- Residential substance misuse service
Archived: Francis House
All Inspections
06/06/2018
During an inspection looking at part of the service
We found the following areas of good practice:
- Francis House had thorough assessments and appropriate procedures in place to manage the risk of fire.
- The service had enough staff to care for the number of patients and their level of need. Overnight, a sleeping duty system was in place, with two members of staff available to patients within the building.
- Staff assessed both the physical and mental health needs of clients. Clients were supported to access local services to address any ongoing physical health concerns.• All staff were trained in the Mental Capacity Act, they understood the principles and were aware of how to advice if required.
However, we also found the following issues that the service provider needs to improve:
- Some clients did not know how to get support from staff overnight. They told us they did not know the process for waking the sleeping staff. We raised this with the provider during our visit. However, staffing numbers were sufficient to provide safe care.
- Therapeutic interventions did not follow National Institute for Health and Care Excellence guidance in terms of frequency or duration of therapy.
18 April 2017
During an inspection looking at part of the service
In our comprehensive inspection in November 2016, we were concerned that as clients were becoming older there were increasing potential safety risks for people using this service. There were no staff after 10pm at night and some clients smoked in their rooms, which meant there were fire risks. Clients could contact on call staff in a neighbouring building but some had mobility issues, which meant there was a risk of falls and staff not being available to help.
We raised our concerns with Devon and Somerset Fire and Rescue Service who carried out an audit in February 2017 and issued an enforcement notice. The fire service required staffing to be in place during the night until fire safety had been signed off by Devon and Somerset Fire and Rescue Service, including a new fire alarm system.
The purpose of this unannounced inspection was to check if staffing was provided at night for the safety of the clients. We did not assess any improvements made to the environment during this visit.
On this inspection (18 April 2017), we found night staff in place. Staff on the late shift worked until 10pm, and additional sleep-in staffing (10pm to 8am) had been provided during the night in the residential building since February 2017. This was shared between four staff on a rota and was reported as working well. Staff had been provided with sleeping quarters in the same building as the client’s rooms (residential building), Staff used this from 10pm to 8am. This meant there was a member of staff available if there was an emergency. Additional staff could be called via an on call phone or radio to other staff that lived elsewhere on site.
We spoke with the staff member on duty and looked at the fire evacuation plan and the residential building (known as Clare House). The staff member showed us the progress that had been made with the new fire alarm systems. The evacuation plan was up to date and identified client’s rooms. The staff member on duty knew which clients had mobility problems and explained how they were sited on the ground floor.
7 - 8 November 2016
During a routine inspection
We do not currently rate independent standalone substance misuse services.
We found the following issues that the service provider needs to improve:
- Francis House did not provide a clear model of care that met all the needs of the male clients using the service. The service was registered to provide accommodation for clients who needed residential and personal care and clients who were recovering from substance abuse.
- Most of the clients had lived at Francis House for a number of years. Some as they were getting older were experiencing a reduction in their mobility and memory loss. For these clients there were concerns that the lack of night time staffing and the environment of the home was potentially unsafe and did not meet their needs.
- Others were accessing the service for a shorter period as part of their recovery from substance misuse. For these clients we did not see a structured programme in line with best practice to support their recovery. In addition, there was not a clear programme of rehabilitation to prepare clients for greater independence.
- Medication was secondary dispensed which meant that clients did not always see medicines in their original pack. This could have led to accidental errors. The service took immediate action to change their processes and we received confirmation that this had taken place following the inspection.
- There were conflicts of interest if staff needed to report concerns or investigate complaints or incidents due to family members both running and working in the service. A freelance consultant in health and social care, who provided additional governance and support, was available but at the time of the inspection, there was not yet evidence that it was not always sufficient or timely.
- The registered manager, whilst living on site was not well enough to participate in the inspection or be interviewed. The provider had not notified the CQC of the providers’ health problems.
However:
- Clients were treated with kindness and staff were caring.
- Morale was high amongst the staff team and staff were enthusiastic about their roles. Staff all described good support from the assistant manager.
- Francis House supported long-term clients education and learning with outside organisations. For example, one client had completed a fine arts degree and others had attended further and higher education courses.
- Clients had up to date care plans and clients felt involved in their care, this included some client’s wishes not to be involved in groups that the service offered.
- Systems were in place to ensure regular mandatory training and supervision. Staff were trained and demonstrated an understanding of the Mental Capacity Act.
- Most clients were very positive about the service and felt that staff consistently treated them with respect and dignity.
27 October 2013
During a routine inspection
We inspected the home on a Sunday. We were able to speak at length, and in private, with eleven of the fifteen people who were resident at the time of the inspection. The majority of people were very happy with the care and support they received. We received a concern about care practice, which prior to the inspection, we referred to Devon County Council, under their safeguarding procedures. At the time of publication this matter has now closed.
Typical comments we received about people's experiences included 'It is great, one of the best places I have lived,' 'If you want to recover from alcohol this is the place to come,' and 'I have been happy here. I have felt safe.' Some people expressed minor concerns about there not being enough structure (although others saw this as a positive) and some people said there could be more staff available.
The people we spoke with were satisfied with the accommodation and the food. The majority of people said that staff were supportive and responsive to their needs.
The home was furnished and decorated to a satisfactory standard. Health and safety standards were adequate although some additional work was required. Quality Assurance systems were satisfactory.
During an inspection looking at part of the service
We did not speak to anyone using this service. The provider sent us a satisfactory improvement plan that showed us the actions taken to improve the procedures and understanding of the legal requirements around notifications. Written evidence was sent to the commission, showing that an external consultant had also looked at the procedures. Additional training had been provided for key staff managing incidents so that they understood how to determine whether the commission needed to be notified or not.
At the last inspection, we had no other concerns with regard to the management of incidents that might require notification to be made. We did, however highlight that some improvements could be made to improve security of medicines and this had been acted on. Therefore, the provider demonstrated that compliance had been achieved.
16 August 2012
During a routine inspection
There were 16 people living at Francis House when we visited. We looked at the records of four people in detail; and spoke with people about their experiences at the service. We observed interactions that took place and spoke with another three people using the service. We spoke with four staff.
People told us that they were fully involved in the assessment and planning of the support they need. For example, we were told 'Most people live independent lives here and free to come and go as they wish'.
A person told us they had a 'Good chat with the doctor about my stay here' and been asked whether they were 'Happy with everything and want to continue on the programme and treatment, which I do.'
People had clear goals and were working towards discharge; all of the people told us that their health had improved and they had 'Something to work towards and have a purpose in life now'.
The staff were described as being 'Great, they always seem to know when I'm not feeling too good and will always come and talk to me about it to find out if I'm ok'. And people said they felt safe.
People had an active say in the improvement of the service. For example, we were told that there were regular meetings held. Additionally, people had been enabled to follow their wish to improve the gardens for others and felt valued for doing this.
At this inspection, we have suggested that the provider look into the way controlled drugs were stored to make improvements to the security of the medicines. We made a compliance action about the legal requirement for the provider to notify the commission about certain events and incidents, as this had not been done.