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Inspection carried out on 20 February 2018

During a routine inspection

Francis House is a care home that provides accommodation and care for up to six people who are living with a mental illness, some of whom may also have a physical disability. At the time of our inspection six people were living in the home. The service was also supporting a further 35

people who were living with mental health illness in their own homes.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

People are 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 support this practice.

Further information is in the detailed findings below

Inspection carried out on 3 & 4 December 2015

During a routine inspection

This inspection took place on 3 & 4 December 2015 and was unannounced.

Francis House is registered to provide accommodation with personal care for up to six people who are living with a mental illness some of whom may also have a physical disability. There were six people living at the service when we visited. The service was also supporting a further 43 people who were living with mental health illness in their own homes.

The service has a registered manager. 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.

Staff had been trained to recognise signs of potential abuse and how to report them. People reported feeling safe in the company of staff.

There were processes in place to manage identifiable risks. People had risk assessments in place to enable them to maintain their independence.

The provider carried out recruitment checks on new staff to make sure they were fit to work at the service.

There were suitable and sufficient staff with the appropriate skill mix available to support people with their needs.

Systems were in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with induction and ongoing essential training to keep their skills up to date. They were also provided with regular supervision.

Staff ensured that people’s consent was gained before providing them with support.

People were supported to make decisions about their care and support needs; and this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of the guidance and followed the correct processes to protect people.

People were supported to maintain a balanced diet and were able to make choices on what they wished to eat and drink.

If required, people were supported by staff to access other healthcare facilities and were registered with a GP.

Positive and caring relationships had been developed between people and staff.

There were processes in place to ensure that people’s views were acted on; and staff provided care and support to people in a meaningful way.

Where possible people were encouraged to maintain their independence and staff ensured their privacy and dignity were promoted.

To ensure people’s identified needs would be adequately met; pre-admission assessments were undertaken before they moved into the service or provided with care and support.

A complaints procedure had been developed to enable people to raise concerns if they needed to.

There was a positive, open and inclusive culture at the service; and the leadership was transparent and visible, which inspired staff to provide a quality service.

Effective quality assurance systems were in place to monitor the quality of the service provided and to drive continuous improvements.

Inspection carried out on 1 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected during our inspection at Francis House. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

People were encouraged to maintain their independence and we saw examples of this during the inspection, with people undertaking activities of their choice. We observed staff talking with and supporting people during our time in the home, and we observed that this was done with the person's privacy and dignity in mind. This demonstrated staff's awareness of people's individual support needs and was reflected in the care plans we viewed on the day.

We found that people were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff were trained in how to follow the procedures. Staff had good knowledge of safeguarding procedures and we saw that potential safeguarding issues had been responded appropriately to by the service.

Staff told us that they involved other health and social care professionals to support people with their needs. We saw evidence to confirm this in the care records, with evidence of engagement with mental health professionals and GPs. Where people displayed behaviour which may challenge others, there was comprehensive guidance for staff to follow in relation to what may trigger the behaviour and how to respond effectively.

Incidents and accidents in the home were recorded by staff, assessed by the manager and appropriate action was taken in response to these incidents. This meant that appropriate procedures were in place for staff to learn from incidents and know how to minimise the risk of them re-occurring.

We saw that the premises were well maintained with no risks to people’s safety. We found that there were enough staff to support people’s safely and to meet their needs appropriately.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DOLs). We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. Whilst no applications had been submitted, proper policies and procedures were in place but none had been necessary. Relevant staff had been trained to understand when an application should be submitted. People’s human rights were therefore properly recognised, respected and promoted.

Is the service effective?

We saw that people were involved in their care planning to the best of their abilities. It was clear that people had stated their preferences, likes and dislikes and the records indicated their involvement. This meant steps were taken to involve people in making decisions about their care and support. We found that care plans gave details of people’s preferences in relation to the way they liked to be cared for and supported. Staff we spoke with had a good understanding of people’s needs and knew how they preferred to be supported. This meant people were supported to express their views in relation to their care and support.

The records we reviewed evidenced that the risks around people’s nutrition and hydration were monitored and managed. We saw that food and drink was stored correctly and the kitchen was clean. We saw that appropriate food and drink was available to meet people’s needs and preferences.

Is the service caring?

People told us that staff treated them with kindness and respect. We observed staff knocking on people’s doors before entering their rooms and respected their decisions. For example, staff asked one person if we could look in their room. The person chose not to allow us entry and staff respected the decision that had been made. One person said, “I really wasn’t sure when I came here, it was different to what I knew, but it is ok.”

Staff had a good understanding and knowledge of people’s needs and preferences and we saw that diversity monitoring took place on admission to explore individual needs and preferences such as culture and sexuality. We saw that staff supported people with their diverse needs, such as dietary preference and religious needs.

We found that there were regular meetings held between the manager, staff and people using the service. These were used to discuss activities and raise any concerns and issues that people had. This meant people were supported to make their views known about the service.

Is the service responsive?

People were supported to give their views on their care and support through monthly sessions held between them and their key worker (a member of staff nominated to each person) and also through monthly meetings held with staff and other people living in the home. We saw that the service responded to people’s comments and acted upon issues when appropriate.

No formal activities took place but a variety of activities were available for people to access and we found that people were supported to do the activities that they wanted to. Records showed that when people’s needs changed, staff made the appropriate referrals and made changes to care plans to reflect the new changes.

People knew how to raise a concern if they had one and information on making a complaint was available. There was a clear procedure on what action would be taken if people made a complaint.

Is the service well- led?

We spoke with a member of staff and they said that they felt management treated them fairly and listened to what they had to say. They told us they felt confident in raising issues of concern with the management. One person we spoke with told us they felt they could approach the staff team if they had anything to discuss. This meant there was an open and transparent culture in the home.

We saw there was a clear procedure for staff to follow should a concern be raised. We also looked at the processes in place for monitoring incidents, accidents and safeguarding issues. These were well managed with clear awareness throughout the organisation on how to learn from these incidents.

There were effective governance procedures in place to monitor and improve the quality of the service provided. This was at all levels from the staff working in the home to the registered manager. Where improvements were needed, these were addressed in a timely manner and followed up to ensure continuous improvement. People using the services were asked their views and they were acted upon.

Inspection carried out on 26 April 2013

During a routine inspection

People told us that they liked living at the service and were able to come and go as they wanted. They told us the home was close to the town centre where they liked to go shopping. On the day we visited, one person was on the way out to visit the cinema; from their care records we saw this was something they liked to do on a regular basis. Staff were supportive in making these arrangements and accompanied the person on the visit.

People told us they were aware that there were some house rules and they had signed to say they would keep to these; an example being to smoke outside of the house. In the care plans we saw that people had been involved in planning their care needs and consenting to their care when this was appropriate.

Within people's care files we noted that each person had contact with the Assertive Outreach Team who supported them and the staff in delivering care appropriate to their mental health needs and legal status. For instance, support was provided for people on Community Treatment Orders and where someone had been released after being detained under the Mental Health Act 1983 and had restrictions placed on them for their own safety.

We were told by the staff on duty that there were two care staff on duty during the day, and one member of sleep in staff member on each night staff on shift. The records we reviewed confirmed that a rota had been developed and staff told us they were aware of the shifts they were required to undertake.

Inspection carried out on 1 August 2012

During a routine inspection

People who were living at Francis House when we visited on 1 August 2012, told us that the home was ‘good’ and that they liked the staff, who were ‘nice’.

A visiting professional told us that people living at Francis House had generally made good progress with their mental health since the home opened in March 2012, although they considered it to be “early days” at this stage. They said the care and attention people received from staff was in part responsible for the progress that people were making.