This inspection took place on 26 June 2018 and was unannounced. We last inspected this service in April 2016 and rated the service as Good. We found the provider was meeting the regulations, but improvements were needed in the management of medicines and risk assessments lacked the detail required to mitigate risks.

Stonesby Lodge 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 Lodge accommodates up to 12 people who have mental health needs. The accommodation is an adapted residential property and is provided over two floors. At the time of our inspection, there were nine people using 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.

The provider had not alerted potential safeguarding incidents to relevant agencies or made appropriate notifications. This meant external agencies were unable to take action to assess and evaluate potential or actual risks in order to ensure appropriate action was taken to keep people safe.

There was a lack of effective systems and processes to monitor the quality of the service and identify where improvements were needed. Informal systems were in place but were not effective in making improvements in the service.

Risk assessments were not sufficiently detailed to demonstrate effective assessment and evaluation of risks. Records did not provide the guidance and information on the actions staff needed to take to mitigate potential risks for people.

Medicines were in the main managed safely. However, further improvements were needed to ensure records relating to stock management were completed accurately and correctly.

There was a system in place to monitor accidents and incidents. However we found no analysis of these was done which would identify any trends to prevent further re-occurrences.

The people we spoke with said they felt safe as a result of the care and support they received and trusted staff who looked after them.

Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people using the service.

There were sufficient numbers of staff available to meet people's needs. Most staff had worked in the service for many years and knew people well, which supported consistent care.

Recruitment files did not demonstrate staff had always been recruited safely as key documents, such as employment references, had been archived and could not be located. The registered manager was in the process of updating these files.

People told us staff were well trained and provided effective care and support. We observed staff were confident and skilful in their interactions with people. The provider's training matrix, a central record of staff training, had not been kept up to date and there were gaps in records showing what training staff had undertaken. Staff told us they had completed a range of training which gave them the skills and knowledge they needed.

People were supported to eat a balanced diet and specific dietary needs were met. Staff encouraged people to make drinks and snacks if they were able. Staff ensured people had enough to eat and drink.

People were supported to access a range of health professionals to maintain their health and well-being. The service worked in partnership with other agencies and was pro-active in ensuring people had the care and treatment they needed.

People were supported to make decisions and choices about their care. Staff understood the principles of the

This inspection took place on 11 April 2016 and was unannounced. The service was last inspected in October 2013 and met all of the standards the we reviewed.

Stonesby Lodge provides accommodation and personal care for up to 12 adults with mental health needs. The service is situated close to the centre of Leicester and is a traditional residential setting. Accommodation is provided over two floors. The service has single bedrooms with shared bathing facilities. There were 10 people living in the service at the time of our inspection.

The service had a registered manager who had been in post for a number of years. 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 were supported to take their medicines as prescribed. However, the arrangements for the administration and storage of medicines required improvements to ensure that people were protected from possible errors. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions.Some risk assessments required more detail to provide staff with the guidance they needed to keep people safe. People who used the service told us they felt safe. There were good systems for supporting staff to report any allegation or suspicion of poor practice and staff were aware of the possible signs and symptoms of abuse.

There were enough staff to provide safe and effective care for people. Staff were skilled in meeting the needs of people living with mental health. Staff understood the specific needs of people living with mental health and how to respond when people were anxious. We saw that staff provided compassionate support that met people's needs.

People who used the service told us that they were happy with their care. They told us how they were included in how their care was provided. People told us about how staff helped them to stay as independent as possible. We saw that people were able to exercise choice in what they did and where they spent their time. People were supported to take part in activities of their choice to meet their social needs, including accessing the wider community. People had been asked what was important to them and how they liked to spend their time. Staff knew people well and used the information they had about people's history, aims and interests to tailor their support. This meant that people received personalised care that reflected their preferences and met their needs.

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 supported people to follow healthcare advice when provided.

Staff sought consent from people before providing care and treatment. People felt that staff respected them as individuals. The registered manager was in the process of completing mental capacity assessments for people to take into account the support people needed to make decisions.

Staff felt they were supported in their roles and the registered manager provided staff with clear guidance and leadership. Staff had completed the training they needed and we saw they used this knowledge to provide people with safe and effective care.

The registered manager operated an open culture in the service where the opinions of people who used the service and staff were valued and respected.

The registered manager assessed and monitored the quality of care provided. In addition to observations of staff working practices, the registered manager carried out audits on health and safety, care records and medicines within the home. We found that audits were not always effective

We spoke with two members of staff. We also reviewed information sent to us from the provider

The provider was able to show us a schedule which identified what the training requirements were for the staff, what training staff had completed and when their next update was due.

We asked the staff when they last received an appraisal. Both members of staff confirmed they had received an appraisal approximately three weeks ago.

We spoke with six people who used the service and four members of staff. We also reviewed five care records.

We spoke with six people who used the service and asked them their views in relation to the care they received. All the people spoke highly of the quality of care and support given. One person told us “I am supported to live independently. I am aware of my care plan and feel able to speak to the staff or manager at any time about my care and support”.

We observed a care worker carrying out the medication round at breakfast time. They were observed administering medication discreetly and at a pace that suited the individual.

The staff we spoke with confirmed they felt supported by the management however they did not attend formal supervisions. We asked the staff when they last received an appraisal. One member of staff explained they may have had an appraisal many years ago the other told us they had never had an appraisal.

We spoke to six people using the service and three members of staff. We looked at four care records and three staff files.

One person told us:” We sign our care plans. The staff read it to us so we understand it” and One member of staff we spoke with told us:” We speak to the people here on a daily basis and gain verbal consent. I always explain what is happening. If they say no, then no means no”.

The care records we reviewed contained personal details, including life history, medical history, spiritual and social needs. Every care record we reviewed contained a hand written document, written by the person who used the service, which detailed how they were feeling, what they liked to do, if they liked where they were living and what their aims and objectives were.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. However the carpet along the corridors and stairs was worn, posing a trip hazard. The manager spoke to the owner during our visit and told us that the carpet would be replaced the following week.

People were made aware of the complaints system. One member of staff told us: “I would talk to the manager and if they didn’t give a response I would talk to the owner. I am an advocate for the people who use this service

We engaged in conversation with three people who used the service. They told us:

“The staff have been very kind and helpful with my care and I am very grateful.”

“We don’t get bored.”

“Staff have helped me to get where I am today.”

“The food is excellent.”

“We’re allowed to come and go as we please.”

“The home arranges a lot of themed evenings and trips out.”

“We have a laugh and a joke; it’s a good atmosphere here.”

Carers told us that they felt well supported, well trained and that they had been supported to develop their careers.