The inspection took place on the 19 and 20 October 2016 and was unannounced. The home was last inspected on 10 and 16 June 2014 and met all the legal requirements assessed at that time.

Stepping Stones is a care home for 33 people with learning disabilities. Accommodation is provided in a number of houses and bungalows on one site. At the time of our inspection there were 32 people being supported by the service.

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.

We received positive feedback from people using the service and health and social care professionals. One person told us “This is the best place I’ve ever been in”. A health care professional stated “I have had no concerns about the care (the person) receives”. A social care professional told us “They do a good job and work as a team”.

People were at risk of receiving care from unsuitable staff because robust recruitment procedures were not always being applied. Medicines were generally managed safely although medicine storage temperatures needed more closely monitoring in two areas. Some laundry rooms needed improvement to ensure people were protected by robust infection control procedures.

People were treated with respect and kindness and their privacy and dignity was upheld, they were supported to maintain their independence as much as possible. People and their representatives were involved in the planning and review of their care and people took part in a range of activities.

Staff received support to develop knowledge and skills for their role. They spoke positively about their work with people. The registered manager was visible and accessible to people and staff.

Systems were in place to check the quality of the service provided.

The home was registered for up to 33 people. On the day of inspection we were told there were 32 people in the home, with one person in hospital. The home was divided into six separate house units.

We looked at the care records for seven people and spoke to ten people who used the service. People were positive about the care and the support they received from the staff. They told us that their dignity and privacy was respected and that staff were polite and caring in their approach. People we spoke with said they were assisted to be as independent as they wished to be. One person told us, "staff are very helpful".

We also spoke to the manager and staff. The care and health records were seen to be detailed and comprehensive. They provided staff with the personalised information needed to support people effectively.

People were supported by a well led staff team, who were suitably trained and supervised, to ensure good care practice. People received appropriate care and support to meet their individual needs. We saw the interaction between the staff and people living at the home to be friendly, supportive and geared to each person as an individual. Staff were encouraged to obtain further qualifications and were trained in subjects relevant to people's needs.

This inspection took place after concerns were raised to us about what appeared to be a high number of safeguarding incidents occurring at Stepping Stones, prior to our inspection. These incidents had been reported by the provider in line with Local Authority protocols. This included incidents between people who used the service and medicines errors. In response to these concerns, we checked how people were safeguarded and how medicines were being managed at Stepping Stones. We also checked whether staff received the right support to enable them to meet people’s needs. During this inspection, we included two additional standards as part of our routine inspection programme.

This inspection was completed by two adult social care inspectors and a pharmacy inspector. We spoke with seven people who used the service, but because of their complex needs, they were not able to tell us about their experiences in any detail. Hence we used a number of different methods to help us understand the experiences of people using the service. This included observing staff as they supported people living at Stepping Stones. We spoke with five members of the management team, including the registered manager and nine care staff. We reviewed five care records, 12 medicine administration records, incident and audit records. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what representatives of people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because risks were assessed and managed effectively. Risk assessments had been carried out and were updated regularly to ensure risks to people were managed. Clear guidance suggesting how staff should react to support people to become calm was available to staff. This included how to keep people safe and when to consider use of ‘as required’ medicine. We observed staff supporting people when upset and saw they followed the guidance in care plans to help people become calm. For example, distracting the person by offering an activity they enjoyed or taking them out for a walk.

The policies and procedures in place to safeguard people from abuse were robust and the provider followed local and national reporting requirements. We spoke with six staff members about their role in safeguarding. During these conversations, staff demonstrated they knew how to recognise abuse, how to respond and they understood their responsibility to protect vulnerable people. This meant people were protected from abuse as staff and people had been enabled to raise concerns and the provider worked with external agencies to keep people safe.

The systems in place to manage people’s medicines were safe. This included appropriate staff training and checks. The checks carried out ensured that any shortfalls could be identified and managed promptly.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made and how to submit one.

Is the service effective?

The service people received was effective because their individual needs, choices and preferences were reflected in their care plans. People were supported to access a range of activities within their local community. For example, they told us they enjoyed going out to local shops and pubs, to play pool and to shop or have a drink.

People were supported by staff who understood how to meet their needs. Staff were provided with training and support which enabled them to understand how to support people’s care and specialist needs.

Staff worked with others, including external health professionals, to ensure people's health and welfare needs were met. There was evidence that people were supported to attend regular health checks with their GP, dentist, optician and chiropodist. Information about people’s health and treatment had been documented so this could be shared with health professionals when needed, including in an emergency.

Is the service caring?

The service was caring because people and their representatives had been enabled to express their views about what was important to them and they had been listened to. People’s care plans described their likes, dislikes and any routines that were important to them. Where people had particular needs or preferences about the way they were supported, these had been identified.

Is the service responsive?

The service was responsive because when people’s needs changed appropriate action was taken. There was evidence that care plans and risk assessments had been updated to reflect changes in people’s needs. Staff told us care plans were also reviewed annually with people and others involved in their care, such as their family or social workers. Some people had signed their care records to confirm they had been involved in their care reviews. We found care records identified where other records should be read alongside them, such as behaviour and mood escalation plans and communication plans. This meant staff had access to relevant and up-to-date information about each person’s needs.

Is the service well-led?

The service was well-led because effective quality assurance processes were in place and where the need for improvement had been identified, timely action had been taken. The provider was proactive in identifying shortfalls within the running and management of the service and in obtaining relevant professional advice. The provider was open and transparent when responding to our information requests and involved other external agencies when this was appropriate.

Staff were clear about their roles and responsibilities. They felt well supported and were confident that if they raised any issues or concerns, these would be managed effectively. People, or their representatives, met with staff regularly to give feedback about the service provided.