What life is like for people using this service:

• Medicines were not always well managed. Temperature readings of medicine storage areas and medicines audits were not being completed and the controlled medicines register did not reflect the controlled medicines stock.

• Staff were kind and caring and there was a warm, family atmosphere. We saw people interacting in a positive way with staff and each other and accessing the providers day service.

• The provider responded when they could no longer meet people’s needs and worked with other services to ensure a smooth transition for people.

• The Stables Flat met the characteristics of Good in most areas and of Requires Improvement in Safe. Overall, we have rated the service as Good.

• More information is in the full report below.

Rating at last inspection: Good (report published 25 May 2016).

About the service: The Stables Flat is a care home that was providing personal care for up to eight people living with a learning disability at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We have rated this service as Good and we will follow up on this inspection as per our re-inspection programme, and through ongoing monitoring of information received about the service.

This unannounced comprehensive inspection took place on 15 and 19 April 2016.

Stables Flat is a care home registered to accommodate a maximum of eight people with learning disabilities. At the time of the inspection eight people were living at the home.

There was a registered manager employed at the home. 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.

The feedback we received from people and their relatives was that Stables Flat was a, “Really good” place to live. People told us they, “Enjoyed” living there and all the relatives we spoke with gave positive views about the home and the care and support their relative was given.

People told us they felt safe and well supported at the home. Staff had been trained in safeguarding adults and were aware of the types of abuse and how to identify, prevent and report abuse. There was an effective system of training in place for staff.

Plans were in place on how to support people in the event of an emergency.

Staff were friendly, kind and caring and gave individual, person centred care to everyone living at Stables Flat. There were robust recruitment practises in place to make sure that appropriate staff were employed to support people.

People’s needs were assessed and areas of risk were assessed and reviewed to ensure peoples’ safety. Support was offered in accordance with people’s wishes and their privacy was protected. Staff knew people well and understood their physical and personal care needs and treated them with dignity and respect.

Staff and people told us they felt the staffing levels were appropriate to meet people’s needs. Staffing levels were planned and adjusted to make sure people were given individualised care.

People’s medicines were securely stored and managed and people were supported to take their prescribed medicines in a timely way.

Staff were knowledgeable about the Mental Capacity Act 2005 and its principles and had a thorough understanding around how people living at Stables flat wanted their care and support to be given.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Systems were in place to support people with budgeting, shopping and cooking. People’s health needs were monitored which included appropriate referrals to health professionals when required.

People were supported to take part in a wide range of activities, hobbies and work placements to maintain their independence and promote a healthy lifestyle. People could choose where they spent their time.

People told us they were happy to raise any issues or concerns with the manager and felt confident they would be listened to. Complaint forms were available in the home in an easy read format for people to use if they wanted to express a concern.

The service was well led with a clear management structure and an open, friendly culture. There were systems in place to promote a continuous drive for improvement.

The provider was developing a quality assurance system to monitor and improve the quality of the service provided.

People who lived at Stables Flat were supported to lead active and fulfilling lives. We found that people were able to do activities of their choice and their independence was promoted in their home and community. We spoke with two people who lived in the home who spoke positively about their lives. For example, one person told us, "I like the atmosphere here. It is a lovely place. I do what I want to do. They are really supportive."

People received the care they needed to remain healthy. People were supported to attend appointments with health care professionals such as the GP, dentist and podiatrist and staff followed professional advice to ensure their needs were met. Staff understood people's needs and tailored people's support to meet these needs.

People's medicines were administered safely. We saw that there were clear procedures in place to ensure people received their medicines as prescribed. People told us they received the help they needed with taking their medicines.

There were enough staff with the right skills, qualifications and experience, to give people the support they needed. Staff worked in a flexible way to meet people's needs and the home provided training to staff to ensure they had suitable skills to carry out their work. People who lived in the home told us they liked the staff who supported them. This was echoed by three relatives we spoke with who described staff as caring and knowledgeable.

The provider monitored the quality of the service to ensure people were happy with the support they received. People who lived in the home were consulted about their care and were able to influence the way their care was delivered. The provider also monitored the safety of the service, reviewing procedures as necessary to ensure that people were protected from unsafe care.

We spoke to four people who used the service. The other people did not want to talk to us. We looked at 'service user' meeting records, care plans and risk assessments, family member compliments. Overall people were very satisfied with the service that they received. People told us that they could choose what activities they wanted to do. One person told us that they were supported to obtain a job.

We spoke to the registered manager and two staff members all who had worked at the service for at least two years. They commented that they would not like to work anywhere else.

People were given sufficient information and were involved about making decisions about their care. People said to us that they felt supported by the staff team and knew who to contact if they were concerned or dissatisfied with the service.

We found that although care plans were in place four had not been reviewed and the risk assessments required printing and putting on four peoples' care files. The staff therefore, did not have up to date information about peoples individual needs to ensure their safety and welfare.

There was evidence that the quality of the service was being monitored by internal quality assurance visits. We saw house meeting agendas and minutes which provided evidence of the collection of and responding to people's feedback. We saw a complaints policy in accessible format and compliments received from family members.