About the service: Florence House offers personal care and support for up to a maximum of nine adults who have a mental health condition.

Florence House is staffed 24 hours a day, with a minimum of two staff on duty during the day and staff awake at night.

People’s experience of using this service:

• People at this service were well support by dedicated staff who knew them well. People and staff had positive relationships that were based upon mutual respect.

• People using the service were relaxed with staff. Staff were appropriately trained. Staff interaction with people and had a positive effect on their well-being.

• People’s feedback was consistently positive about the support and said there were sufficient staff. One person told us, “Yes it is supportive living here. Staff arranged a visit for me once a week. The person gets me to think positively.”

• People were supported to maintain good physical and mental health. People were enabled to access healthcare services and to take their medicines regularly.

• People were 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 supported this practice.

• People were enabled to be as independent as they could be within the service. People were supported to move on and out of the service to less dependent service provisions when the time was right for them. The service staff worked well with other agencies to make this possible.

• The registered manager was well regarded by people and staff. They were responsive to any matters brought to their attention. Management had good oversight and monitored the service well. This included seeking feedback from people and staff.

Rating at last inspection: We rated Florence House as good and published our report on 15 June 2016.

Why we inspected: This was a scheduled inspection based on previous rating.

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

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

We carried out an unannounced comprehensive inspection of this service on 14 July 2014. Breaches of legal requirements were found. This inspection took place on 13 and 16 May 2016. We found that the required improvements had been made to the safe recruitment and effective training of staff and legal requirements were met. Records were available to demonstrate that the required references and checks had been completed when staff were recruited. Staff had received training on areas specific to mental health issues.

Florence House provides personal care in a supported living scheme for up to 9 people who have an enduring mental health condition. There were seven people receiving a service on the day of our inspection.

Systems to monitor and improve the quality and safety of the service were being developed and required further improvement. Some checks were being completed by the registered manager and people’s views were sought. Actions were needed to analyse the outcomes and plan ongoing actions to ensure continuous monitoring and improvement of the service.

A registered manager was 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.

Systems were in place to ensure the management of risks both for individual people and to the environment so as to ensure people’s safety. This included the safety of the premises and equipment used. Equipment such as that relating to fire and electrical equipment had been tested and checked to ensure it was safe and in good working order.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Risk management plans were in place to support people to have as much independence as possible while keeping them safe.

Medicines were safely stored, recorded and supported in line with current guidance to ensure people received their prescribed medicines to meet their needs. People had support to access healthcare professionals and services. People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People’s dignity and privacy was respected and they found the staff to be friendly and caring. Peoples’ goal of being more independent was recognised and supported in the service.

Staff used their training effectively to support people. The manager understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff were aware of their role in relation to MCA and DoLS and how to support people so as to ensure their rights were respected and met.

Care records were regularly reviewed and showed that the person had been involved in the planning of their care. They included people’s preferences, individual needs and goals so that staff had clear information on how to give people the support that they needed. People were supported to participate in social activities both at home and in the community. People told us that they received the care and support they required.

People living and working in the service knew the registered manager and found them to be approachable and available in the home. People had opportunity to express their views and influence the service provided.

A single inspector carried out this inspection. Below is a summary of what we found.

The summary is based on our observations during the inspection, from speaking with four people who were using the service and three staff who supported them. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included four support plans, daily support records and three staff files.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People told us they felt safe. Safeguarding procedures were clear and staff understood how to safeguard people they supported. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

People told us that they felt their rights and dignity were respected.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and were fully involved in decisions about their care and lives.

Staff we spoke with said they received induction training when they started in their roles. We saw records of induction training but did not see that staff had received training specific to supporting people with assessed mental health needs.

Staff told us that they received day to day line management support in their roles. However we did not find that all staff received regular and recorded supervision to support them in providing a caring and responsive service.

Is the service effective?

There was an advocacy service available if people requested it, this meant that when required people could access additional support.

People’s health and care needs were assessed and they were involved in their plans of care.

People thought that their care plans were up to date and reflected their needs. Our review of records found this to be the case.

Is the service caring?

We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “The staff here are all nice to me and I go shopping with them.” “The staff at Florence House are good and ask me if I’m ok.” “I know about my care plan, I can look at this with staff and talk about what’s in it”.

People using the service completed an annual satisfaction survey. If shortfalls or concerns were raised these would be taken on board and dealt with.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. One person using the service told us, "If I’m worried about anything I talk to the staff and they try to sort it out for me." Another person said, "I know I can complain if I want to, I was given guidelines to tell me how to make a complaint but I have not needed to complain." A person using the service told us that they once made a complaint. They said that action was taken by the provider to their satisfaction. We found that people could be assured complaints would be investigated and action taken as necessary.

The service worked well with other agencies and services to try to make sure people received care in a coherent way.

Is the service well-led?

The service had a quality assurance system. Records showed that identified problems and opportunities to change things for the better had been taken note of and addressed. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a sound understanding of the aims and ideals of the service. This helped to ensure that people received a good quality service at all times.

We found that staff had good understanding of people's individual needs. We saw that people were treated respectfully and their individuality and diversity understood. The interaction we saw between staff and people was relaxed and friendly.

Staff we spoke with told us that they were supported in their roles. Staff also said that they thought they had been properly recruited and trained. However when we looked at staff files we found that some systems relating to staff records needed improvement to ensure that the correct information was held on staff employed at the service.

We saw that people’s care and support was planned and reviewed regularly. Risks to the health, welfare and safety of the person were identified and managed.

People using the service told us that they were satisfied with how they were treated and with the level of support provided. One person told us, "The staff are good to me, they help me a lot and I like it here.” Another person said, “Staff here are ever so good, they listen to me if I have any problems and the manager is very good.” One person said, the staff here have helped me and I’m hoping to move to my own place soon.”

People told us that they felts safe and were well cared for and supported living at Florence House. Some people said that their general and mental health had improved and that they had been encouraged and helped to develop daily living skills and to find local voluntary work.

We saw that people were supported for their individual needs. A detailed and person centred assessment of each person's needs was carried out before they were offered accommodation at Florence House. From the assessment an individualised plan of care was developed for each person with their involvement and agreement.

There were arrangements in place to ensure that staff were recruited robustly, trained and supported to provide safe and effective support to people who were using the service.

Florence House had systems in place to regularly assess, monitor and improve the quality and safety of services provided to people who jived there.