The inspection took place on 19 November 2016 and was unannounced.

Stable Cottage is registered to provide accommodation and personal care for up to three people with learning disabilities and autistic spectrum disorder. There were three people using the service on the day of our inspection.

A registered manager was in post, and present at the beginning 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.

Staff had received training in how to protect people from harm and abuse. They understood how to recognise and report any potential or actual abuse. People and their relatives knew how to report any concerns they may have about people’s safety and wellbeing, and felt comfortable doing so. The management team had assessed, recorded and managed the risks associated with people’s care and support needs. The provider maintained appropriate staffing levels to ensure people’s individual needs were met. People received their medicines safely from trained staff.

People were supported by staff who had the necessary skills and knowledge to meet their individual needs. Staff received effective induction, training and ongoing support from the management team. The provider and staff team understood how to protect people's rights under the Mental Capacity Act 2005. Staff supported people to have enough to eat and drink, promoting healthy food choices. The management team had assessed any risks associated with people eating and drinking.

Staff took a caring approach towards their work. They knew the individual needs and preferences of the people living at the home well, and treated them in a respectful and dignified manner. The provider encouraged and facilitated people’s involvement in decisions that affected them.

People received care and support that was shaped around their individual needs, preferences and aspirations. People and their relatives knew how to raise a complaint about the service, should they need to. The provider actively sought feedback on the service provided from people and their relatives.

The provider promoted an open and inclusive culture within the service. People, their relatives and staff found the management team approachable and willing to take on board their comments. Staff were well supported by the management team and clear about what was expected of them. The provider made use of quality assurance systems to drive improvement at the service.

We carried out a visit to Stable Cottage on 9th April 2014. We talked with the manager, the staff and we reviewed information given to us by the provider. We spoke with the people who used the service and observed the care and support they received from the staff who supported them.

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report

Is the service safe?

We met the three people who lived at Stable Cottage. One person we spoke to told us they were happy at the home and liked the staff that supported them, but they had some favourites.

During the inspection we spoke to a relative of one person. They told us, "I think the standard of care is very high, the staff really care and make sure everyone is happy, safe and well".

From our observations and from the information we saw in care plans, policies, procedures and audits the provider’s safety systems were robust.

The staff showed that they understood their role in providing care and safeguarding the people they supported. The staff showed us that they knew the people well and had read and understood the instructions set out in individual care plans.

We saw evidence that people were supported to make decisions for themselves. Their care plans set out detailed instructions for staff as to how each person could give consent. This meant when people lacked the capacity to make important decisions, meetings were held to make decisions for them that were in their best interests.

The staff we spoke with understood about the risk management plans that had been written for all the people and how these met with their particular needs. Staff showed that they understood how to show people respect and maintain people’s dignity at all times.

We found that medicines were safely stored, handled and administered. Medicine records were audited on a regular basis and staff received regular training. This meant that the medicines management provision was regularly inspected to ensure safe practices were in place.

The registered manager told us that there were no deprivation of liberty safeguards in place for the people living at Stable Cottage.

The staff rotas showed that the manager had taken people’s care needs into account when making decisions about the number of staff required, the skills mix and experience staff would need. The rotas showed where additional staff had been used with bank workers, overtime and more recently agency to ensure safe staffing levels were maintained. The night time staffing levels and on call system showed that out of main hours the staffing provision was safe.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that the staff were learning from adverse events and the people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. There was evidence of people and their representatives being involved in assessments of their needs and planning their care, particularly people with epilepsy.

We found that care plans were person centred and contained lots of information about people's choice and preferences. We saw that everyone’s care plans contained detailed information about each person’s support preferences.

We found that people's health and care needs were being regularly assessed. There was regular input from external social care and health professionals when needed.

Specialist health care needs were always assessed and included in care plans and health action plans. Specialist health and social care professionals regularly gave input to the service. All care, activity and risk assessment plans were reviewed regularly. Every person had a representative and advocacy services were available if required.

Is the service caring?

We observed during our visit and saw in people’s care plans that people were supported and encouraged to live full and active lives. People took part in a wide range of leisure and social activities. Activities were organised to include families and promote friendships.

The staff we spoke with demonstrated to us that they were committed to providing the best levels of care and to facilitate activities for the people who used the service. They demonstrated to they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We saw that a new service satisfaction questionnaire had been developed to allow families and representatives to comment more easily and responsively about the service provided at Stable Cottage.

We saw in the complaints log that action had been taken in all instances to address any concerns expressed regarding the care and support provided at Stable Cottage. These actions showed that the management and staff took seriously any concerns raised or complaints made.

We were told about and we saw that staff received regular training to meet the support needs of the people who used the service. For example training had been provided about the care and support of people with epilepsy. In the future new autism training is being developed.

We were told by the registered manager how people were supported when a hospital admission was required. This support was provided by the provision of additional staffing from the service and support from community nurses. When a person went into hospital they took with them a hospital passport with information about the person and their care needs.

Is the service well-led?

The service has had stable management for some years. There was a clear management structure within the service and the provider organisation. From the discussions with the registered manager, they were knowledgeable about the service, the people and staff. They met with their managers and peers regularly to maintain up to date their knowledge

The service had a quality assurance system in place. Records seen by us showed that any shortfalls identified had been addressed. There were systems in place, such as team meetings and the communications book enabled the organisation to feedback key points about service changes and developments to staff.

The staff we spoke with had a good understanding of the provider’s policies and procedures. Information was available around the building on posters about safeguarding and whistleblowing. All of the staff we spoke with said that if they witnessed poor practice they would report their concerns

Staff we spoke with told us that they had worked with the people for some time and enjoyed their work. They told us that there was a good team spirit and that they were supported by the managers.

When we visited Stable Cottage we met the three people who lived there. People told us they were happy at the home and liked the staff who supported them. After the inspection we spoke to a relative of one person. They told us, "I know X is absolutely safe at the home and they so enjoy being there”.

We found that people were supported to make many of their own decisions and give consent about how they were assisted. Staff listened to them and respected their decisions. Where restrictions were in place because they were thought to be in a person’s best interest the process required under the Mental Capacity Act 2005 that helps to safeguard people’s rights had not been fully followed and recorded.

We found that people’s health and care needs had been assessed and their care plans had been kept under review. People’s wellbeing and any concerns were taken seriously and external professionals were involved when needed. People were encouraged to be active and do activities that interested them.

Systems were in place to support staff and appropriate training was provided. Information was shared effectively between staff.

People and their relatives felt able to raise any concerns with care staff or senior staff. There were effective leadership arrangements in place to manage the care service and monitor health and safety risks.

When we visited Stable Cottage we met all three people who lived there and one of the two permanent care workers who worked there.

Two of the people who lived in the home that we spoke with told us they liked all the care staff. They felt there were enough staff to give them the support they needed.

After the inspection we spoke to the relative of one person to get their views on the service. They told us, “My relative is always happy to return to the home after staying with us. They love the home and have lived with the other two people there for 16 years”.

The care worker spoke about the people in the home in a caring and respectful way. They understood that people had different needs and were encouraging people to become more independent.

The system of incident reporting and supporting care staff during incidents could be made more effective.

We found that people were given support by the provider to make comments or complaints where they needed assistance.

When we visited Stable Cottage we met two of the three people who lived there and one of the three support workers who worked there.

One person who lived at Stable Cottage told us they liked living there and they got on well with the people they lived with and the support workers. The other person we met was unwell and was not able to tell us much about their experience at the home.

We saw some friendly and positive interactions between support workers and people who used the service. We also saw that opportunities to involve people in their home life and empower people were missed. Activity records showed that people had been into the community and had taken part in a variety of activities. The staffing arrangements meant that sometimes people’s daily choices and plans were limited.

We looked at the health and care records for two people living at the home. We found that some records provided clear information for support workers to follow but others had not been reviewed and updated. We found that guidance was not always followed by support workers. We were concerned about one incident where guidance had not been followed so we asked the service to make a safeguarding alert about this and make improvements for the future.

The house appeared clean and homely but some adaptations may make the environment more suitable for one person. The atmosphere was calm and we saw that people were relaxed and at ease in their home.

We met one of the three support workers who regularly worked at Stable Cottage. They told us they were experienced and had been trained to help understand how to meet and support the needs of the people who lived at the home. They were able to tell us about each person’s individual health needs. We found that there was a lack of formal supervision for support workers and that more management input was needed.