Stiperstones is registered to provide accommodation with personal care for up to eight adults with physical and learning disabilities. At the time of our visit eight people lived at the service.

Stiperstones is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At out last inspection, the service was rated Outstanding. At this inspection we found the service had not sustained the outstanding rating in all domains. We found the service was good.

People had access to activities, however due to staffing issues, people were not participating in as many individual outings as they could do. We found that staff did not always support people to work towards goals to increase their life skills and independence. We have made a recommendation to the registered provider in this respect.

People were supported by sufficient, skilled staff to meet their needs. Staff had been through a recruitment process before commencing at the service and they received on-going training and supervision to support them in their roles. However, morale within the staff team was low due to provider-level changes. Although this did not have an impact on the care people received as staff remained professional and caring, it had resulted in some key staff leaving the service which in turn meant people were not able to go out as much.

Staff were aware of their responsibilities in safeguarding people from abuse. Risks to people’s safety were identified and control measures implemented to keep people safe. People received their medicines safely and in line with prescription guidelines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The principals of the Mental Capacity Act 2005 were followed to help ensure this.

People received support from staff who knew them well and positive relationships had been developed. On the whole staff treated people with kindness and were aware of their preferences and staff demonstrated a good understanding of people’s communication styles. However, we did observe occasions when staff could have been more attentive towards people.

The service worked closely with healthcare professionals to ensure that people’s healthcare needs were met. People had access to food of their choosing and people’s individual dietary needs were met. People’s care records were completed in detail and end of life wishes were being collected from people.

Systems were in place to monitor the quality of the service provided and ensure continuous development. The service worked proactively with other agencies. There was a complaints process in place and the registered manager submitted notifications to CQC in line with their registration requirements.

People lived in an environment that was clean, checked for its safety and adapted for their needs.

The inspection of Stiperstones took place on 24 February 2016 and was unannounced.

Stiperstones is a care home which provides accommodation and personal care for up to eight people, who have different forms of learning disabilities such as Pica syndrome (an eating disorder), angelman syndrome (a genetic disorder that primarily affects the nervous system) and Autism whilst living with other complex needs such as: epilepsy and mental health issues. These conditions made daily tasks an increased challenge. At the time of our inspection there were eight people living there. Most of the people living at the home were unable to engage in a full discussion; we were able to briefly speak with them at the home and observe how they interacted with staff. The premises consisted of a detached house with communal lounge, dining room, kitchen and bathroom facilities. There was also a spacious and secure garden for people to use. There was also log cabin in the garden which was equipped with items which created sensations that could assist relaxation, or stimulate people’s senses.

At the time of our visit, 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 and associated Regulations about how the service is run.

People were happy and felt safe, their confidence and ability to be as independent as possible had grown since being at Stiperstones. Risks were managed effectively and people felt confident meeting new challenges with the support of the staff. There were enough staff deployed so that they could take part in the activities they wished and be supported in meeting their individual needs. People had access to activities that were important and relevant to them, both inside and outside their home. They were protected from social isolation because of the support and opportunities offered by staff.

People were at the heart of the service. The provider's philosophy were understood and shared across the staff team. People's right to lead a fulfilling life was enshrined in the ethos of the home.

Relatives were thrilled with the kindness, thoughtfulness and compassion of staff. People, relatives and healthcare professionals described the home as ‘truly a home and not just a house’ and ‘It is a warm and friendly environment.’

People and relatives felt valued by staff team and felt that they often go ‘the extra mile’ for them, when providing care and support. As a result they felt really cared for and that they matter.

There were systems and processes in place to protect people from harm. They had their medicines administered safely. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

People’s needs were assessed before and when they moved into the home and on a continuous basis to reflect changings in their needs. Clear arrangements were in place for people moving into the service which helped to reduce anxiety about this change. Care plans were person centred with the involvement of their relatives and health and social care professionals. People were cared for by staff that knew them really well and understood how to support them to attain their goals. Care staff respected people's individuality and encouraged them to live the lives they wanted. People's progress was monitored and celebrated.

People and those important to them were closely involved in developing the service. They were encouraged to voice their concerns or complaints about the home and there were different ways for their voices to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the home. Planned improvements were focused on improving people's quality of life.

Staff treated people wi

Our inspection was facilitated by a senior member of care staff who was present throughout.

During and after the inspection we spoke with people’s relatives and with staff who worked at the service. Although we were unable to speak directly with people who used the service about their care and support, we observed their interactions with staff and each other.

We found that there were processes in place to gain the consent of people or their representatives to the care provided and that people’s rights had been upheld.

We found that relatives of people who used the service were happy with the care provided. One who responded to a satisfaction survey wrote, ‘We feel very confident that my relative is being well looked after’.

People’s relatives expressed confidence in the staff to safeguard people from abuse. One told us, ““I know that my relative feels very safe and happy at Stiperstones and there are never any problems when it’s time to go back. They are like another family”.

We found that staff were supported in their roles in terms of training, supervision and opportunities for professional development. One member told us, “The supervisions give you a chance to talk about how to improve things for the residents and how we work. I enjoy working here and I feel valued”.

We found that there were effective systems in place to monitor the quality of the service provided and that the provider maintained procedures that were in line with best practice.

When we visited Stiperstones on 15 March 2013, we saw that people were happy and at ease. We used different methods, such as observations, to help us understand peoples' experiences. This was because people had complex needs which meant that they were not able to tell us about their experiences.

We observed a relaxed atmosphere in the home with positive interactions between staff and people who were engaged in activities of their choice. Staff were friendly and polite in their approach and interacted effectively with people. This showed that staff understood the needs of the people they were supporting.

People told us that the home was clean and we noted that the home had effective infection control processes.

During our visit, we spoke with two members of staff who told us they were happy working at the home and felt supported to carry out their roles, receiving a robust programme of training and supervision. We noted that personal files contained evidence of a robust recruitment process.

We saw evidence of information on how people could complain if they were unhappy with any aspect of the service provided. This meant that people were supported to raise any concerns or issues they had.

Due to people’s special communication needs it was difficult to ask all of the people directly about their views of Stiperstones.

We spent some time with people and observed how they were and all the people that we saw appeared calm and relaxed.