This inspection took place on 19 January 2018 and was unannounced.

This was the second comprehensive inspection carried out at Flora Innes House. The last comprehensive inspection was 8 October 2015 where we rated the service as Good. The overall rating for this inspection was also Good, however, there were areas that required improvement in the Well Led domain.

Flora Innes House is a care home for adults with learning disabilities. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Flora Innes House does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Flora Innes House accommodates up to nine people in one building. On the day of our visit, there were nine people using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The provider did not always enable the registered manager the autonomy they required to assess, monitor the service or make changes in a timely way. Some areas of the service required more frequent quality monitoring to identify issues. The registered manager implemented more frequent systems during the inspection however we have been unable to assess these systems for effectiveness.

The provider had recognised that the aging and changing needs of people using the service meant that the existing environment, activities and working practices would need to be updated to meet people’s needs. Although this had been discussed at board level actions had not yet been implemented to accommodate everyone’s future needs.

There was a strong sense of belonging shared by staff and people using the service. All staff believed in the ethos of the service of providing care that was inspired by the principles of Austrian philosopher, Rudolf Steiner.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

Staffing levels ensured that people's care and support needs were safely met. Safe recruitment processes were in place. People received care from staff that had received training and support to carry out their roles. People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People were supported to express themselves, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

We made a recommendation that the provider refers to research and guidelines on providing residential and supported living for adults with learning disabilities.

This announced inspection took place on 8 October 2015. The service provides support for up to nine people with learning difficulties. At the time of our inspection there were nine people living at 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.

People felt safe in the home and relatives said that they had no concerns about their family member’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

Staffing levels ensured that people received the support they required at the times they needed it. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service.

Care records contained individual risk assessments to protect people from identified risks and help keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were in place detailing how people wished to be supported and where possible people were involved in making decisions about their support. People participated in a range of planned activities both in the home and at a sister service in the community and received the support they needed to help them to do this.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed.

People and their families were actively involved in decision about people’s care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had developed positive relationships with the people who lived at the home and support was provided in a kind and caring way.

The registered manager was visible and accessible and staff, people and their relatives had confidence in the way the service was run.

We spoke with two people who used the service who told us that they liked living at Flora Innes House and that they got to do things that they enjoyed. One person told us “I like to go to the pub and the staff take me”. Another person told us “I like the staff and I feel safe”.

We spoke with a relative of a person who used the service. They told us “We’re thrilled to bits with the service and the staff are wonderful.” They told us that their relative was involved in a wide variety of activities and that they were very happy.

We spoke with two staff members who both told us that they received regular training and that they felt well supported in their roles.

We saw that people’s preferences, likes and dislikes were recorded and that people had activity plans that reflected their interests. We found that people’s dietary and nutritional needs were met and that people were supported to maintain their independence.

We found that where best interest decisions had been made that they had been recorded. We saw that audits were carried out and there were systems in place to ensure that where any concerns were identified that they followed up.

People who used the service told us "it's nice living here" and "it's good, they always take us out". We saw comments recorded from relatives of people who used the service that said 'as parents we are often touched by the understanding of our son's many needs' and 'we feel that all aspects of care are highly satisfactory'.

Staff told us that the best thing about the service was that the people who lived there always came first.

However, we found concerns with the assessments and planning of care and with the assessing and monitoring of the service provision.

We spoke with four people who live in the home. All the people said that staff were friendly and helped them, and that they liked their bedrooms. They spoke eagerly about their forthcoming holidays and they said that they like the activities that they do during the week. No one had any suggestions for improving the service.

Relatives highly praised the service: ’my son has a satisfying life and he is well cared for. His activity plan is flexible. Staffing levels seem to be good. It's a very personal service ‘. 'A first-class service in every respect. My daughter is very well looked after. She is very attached to the staff and we are lucky she is living there’. ‘My daughter has lived at the home for many years. Staff are very, very caring. They are very well trained and my daughter is perfectly safe there. There are lots of activities like riding, walking, pets, and college’.