About the service: Florence House provides accommodation, nursing and personal care for up to 27 people living with a mental health condition who require 24 hour support and care. At the time of our visit 24 people were using the service.

What life is like for people using this service:

• People who live at Florence House have their needs met by sufficient numbers of suitably trained staff. Staff were kind and caring towards people and knew them as individuals.

• The environment was comfortable and safe. People had input into how their home looked.

People were supported to remain engaged and had appropriate access to meaningful activity.

• People were offered a choice of good quality, nutritional meals. People were provided with appropriate support to make positive choices and reduce the risk of dehydration or malnutrition.

• People received the support they required at the end of their life. Improvements were required to end of life care planning in line with best practice guidance.

• Some improvements were required to implement a consistent care planning format and address conflicting information in some care records.

• The registered manager was receptive to our feedback and told us what action they would take to improve care planning and risk assessment.

• Despite the shortfalls we identified, staff knew about reducing risks to people and people were provided with the care they required. This was confirmed by comments from external healthcare professionals.

• The service worked well with other organisations to ensure people had joined up care. People were supported to have input from external healthcare professionals.

• People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

See more information in Detailed Findings below.

Rating at last inspection: Good (report published 25 May 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

The inspection took place on 25 and 26 May and was unannounced.

Florence House provides personal care and support for up to 27 people living with mental health conditions. At the time of our visit there were 26 people living in the home.

There was a registered manager in post. 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.

Processes were in place to ensure that only those suitable to work in health and social care were employed. Staff received an induction and on-going training which included the Care Certificate. Staff felt supported and received regular supervision and annual appraisals.

The manager encouraged a respectful, friendly and welcoming culture that was mutually supportive. Staff demonstrated professionalism, patience and compassion when interacting with those they supported. Staff, and the people living in the home, were aware of professional boundaries. People had privacy and staff demonstrated that they promoted dignity, choice and independence.

The staff we spoke with understood the types of abuse people could experience and knew how to report any concerns they may have. The service had processes in place to manage any safeguarding issues and contact details for the local safeguarding team were on display.

People received their medicines as prescribed and the service managed, stored and audited medicines appropriately.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service demonstrated that they worked within the principles of the MCA. Staff had received training in this and could give us basic information on how they were applied. DoLS were in place for some people and the people who used the service had support and encouragement to make their own decisions.

People and, where appropriate, their relatives, had been involved in planning the support they required. Support plans were in place that were detailed and individual to each person and staff demonstrated that they knew the life histories, support needs, likes, dislikes and preferences of those they supported. People told us their needs were met and the relatives we spoke with agreed.

People were supported and encouraged to participate in activities in the home and in the community. People were supported to attend church if they wished.

People’s nutritional needs were met and the staff monitored people’s food and drink intake to ensure their wellbeing. Additional monitoring had been implemented as required for each person. People had access to healthcare professionals and staff supported people to attend appointments. Robust recording was in place regarding this that identified the treatment each person had received, any actions required and any follow up treatment needed.

The manager had robust and effective systems in place to monitor the effectiveness of the service and the safety of the premises. The manager was visible in the service was valued and respected by people living in the home and the staff.

In June 2013, we carried out an inspection and found that the service was not compliant with five essential standards of quality and safety. The provider sent us an action plan to tell us what action they would take to become compliant. The purpose of this inspection was to check if they were meeting the essential standards.

We spoke with five people who used the service. People we spoke with were complimentary about the care and support they received. One person told us, “We are like one big family here. I do not ever want to move.” Another told us, “It is safe here. The staff are good to us and listen when we need them.”

The provider had implemented new care planning documents. We looked at the records of two people who used the service. We found that care plans were more person centred. This meant that assessment of information, the planning and delivery of care was centred on individuals and considered all aspects of their care.

Staff had been provided with written guidance which described the use of de-escalation and restraint in a way that respected the person’s dignity and protected their human rights. This meant that people who used the service had their human rights respected and upheld.

We spoke with two staff who told us that there had been improvements in the training provided to staff. This included training in safeguarding vulnerable adults from abuse.

We observed a programme of major works being carried out to maintain and improve the premises. We saw that several rooms had been decorated with some shower cubicles had been replaced. Mattresses, pillows and bedding had been that were stained and old had also been replaced. Worn carpeting was being replaced with new flooring to the hall stairs and landings within the service.

We spoke with eight people who used the service. One person told us, “Staff always ask you if you are alright. We get on like a house on fire.” Another told us, “We used to have residents meetings but they have stopped. It would be good to have them again.”

We looked at the care records of four people who used the service. We found that care records and assessments in terms of care needs and risks to people’s welfare were brief in detail and not always robustly completed.

We spoke with staff and the manager. Staff told us how they worked well as a team and found the manager approachable.

We found shortfalls in the maintenance of the premises. We saw a number of bedrooms and communal areas which were in need of cleaning, refurbishment and redecoration.