Florence Road

Florence Road is registered to provide accommodation and specialist nursing care, treatment and rehabilitation for up to 57 adults who have a neurological disability. At the time of our inspection 37 people were living at Florence Road. Accommodation is divided between two buildings. Florence House is the main hub and provides care to people with acquired neurological conditions and end of life care. Westby House is within the grounds and provides transitional accommodation for people preparing to move back into the community.

Florence Road is also registered for providing personal care to people living in their own homes but had not commenced these activities so were not included in our inspection.

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

People, families and staff spoke positively about the new management structure and improvements in communication and teamwork. Quality assurance processes had been effective in identifying areas of improvement which had been actioned. Staff understood their roles and responsibilities, felt appreciated and involved in the development of the service. Scheduled meetings provided opportunities for people, families and staff teams to be involved and provided opportunities for learning. Links with other professional health and social care organisations ensured care kept up to date with best practice guidance.

People were cared for by staff who understood their role in identifying and acting upon concerns of abuse or unsafe practice. The registered manager understood their responsibilities for reporting safeguarding concerns to external agencies such as the local authority and CQC. Risks to people were regularly assessed, monitored and reviewed including risks associated with fire and infection. Actions in place to minimise avoidable harm were respectful of people’s freedoms and choices. People were cared for by staff that had been recruited safely, including checks on their suitability to work in a care setting. Medicines were managed and administered safely.

Pre-admission assessments captured people’s care needs and life style choices and were used to create an initial care and support plan. People were cared for by staff that had completed an induction and had on-going training and support that enabled them to carry out their roles effectively. People had their eating and drinking needs understood and met by both the catering and care teams. This included specialist diet plans for people who had difficulties with swallowing.

Effective working with internal and external therapists and clinical specialists enabled positive outcomes for people. People were supported to access healthcare services such as GP’s, dentists and opticians. 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.

People and their families spoke positively about the standard of care. The importance of maintaining contact with family and friends was recognised and families told us they were made very welcome. People had their communication needs understood enabling them to be involved in decisions about their day to day lives. People had their privacy, dignity and independence respected.

People received person centred care that was regularly reviewed and responded to changing needs. Social activities were varied and reflective of people’s culture, interests and abilities. People and their families felt listened to and had confidence in the complaints process. People had end of life plans that were reflective of their individual wishes and their spiritual or cultural needs.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 12 March 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

• Everyone we spoke with praised the service they received. Staff cared about the well being of people they supported and we received positive feedback from people about the kindness of staff.

• People told us they felt safe and staff were trained in how to recognise abuse and how to keep people safe. However, a safeguarding incident had not been reported to the appropriate authorities.

• There were enough appropriately qualified staff available on each shift to ensure people were cared and supported safely.

• People were supported by staff that were trained to meet their specialist and complex needs.

• Risks to people were well managed and overall medicines were managed effectively.

• People’s needs were assessed and planned for and they had access to the specialist health care professionals. People received a personalised service that reflected their preferences.

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

• People told us they thought the service was managed well and they were listened to. However, although whilst there had been a core of senior staff managing the home. There had not been a registered manager in post since October 2017. A new manager had been appointed three weeks prior to the inspection.

More information is in the full report.

About the service: Shelley Park provides specialist nursing care, treatment and rehabilitation for up to 43 adults who have a neurological disability. At the time of the inspection 25 people were living at Shelley Park.

The home is comprised of three buildings:

• Florence House, which can accommodate 37 people on pathways of care for acquired/traumatic and enduring/complex or end of life care.

• Westby House, which can accommodate six people on the transitional pathway; four people in transitional living units with shared facilities and two independent flats where people can prepare for moving on to independent living.

• Shelley House was the main reception 'hub' for the service where day care and therapy services were based.

Rating at last inspection: The service was last rated Good. Our last report was published on 5 August 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we identified some areas, which required Improvement.

Enforcement: We issued a requirement notice in relation to the shortfall in reporting a safeguarding incident to the appropriate authorities.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

• Acquired Brain Injury

• Traumatic Brain Injury

• Neurological Conditions

• Progressive Degenerative Conditions

• Physical Disability

• Learning Disability

• Behavioural Impairment

• Complex Nursing Care Needs

They offer a range of services including domiciliary care services, specialist multi-disciplinary assessment services, respite care and long term care for people with enduring conditions. People’s treatment is managed through three pathways of care: acquired/traumatic conditions, transitional (for people working towards greater independence) and enduring/complex or end of life care.

The home is comprised of three buildings:

• Florence House, which can accommodate 37 people on pathways of care for acquired/traumatic and enduring/complex or end of life care.

• Westby House, which can accommodate six people on the transitional pathway; four people in transitional living units with shared facilities and two independent flats where people can prepare for moving on to independent living.

• Shelley House, main reception 'hub' for the service where day care and therapy services are based.

The home was last inspected in January 2014 when it was found to be meeting all the required standards.

There was a registered manager at the time of the 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.

Overall, people were very positive and complimentary about the staff team and the way they cared for and supported people.

People felt safe living at the home and there were comprehensive systems to make sure that the environment and the way people were cared for and treated were safe.

Staff had been trained in safeguarding adults and were knowledgeable about the types of abuse and how to take action if they had concerns.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce likelihood of their recurrence.

The service employed a multidisciplinary team and there were sufficient staff to meet the needs of people accommodated.

Recruitment procedures were being followed to make sure that suitable, qualified staff were employed at the home.

Medicines were managed safely and administered by trained staff.

The staff team were both knowledgeable and informed about people’s care and treatment needs. There were good communication systems in place to make sure that different professionals involved in people’s care were kept up to date and worked to agreed overall objectives.

Staff were well-supported through supervision sessions with a line manager, an annual performance review and also direct supervision or external peer supervision.

Staff and the registered manager were aware of the requirements of the Mental Capacity Act 2005 and acted in people’s best interests where people lacked capacity to make specific decisions. People were consulted and gave consent to the care and treatment where they were able.

The home was compliant with the Deprivation of Liberty Safeguards with appropriate applications being made to the local authority.

People were provided with a good standard of food and their nutritional needs met.

People’s care needs had been thoroughly assessed. Comprehensive and detailed care plans had been developed to inform staff of how to care for people. The plans were person centred, covered all areas of people’s needs and were up to date and accurate.

People and staff were very positive about the standards of care provided at the home. People were treated compassionately as individuals with staff knowing people’s needs.

People were involved in planning a programme of individualised activities to keep them meaningfully occupied and as part of their rehabilitation.

There were complaint systems in place and people were aware of how to make a complaint.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed on so that people could experience continuity of care.

The home was well-led. There was a very positive, open culture in the home with staff proud of how they supported people.

There were systems in place to audit and monitor the quality of service provided to people.

The relative we spoke with said, 'I have peace of mind that my relative is getting the care they need'. The person receiving domiciliary care said their care was, 'Excellent'.

People's needs had been thoroughly assessed and care plans put in place to make sure that there was a consistent approach in meeting people's needs.

There were systems in place to manage people's medication safely.

There were effective and robust recruitment procedures in place to make sure that skilled and competent staff were employed to work at the home.

The home was well managed with systems in place to make sure that the quality of service was reviewed and responsive to people's needs.