The inspection took place on the 02 December 2015. The provider was given 48 hours’ notice because the location is a small care home for younger adults who are often out during the day; we needed to be sure that someone would be in.

Stoneybridge Cottage provides care and accommodation for a maximum of two people. People living and supported at Stoneybridge Cottage are usually younger adults with a learning disability and associated conditions such as autism and Asperger’s.

The service had 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 said they liked living at Stoneybridge Cottage. The atmosphere in the home was warm and welcoming and people behaved in a way that demonstrated a sense of belonging. We saw people pottering around the house, tidying up and organising the house in a way they wanted and preferred. For example, one person told us how they had put up all the Christmas decorations how they wanted and showed us all their birthday cards displayed in the main sitting room. Relatives comments included, “I think […] is very happy and well cared for, they always seem very content and have all their needs met”.

Staff spoke in a compassionate and caring way about the people they supported. People were supported when they moved between services. For example, one person had moved from the home to a new placement and staff had done as much as they could to provide good and clear information about the person’s needs to make the move as smooth as possible for all concerned. Hospital passports and communication profiles were used to support people should they require an admission to hospital or other healthcare facility. This information helped ensure people received consistent and appropriate care when they used or moved between different services.

People received care and support from staff who knew them well and who had the skills and training to meet their needs. Staff told us they had lots of opportunities to develop their skills and training was relevant to the needs of people they supported. Staff confirmed they undertook a thorough induction when they first started working in the home and felt well supported by the registered manager and their colleagues.

There were sufficient numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to ensure they were fit and appropriate to work with vulnerable people in a care home setting. Staff were able to recognise possible signs of abuse and/or poor practice and understood what they needed to do to ensure people were protected.

Medicines were managed, stored, given to people as prescribed and disposed of safely. People’s care records included clear information regarding their medicines and how they needed and preferred these to be given to them. Staff undertook training and understood the importance of safe administration of medicines. The registered manager completed regular audits to ensure practices remained appropriate and safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The registered manager demonstrated a good understanding of the Mental Capacity Act and had followed the correct processes when it had been assessed that a person’s liberty could be restricted.

People’s health and well-being were well monitored. The registered manager and staff responded promptly to any concerns in relation to people’s health and also encouraged people to attend health checks recommended for their age group and gender. People were provided with information about diet and healthy eating and were fully involved in all aspects of menu planning, shopping and meal preparation.

People were supported to lead a full and active lifestyle. On the day of the inspection one person went out for the day to celebrate their birthday. The day had been planned to include activities they enjoyed including a train trip and meal out. In addition to a busy social schedule people also attended planned weekly activities aimed at developing their daily living skills and social opportunities. One person went to college two days each week to learn writing and life skills and also attended a farm project one day each week. Staff said, “They love the learning aspect, but also the socialising and making friends”.

The registered manager took an active role within the home. Staff said they felt well supported and always had someone to contact, which they said was particularly important when working on their own. The registered manager maintained their own professional development by attending regular training. They had also been actively involved in a local communication initiative ‘Communication Charter’ organised by Cornwall County Council. The aim of the charter was to improve the lives of people with a learning disability. As part of this initiative the registered manager had attended communication training and agreed to use this knowledge to its full potential by rolling out the training to their staff and other services.

The registered manager had an effective quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service, relatives and other agencies. Learning from incidents and feedback had been used to drive continuous improvement across the service.

During our visit we were able to meet people who used the service and observed the care being provided by staff.

We spoke to other agencies who had been involved in the service. Comments we received were positive and included “I have no concerns, I attend review meetings and see that people are active and happy”

We also spoke to a relative who told us “So far so good, I have confidence in the provider”

We observed that staff spoke to people respectfully and had a good understanding of people’s needs and daily routines. People were supported to partake in a range of activities inside and outside the home. Arrangements had been put in place to ensure that people could visit and maintain links with their family members.

We saw that when necessary the provider had liaised with other services, such as healthcare professionals and Social Services. This had ensured that people’s full range of needs were being met.

Since the last inspection the service had reviewed procedures to ensure that people’s rights were protected and that they were kept safe. This had included updating staff training in relation to safeguarding as well as the review of any restrictive practices within the home.

Staff we spoke to said that they felt well supported and that there was an open culture within the service, which encouraged discussion and the reporting of any concerns.

Records were found to be detailed and included good information about people’s needs.

During our visit we were able to meet people who used the service and observed the staff as they provided care and support.

Comments from other agencies was positive and included “People in the home are always extremely happy, the environment works well for the people living there”

We saw that staff treated people respectfully at all times, promoting choice and independence whenever possible. The interactions and relationships we observed were positive and helped create a homely, age appropriate environment for people using the service.

Concerns were raised that the use of locks in the service may restrict people’s freedom and not protect their rights. Correct procedures had not been followed to ensure people's rights, freedom and liberty were protected.

People were able to access a range of healthcare services and consideration had been given to people’s rights and best interests when any treatment was needed.

People had access to a range of appropriate and meaningful activities inside and outside the home.

Sufficient staffing levels were in place to meet people’s assessed care needs and staff undertook training relevant to their role and the people they supported.

Systems were in place to regularly review the quality of the service, and changes were made when improvements were identified.