We rated Francis House good because:

• Clients who used this service were active partners in their care. Staff were fully committed to working in partnership with people and making this a reality for each person. The service had a strong recovery ethos with staff devoted to ensuring that clients had excellent outcomes. Clients praised the staff in helping them open-up and talk about areas of their life they had previously kept to themselves.

• Staff were highly motivated and inspired to offer care that was kind and promoted clients’ dignity. Staffing levels were safe and there were plans in place to cover vacancies, sickness and annual leave. There was a positive culture within the house, staff felt respected and valued as members of the team and there was support from the registered manager. Staff received supervision and an annual appraisal.
• Staff had good knowledge of safeguarding procedures that helped them protect vulnerable adults from abuse. Staff reported incidents as they arose and learnt from accidents and incidents in the house.
• The service provided care based on National Institute for Health and Care Excellence guidance. Both one to one time and group work was provided. Staff monitored and addressed physical health of clients in the house. Staff received mandatory and specialist training and they had a good understanding of the Mental Capacity Act.
• Francis House was visibly clean and there were arrangements in place to ensure the service was kept clean and tidy. The manager completed environment health and safety checks, this included an assessment of ligature points.
• There was no waiting list for the service. In the event of clients relapsing, staff tried to work around triggers for relapse. The service had a range of rooms for clients, including living rooms, a large dining room and a multi-faith room. There was wheelchair access and access to outside space. Staff provided care according to ethnic, cultural differences and personal preferences. Staff supported clients to access and attend external support groups.
• Clients knew how to complain. Policies were in place to guide staff within their work. Managers and staff conducted audits. The provider maintained and discussed the organisational risk register. Clients had regular opportunities to give feedback about the service, including; house meetings, evaluation forms, suggestion box and a feedback book.

However:

• Staff did not complete comprehensive risk assessments for clients admitted to the service and there was no evidence of crisis planning. Staff did not complete individualised care plans for clients accessing the service. Staff did not document discharge plans. Staff kept a lot of information in their heads and this was not translated into the documentation. There were blanket restrictions in place.
• Medicines were not always prescribed safely due to staff not using medicines reconciliation processes as routine. This means that staff did not routinely check that the medicines they were giving were the ones prescribed by the GP.
• The service did not have sufficient governance systems in place to ensure sufficient oversight and risk management of incidents and safeguarding. Managers therefore did not monitor to look for trends, this meant that if the same incident kept on occurring then there was no oversight to look at the reasons why or for example, if there was a gap in staff training.

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

• Clients receiving treatment at Francis House felt safe. The provider had an excellent understanding of client risks and clear plans were in place to manage concerns. Procedures were in place to ensure safe administration of medication. Staff demonstrated knowledge of procedures in reporting incidents. Staff understood how to identify and raise safeguarding issues and followed the organisation’s policies. The environment was clean and comfortable and staff managed medication using clear robust systems.

• Care records contained comprehensive, detailed and holistic assessments of the client, and all therapies provided followed National Institute of Clinical Excellence guidelines (NICE). Staff were well trained to provide the care required and received regular supervision and support from managers, and clients described feeling well cared for and supported by the staff who treated them in a dignified and respectful manner. Staff worked closely with clients to create care plans that addressed the needs of each individual.

• Staff provided individualised methods of supporting clients’ recovery dependant on their needs, for example, information provision for non-English speakers. There was a robust complaints management policy within the organisation and staff understood and worked within the duty of candour.

• Staff in Francis House demonstrated high levels of care for the clients. All staff were ‘dignity champions’. They had made a commitment through the national dignity council to uphold clients’ dignity in all situations and acted accordingly when working with clients.

• Francis House had clear, robust admission and discharge procedures. They offered a vast range of therapeutic activities, tailored to the client’s individual needs. This included Equine Assisted Learning which was very positively received.

• The provider’s leadership team were approachable, enthusiastic and extremely knowledgeable. They demonstrated high levels of commitment and compassion, and were highly inspirational. They offered unfunded crisis admissions to former clients and fundraising to be able to offer a service to people who were unable to access statutory referrals or funding.

However, we also found the following issues that the service could improve:

• The service did not have an automated external defibrillator (AED) available for use in a medical emergency.

At the time of our visit there were 14 people using the service. We spoke with three of them. They were all satisfied with the care and support provided. One told us, “I’m happy with everything.” Others said the staff “support us through everything” and were “nice people, decent people”. They told us they had agreed to their care plans. Care and support were provided according to the plans and with their consent. They were satisfied that their rooms and the shared areas of the home were well maintained and kept clean.

We spoke with staff and reviewed records related to people’s care and the management of the service. We found people’s care needs were assessed and their care plans were developed in line with their assessments. Care and support were delivered according to plans which were reviewed regularly. Procedures were followed to document that people consented to their care and treatment plans.

Appropriate measures were in place to maintain cleanliness and prevent the spread of infections. The service was receptive to comments and complaints, and there was a documented procedure to handle formal complaints. There was an effective recruitment process which included carrying out the required checks before people started work.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with five people using the service. They told us that Francis House was a "very supportive" even "life-changing" environment which helped bring about successful treatments. They said the staff "really know what they are doing". One person using the service said that they had had "ups and downs" but the staff were "very good and supportive". People said they were fully involved with and understood their care plans.

We found that the care plans were very thorough, centred on the person, and that they were regularly reviewed. We found that risk assessments were in place and followed up and that processes were in place for regular audits. We saw that people using the service could provide input into the day to day running of the house through the "House Group Leader" system. People were supported by adequate numbers of staff and appropriate steps had been taken to ensure their safety and welfare.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.