. People and their representatives were asked for their opinion of the service through regular meetings and a survey. People's relatives knew how to complain if they needed to.

Staff encouraged the people who used the service to live an active life, there were daily activities at the home and there was the opportunity to take part in community activities and an annual holiday.

Staff said that "the key-workers stand up for the people who use the service and care so passionately, we work like a family."