This inspection took place on 28 September 2015 and was unannounced.

Stonesby House is a care home for a maximum of nine people with a range of different needs. These include mental health needs, dementia, and learning disabilities. Most of the eight people who lived at the home at the time of our visit had mental health needs. One person arrived on the day of our visit for emergency respite support.

The service had a registered manager. 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.

Since our last inspection the registered manager had started to manage another home for the provider as well as Stonesby House. Some management responsibilities had therefore been delegated to other senior staff but we found these had not always been carried out. The provider and registered manager did not have sufficient checks to know these responsibilities had not been undertaken. The lack of checks had not led to any negative impact on people.

The registered manager was a strong advocate for the rights of people who lived in the home and staff worked to the same principles.

Staff understood the risks related to people's mental and physical health as well as their well-being and followed people’s individual risk assessments to ensure they minimised any identified risks.

The registered manager and most staff understood the local authority's safeguarding policies and procedures. Checks which reduced the risks of employing unsuitable staff were carried out prior to staff working at the home. Staff received training to meet people’s needs effectively.

The provider understood the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards and the service complied with these requirements. People had good access to health care professionals when required, and their medicines were administered to them as prescribed.

There were enough staff to meet people’s needs. People were supported to live their lives as independently as possible and enjoyed activities within the home. People had choices about what meals were provided and enjoyed the food made available to them.

People who lived at Stonesby House liked the staff who supported them. They felt staff were kind, and we saw staff treat people with respect and dignity.

We saw improvements since our last visit in safeguarding people who uses services from abuse; and in the cleanliness of the environment. Staffing rotas confirmed when new staff started work they were matched up with experienced staff to work alongside. This would ensure staff were well supervised and supported; and people who use services were kept safe.The manager talked about learning from incidents and keeping people protected. The manager had checked the physical environment to ensure people's rights were respected and upheld. The service now has new digital door key pads to ensure people are safe and not restricted from entering and leaving the home.

We found one person was receiving positive interventions as directed by a clinician to encourage them to maintain personal hygiene. Staff were working closely with the individual to help support them. The manager confirmed this had starting to have a positive impact on the person and other people who use services. We saw staff were caring and well led. New training around food hygiene had been identified for all staff to attend. We saw a new housekeeper had been appointed since our last inspection and was making a difference in the standards of cleanliness and hygiene at Stonesby House. We found some shortfalls around the environment where maintenance work had been overlooked but managers responded immediately with actions to ensure positive outcomes for people.

We inspected Stonesby House with the assistance of an expert by experience. We inspected four outcome areas: Care and welfare, safeguarding people who use services from abuse, cleanliness and infection control, and supporting workers. We found the outcome for: safeguarding people who use services from abuse, was non compliant with a minor impact on people using services. We found the staff supervision arrangements were inadequate and does not ensure the safeguarding of people using services. We found the outcome for: cleanliness and infection control was non compliant with a moderate impact on people who use services. Adequate systems were not in place to provide and maintain a clean environment and facilitate the prevention and control of infection.

The expert by experience interviewed five people who used services and two relatives. People who use services told us : Two people felt they were treated with dignity and respect. Another person said: "I have a keyworker. More time with her would be very nice." One person said: "Haven’t been to church lately, but would like to if someone would go with me." A relative told us: "Yes, more safe here than the other place (previous care home)." The person described in detail how staff had on a number of occasions handled accidents safely and in a timely fashion with care.

Some people living at Stonesby House had limited communication and were unable to answer direct questions about some of the essential standards we reviewed. We spoke with one person who uses services. We observed people and their interactions with each other and with staff. We saw people watching television and staff engage positively with people throughout our visit.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff worked as a team to ensure people's care and social needs were met. We saw people were not left alone for long periods. We saw staff treat people with respect and dignity.