This inspection visit was carried out on 8 May 2018 and was unannounced.

At our last comprehensive inspection in May 2017 we rated the service as 'Requires Improvement'. We found although the provider had made improvements to the service, further improvement were needed to ensure adequate staff were deployed in the service at all times and quality assurance systems were effective in driving improvements in the service.

At this inspection, we found the provider had made improvements in the areas of staffing, but further improvements were needed to ensure care records were accurate and completed consistently, staff were effectively deployed and people were provided with personalised care. The overall rating for this inspection remained 'Requires Improvement.'

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

Stonesby House LTD accommodates up to 14 people across two buildings, one of which has been purpose built to support people to maintain and develop their daily living skills. Many of the people using the service have mental health needs.

The service had a registered manager who was new to 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.

There were limited systems in place to monitor the quality of the service. Some improvements had been identified and actions taken in response to concerns. However, there were no formal systems in place to monitor the quality of the service. The provider was not ensuring people received good care that was sustained and embedded in staff working practices as a minimum standard.

Staff demonstrated a good understanding of the actions they needed to take to keep people safe. Records showed potential risks to people had been assessed and provided guidance for staff on the actions they needed to take to keep people safe. Further improvements were needed to records to ensure staff were provided with the information and guidance they needed to manage behaviours that can challenge.

People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. The registered manager was in the process of organising and indexing staff files to ensure all recruitment information was organised and easily accessible. There were enough staff available to meet people's needs but they were not always deployed effectively to ensure people were safe.

Systems were in place to support staff to follow safe infection control procedures to prevent the risk of infection when providing care and support.

Accidents and incidents were reported and monitored. There were no formal systems to support the effective analyse of these to ensure lessons were learnt and appropriate action taken to improve safety across the service.

Staff were supported to complete the training they needed to provide effective care. They received on-going support and supervision to enable them to develop in their role. The registered manager had reviewed and evaluated training to ensure it was effective and based on best practice.

People's needs were assessed before they began to use the service. People were supported to make decisions and choices about their care. Staff understood the need for people to consent to their care and respected people's right to decline care and treatment in line with the Mental Capacity Act 2005. Staff ensured people's freedom was not restricted without appropriate legal authorisation.

People spoke of staff as being caring and kind. Staff felt they did not

This inspection was unannounced and took place on 2 March 2017. At our last inspection of the service in November 2015 we found the provider's arrangements for the storage, administration and recording of medicines were not sufficient to ensure people received their medicines safely. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection the provider told us about the action they were taking to rectify the breach. At this inspection we found that improvement made were sufficient to rectify the breach.

Stonesby House Ltd provides accommodation and personal care for up to 14 adults, many of whom have mental health needs. Accommodation is provided across two buildings, with many bedrooms providing private en-suite facilities. At the time of our visit, there were 13 people living at the service.

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 2008 and associated Regulations about how the service is run.

People felt safe in the service. Staff knew people well and understood their responsibilities to protect people from the risk of harm. There were usually enough staff to provide people's care, but arrangements to cover in the event of unplanned staff absence were not always sufficient to ensure staff provided care in a timely way. Action taken to recruit into vacant care staff posts, plans for a revised management structure and use of agency staff helped to mitigate the risk to people's safety from insufficient staffing arrangements.

People's medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them.

Staff were trained and supported to perform their role and responsibilities. The provider was in the process of supporting all staff to update their skills and knowledge and had developed a revised induction programme to ensure new staff were safely inducted to the service.

The service ensured people's rights and best interests by working within the principles of the Mental Capacity Act 2005 (MCA). Mental capacity assessments required further development to ensure staff were clear in how to support people to make specific decisions about their care and well-being.

People were positive about the food provided; they enjoyed their meals and were supported to eat and drink sufficient amounts. People were supported to maintain and improve their health and well-being. People were supported to access a range of external health professionals when they needed to.

People were appreciative of staff who were caring and helpful. Staff knew people well, treated people with respect and promoted their dignity, privacy and rights when they provided care. Staff ensured people's independence, known wishes and choices for their care was upheld.

People had their care needs assessed and care plans were put in place to meet their needs. Staff used the information in care plans to tailor their support to individual preferences. This meant that people received personalised care that reflected their wishes and met their needs.

A range of activities were organised for people in the service and within the local community. People spoke positively about being able to choose what they wanted to do when they wanted to do it and were happy with the opportunities provided.

People and relatives were confident they could raise any concerns with the registered manager and felt their complaints would be listened to and acted upon.

People, relatives and most staff had confidence in the management of the service. The registered manager undertook checks and audits to assure themselves that people were receiving good care. However, outcomes of quality assu

We carried out an unannounced inspection of this service on 17 November 2015. Stonesby House Ltd provides accommodation and personal care for up to nine adults with mental health needs. It is situated in the centre of Leicester, close to local amenities. The home has seven ground floor bedrooms and two first floor bedrooms, all with en suite facilities. The ground floor is accessible for people who use a wheelchair. There were seven people living in the service at the time of our inspection.

Stonesby House Ltd has a registered manager in place. 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 found a breach of regulation in relation to the management of medicines. We found that systems for recording, auditing and storing medicines were not robust and had the potential to put people at risk. . This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe in the home and that they trusted staff to look after them. They told us how the staff included them in decisions about the running of the home and how their care was provided. Throughout our inspection we saw examples of good care that helped make the home a place where people felt included and comfortable. People were treated with dignity and respect.

There were enough staff to provide safe and effective care for people. Staff working in the home understood the needs of the people who lived there. We saw that staff and people living in the home communicated well with each other and that people were enabled to make choices about how they lived their lives. People living in the home told us they were happy with their care.

People were supported to take part in a range of activities to meet their social needs. People had been asked what was important to them and how they liked to spend their time. Staff used this information to plan the activities provided. This meant that people were able to spend their time in the way they preferred.

The risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people's safety. This meant that people were protected from risks to their welfare whist being supported to be as independent as possible.

People were supported to have their mental and physical healthcare needs met and encouraged to maintain a healthy lifestyle. Staff made appropriate use of a range of health professionals and followed their advice when provided.

Staff told us they felt supported in their roles and the registered manager provided staff with clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care. Staff were clear in their roles and confident they could raise concerns with the registered manager. The registered manager had shown how they had learnt from incidents in the service and responded by making changes and improvements to improve care. This showed that the service was well-led.