Florence House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. Suitable arrangements were not in place to ensure all staff employed were safely recruited or received a robust induction. Staff told us they received an induction when they started work. However, there was no written evidence of a completed induction on some staff files. There was no formal record in place for lessons learnt.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew how to record accidents and incidents. The registered manager told us there had been no accidents or incidents this year. However, there had been a recent incident prior to our onsite visit with the environment which led to destruction of records. This had not been recorded and there was no formal record of lessons learnt following the incident. The registered manager completed a monthly audit for accidents and incidents however, they were unable to provide evidence of the completed audits.

There was no up-to-date record of incidents. Prior to our visit there had been an incident with the environment which led to destruction and loss of a variety of care and management records. There was no evidence this had been reported to the provider. There was no formal record of lessons learnt in place. There was no evidence of completed audits for this year.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe. One person told us, “I feel safe living here.” However, our assessment found elements of safeguarding did not meet the expected standards.

Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people including informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to.”

On the day of the assessment, we observed care records containing sensitive personal information were not securely stored. The office containing these records was not always locked during our assessment. This posed a risk that people, relative or visitors could access information increasing risks to service users’ data and personal confidential information. There was sufficient staff on duty on the day of our assessment. Throughout the visit, we observed staff were attentive to people’s needs and responded quickly to requests for support.

Safeguarding systems were in place to safeguard people from abuse. The provider had safeguarding policies and procedures in place and had a procedure for ‘whistleblowing’. The registered was aware of the reporting procedures and raised appropriate safeguards when required. Safeguarding was discussed during staff meetings. All staff had received training in abuse awareness. However, the training matrix did not include dates of when training had been completed.

A person told us they were involved in planning their care and managing risks. Care plan and risk assessments were person centred and aim to provide positive outcomes for people whilst maintaining their choice and independence. However, there was limited information in care plans to evidence people were involved in planning their care.

Staff knew the risks to people well and told us they were kept up to date if there had been any changes to risk assessments. Staff completed health and safety, including fire safety checks of the environment to help ensure risks were mitigated as far as possible.

Risks to people had been assessed and risk management plans had been put in place to help mitigate risks as far as possible. . These risks included areas such as supporting people with mobility equipment or with personal care. Each person had a personal emergency evacuation plan in place. This is used to document how people can be evacuated safely when they may have difficulty responding to a fire alarm or exiting a building unaided in the event of an emergency. The registered manager told us they completed regular audits and action plans were put in place if any risks were identified however, they were unable to provide any evidence to support this.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff we spoke with told us there were enough staff. A staff member told us, “I think there is enough staff. It is a nice place to work, we all get on really well with each other. We work well together.” The registered manager told us, “I have got a very good staff team. Everyone works well together and some of our staff have been here for many years.”

On the day of the assessment, we observed there to be sufficient staff on duty. Throughout the visit, we observed staff were attentive to people’s needs and responded quickly to requests for support. However, a lack of completed induction records meant we were unable to be assured staff were carrying out their roles and responsibilites effectively.

The registered manager had not always ensured staff were safely recruited. We saw gaps in recruitment files, such as incomplete interview notes, no contracts of employment on file and references received had not been verified or dated. Staff told us they were supported with an induction when they first started working. However, limited information was available on staff files to demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively. Staff supervisions were being carried out regularly however, not all completed supervision records had not been signed off by staff. Suitable arrangements were not in place to ensure all staff were safely employed and received a robust induction. This was a breach of Regulation 18 [Staffing] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. Disclosure and Barring service (DBS) checks were undertaken. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager told us, "Staff did not support people with medicines until they had completed the required training, and medicine competency assessments were completed." Medicine competency assessments were seen on staff files.

People were given their medicines safely and as prescribed, and it was recorded on their medicine administration record (MAR).

People had care plans and risk assessments in place which detailed what medicines they were prescribed and how they liked to be supported. The registered manager completed regular audits. There was a robust system in place to identify any shortfalls and to ensure people received their medicines safely.