Francis 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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. The service was safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to clients and themselves well. Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. The service managed client safety incidents well.

However,

At the time of the inspection, not all volunteer workers for the service had received disclosure and barring checks. Staff were unaware of the provider’s policy on transporting medicines.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

There had been 5 serious incidents in the 12 months before this inspection. All 5 incidents involved clients with deteriorating physical health. The service demonstrated learning from these incidents, for example changing their admission paperwork to include client’s signs of deterioration.

All staff knew what incidents to report and how to report them. Staff reported all incidents that they should report.

Staff understood the duty of candour. Staff were open and transparent and gave clients and families a full explanation when things went wrong.

Staff received feedback from investigation of incidents, both internal and external to the service. Staff met to discuss that feedback.

Staff were debriefed and received support after a serious incident.

The service’s referral and admission processes ensured that all essential information about the client was received to determine if the client’s needs could safely be met.

Staff involved all the necessary healthcare and social care services to ensure clients had continuity of safe care, both within the service and post-discharge.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate.

Staff could give examples of how to protect clients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

Staff followed safe procedures for children visiting the service.

We reviewed 5 care and treatment records at this inspection and saw that staff involved clients in care planning and risk assessments.

There had been no incidents of restraint at the service.

Staff communicated with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties.

Staff enabled clients to give feedback on the service they received for example, via surveys and community meetings.

Staff ensured that clients could access advocacy.

Staff did regular risk assessments of the care environment. This included ligature audits, fire checks and legionella checks.

The house complied with guidance on eliminating mixed-sex accommodation.

Staff had easy access to alarms and clients had easy access to staff call systems.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

The service employed 9.11 Whole time equivalent (WTE) staff and had 1 WTE vacancy. Staff sickness was at 4.5%. However, the service also used 2 kinds of volunteers, called ‘volunteers’ and ‘recovery champions’. The volunteers were checked by the disclosure and barring service but the recovery champions were not. This put clients at risk. After this inspection, the service had all volunteers checked by the disclosure and barring service.

The manager could adjust staffing levels daily to take account of case mix.

Staffing levels allowed clients to have regular one-to-one time with their named staff member.

Staff shortages rarely resulted in staff cancelling escorted leave or activities.

Staff had received and were up to date with appropriate mandatory training. The training was appropriate for the patient group using the service.

Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date.

All ward areas were clean, had good furnishings and were well-maintained.

Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing.

The provider had a policy for transporting medicines in a lockable container. However, staff we spoke with were unaware of this policy and said they would transport medicines in a non-lockable container. This put medicines at risk of theft.

However, dispensing and administration of medication, medicines reconciliation, recording and disposal of medicines were done in line with national guidance.

Staff reviewed the effects of medication on clients’ physical health regularly and in line with NICE guidance, especially when the patient was prescribed a high dose of antipsychotic medication.