The inspection took place on 21 November 2018 and was unannounced.

Francis House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates nine people who are living with a learning disability or autism spectrum disorder. At the time of our inspection there were nine people living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection on 25 February 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall. There was no evidence or information from our inspection and ongoing monitoring which 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.

People continued to receive a safe service. Medicine administration records were completed by staff when they had administered the medicines safely. Risks associated with people’s needs had been assessed and measures were in place to reduce risks. There were sufficient staff to meet people’s needs and safe recruitment procedures for staff were in place. Accidents and incidents were monitored to identify any trends and measures were put in place to reduce the likelihood of these happening again.

The service remained effective. Staff received the training and support they required including specialist training to meet people’s individual needs.

People were supported with their nutritional needs. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People received care from staff who were kind, compassionate and treated them with dignity. People were comfortable in the presence of staff and the manager. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to support people when they were distressed and made sure emotional support was provided. People were supported to cope with the loss of loved ones. Their independence was promoted.

People continued to receive a responsive service. Their needs were assessed and their support was planned with them and or their relative where required. Staff knew and understood people’s needs well. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaints procedure available if this was needed.

The service remained well-led. The monitoring of service provision was effective because shortfalls had been identified and resolved. There was an open and transparent and person-centred culture with adequate leadership. People were asked to share their feedback about the service.

Further information is in the detailed findings below.

This inspection took place on 25 February 2016 and was unannounced. The inspection was undertaken by one inspector. We last inspected the service 03 January 2014, all the regulations we assessed were met.

Francis House provides residential care and support for nine adults with learning disabilities in the Sutton Coldfield area of Birmingham.

There was a registered manager in post at the time of our inspection. 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.

People received a safe service, because the provider had clear procedures in place to support staff in reducing the risks of harm to people. Staff were trained and knew the procedures to help to keep people safe. This ensured that people received a service that was safe as possible.

People were supported by sufficient numbers of staff that were trained, supported and suitably recruited to support people’s needs.

People received their medicines as prescribed and staff followed the provider’s procedure to ensure people's medicines were administered and managed safely.

People’s rights, privacy, dignity and independence were promoted and respected at all times. People received food and drink to ensure they remained healthy and had access to health care professionals to support their health. People pursued a range of social, work and community interests to enhance their lifestyle and well-being.

People received a service which focused on their individuality and they were involved in assessing and planning their care.

People and their relatives were confident that their concerns and complaints would be listened to and acted upon.

People received a good quality service from staff that were friendly and approachable. The management of the service was stable, with robust processes in place to monitor the quality of the service and to seek the views of people using the service.

There were nine people living at the home, with one person in hospital on the day of the visit. We spoke with the registered manager, the deputy manager and a support worker. We also spoke with three people using the service. We looked at written information about how medicines are managed. We also looked at records and spoke to people about their lives and experiences.

Two of the three people using the service told us that staff had always asked them what they want. They also said that they had regular meetings with a support worker who had been allocated to work with them (key worker) to talk about what they wanted. One person told us, “The staff help me do what I want”.

We saw that people were dressed in their own clothes and one person told us that they buy their own clothes and choose what they want to wear. This means that individuality is respected and supported.

One support worker told us that working with the people who use the service is about taking time to understand each person’s needs and to ensure they are happy with the service they had received. They also told us that any concerns had always been dealt with quickly. This meant that people are listened to and their views respected.

The support worker and deputy manager told us that they had held weekly meetings with people who lived at the home, so they can decide on the menu for the week and the shopping that was needed, and to discuss other house issues.

There were designated training days for each person that lived at the home where they were involved in undertaking daily chores, so that their daily living skills and independence could be promoted. Two people who used the service showed us their certificates of training; one had been framed and was seen on a side board in the service. This meant that people had been supported to continue with education.

During the visit four people were at day services or in employment. One person told us that they worked at fixing bikes. The registered manager confirmed that two people had attended a centre where bikes are repaired. This meant that people are supported to undertake meaningful occupation.

We looked at two bed rooms and saw that they had been individually decorated and furnished. One person using the service told us, “I have recently had new furniture, I like my room”. This meant that people were able to choose how their home was decorated and furnished.

There were nine people living at the home at the time of our inspection. During the inspection we spoke with two people that lived there, the manager, a visitor to the home, a student social worker on placement and two of the support workers.

People told us that they were able to make choices about their daily living. We saw that people living at the home were able to maintain their independence and were involved in community activities. One person told us, “I help with the shopping, cooking and keeping my room tidy.”

Everyone living at the home that we spoke with said that they liked living there. We saw that people received the care and support they needed to help them live full and independent lives. A visitor to the home told us,” I have no concerns about the home at all.”

People told us that if they were worried about anything they would tell the staff. We saw that systems were in place to ensure that people were safeguarded from abuse.

People told us that they liked the staff that supported them. We found that staff were trained and supported to deliver care and treatment safely and to an appropriate standard.

People said they were able to raise any concerns they had with staff. We found that there were systems in place to investigate and respond to people’s complaints.

People living at Francis House were very happy there. They were well cared for by a competent skilled and friendly staff team. They participated in numerous activities and were encouraged to make their own choices and decisions.