Francis House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Personal care is provided in one adapted building for up to eight older people with mental health needs.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing 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 in October 2015. There were seven people accommodated.

People continued to receive safe care in a clean, well maintained and adapted environment, which they were comfortable and happy with. People and staff were informed and confident to raise any safety concerns relating to people’s care, if they needed to. People felt safe at the service and staff knew how to keep them safe from any abuse or harm associated with their assessed health, environment or care equipment needs.

Staffing measures, emergency contingency planning and related safety procedures, helped to ensure people’s safety at the service. Management action was agreed, to review staff lone working and deployment arrangements at night, to further ensure people’s safety.

Risks to people’s safety associated with their health conditions, medicines, environment and any care equipment, were assessed before people received care and regularly reviewed in consultation with them. People’s medicines were safely managed.

Staff were trained, knew how and provided people’s care in a way that ensured their choice, involvement and least restrictive care. People’s consent or appropriate authorisation was obtained for their care, to ensure their rights and best interests.

Safety incidents were monitored, analysed and used to inform any care improvements needed. Care and service improvements, including any lessons learned from this; were shared with staff and followed to reduce any further risks to people’s safety.

People continued to receive effective care. Staff helped people to maintain and improve their health and nutrition. People were supported to access external health professionals when they needed to and staff followed their related instructions for people’s care when required.

People’s health and personal care plans were devised in consultation with them and regularly reviewed. Staff consulted with people to optimise their inclusion, understanding and ownership of their agreed care; and to ensure effective information sharing with external care providers when required. People were provided with care and service information in a format they could understand.

People continued to receive individualised care from staff, who were kind, caring and fostered good relationships with them and their families. Staff understood and followed people’s preferred daily living routines, lifestyle and care preferences. This was done in an individualised way that helped to ensure people’s choice and independence.

Staff knew how to communicate with people in the way they preferred and understood. People were informed to help them understand their rights, what they could expect from their care and how to access relevant advocacy, if they needed someone to speak up on their behalf. People’s views were regularly sought about their care and they were informed, confident and knew how to make a complaint if they needed to.

The service continued to be well led. The provider operated effective systems to ensure the quality and safety of people’s care, ongoing service improvement and partnership working to enhance people’s care experience.

Staff understood their roles and responsibilities for people’s care. People’s care was effectively in

We completed an unannounced inspection of the service on 14 August 2015. At our previous inspection on 4 December 2013 we found that there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. These related to consent to care and treatment and management of medicines. We asked the provider to send us an action plan to demonstrate how they would meet the legal requirements of the regulations. During this inspection we looked at whether improvements had been made and we found that they had.

Francis House provides accommodation for people who require personal care. The home can provide accommodation for up to 8 people who have mental health conditions. There were 7 people using the service at the time of our inspection. The building is an eight bedroom bungalow, with easy access throughout the house and garden for people with limited mobility.

The home had a manager registered with the Care Quality Commission. A registered manager is a person who has registered with CQC 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.

There were enough staff available to safeguard the health, safety and welfare of people. Staff were trained in how to protect people from the risk of abuse and understood how to raise concerns.

Staffing levels could be adjusted to meet people’s changing needs and people’s care was reviewed with them regularly.

The provider had robust recruitment procedures in place. All staff were subject to a probation period. There were procedures in place to ensure that staff had ongoing training and supervision to ensure that they met the provider’s standards of care.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The registered manager and staff understood the need to obtain consent to provide care for people. Where people lacked the capacity to consent to an element of their care, staff understood their roles and responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People were supported by staff to have meals and snacks that were balanced and nutritious. Staff knew about people’s dietary preferences. People were encouraged to develop and maintain their skills in cooking.

People were encouraged to develop and maintain their independence, and we saw that staff treated people with kindness, dignity and respect. Staff demonstrated knowledge about people’s individual needs and preferences.

The service was managed in an inclusive manner. People had regular opportunities to talk about their care and support, and were encouraged to make suggestions to improve the service. Staff also felt able to contribute to the development of the service. They told us that they felt supported to provide a quality service for people. People knew how to make a complaint and felt confident to do so. The provider had systems in place for investigating and acting on complaints.

People were supported in promoting their independence and community involvement. People we spoke to who used the service, told us that they regularly went out into the local community. We spoke with a social care professional who said, “the service supports my client’s independence; they enjoy cooking and baking here.”

All people using the service had capacity to make decisions about their care at the time of our inspection. Where people may not have the capacity to make some decisions about their care, the provider's arrangements were not fully adequate to meet legal requirements.

During our inspection we observed staff taking time to sit with and talk with people receiving care. Some people were involved in crafts and others were watching television. One staff member we spoke to told us, "We always make time to talk with people using the service."

We found appropriate arrangements were not in place in relation to managing people's medicines.

There were enough qualified, skilled and experienced staff to meet people’s needs.

We found staff records and other records relevant to the management of the service were generally accurate and fit for purpose.

We spoke with and observed the care of four people living at Francis House. People living at the home told us that they were happy there. One person told us, “It feels safe, and I think that staff are very good.”

People’s views and experiences were taken into account in the way their care and support was delivered at Francis House. People's consent was also generally being sought for the care they received at the home.

We found that staff were trained to provide appropriate support for people, and received support from managers in supervision and team meetings.

We saw that a range of different ways were used to assess and monitor people's care and safety at Francis House, and that people's views were taking into account when assessing quality.

Although we saw that some positive support strategies were used at the home, care planning and risk management systems did not fully describe people's needs or personalised ways of providing support. Because of this we found that people were not fully protected from receiving inappropriate or unsafe care at Francis House.