Stonham Bradford provides support within the domestic environment and wider community to enable people to live independently in their own homes. At the time of this inspection the service supported seven people with personal care. Most people who used the service were adults who lived with a learning disability but the agency also provides care and support to older people, younger adults, people living with a physical disability and people living with mental health problems.

We inspected Stonham Bradford on the 21, 28 July 2017 and 4 August 2017. We announced the first day of inspection 48 hours prior to our arrival to make sure the registered manager would be available.

Our last inspection took place on the 7 and 8 December 2015 and at that time we found the service was not meeting one of the regulations we looked at. This related to safe care and treatment and the overall rating for the service was required improvement. This inspection was therefore carried out to see what improvements had been made since the last inspection.

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.

We found staff received training to protect people from harm and they were knowledgeable about reporting any suspected harm. Staff told us the training provided by the agency was very good and they received the training and support required to carry out their roles effectively.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Staff were aware of people’s needs and followed guidance to keep them safe.

The feedback we received from people who used the service or their relatives about the standard of care provided was consistently good and people told us staff were reliable and conscientious.

The support plans we looked at were person centred and were reviewed on a regular basis to make sure they provided accurate and up to date information. The staff we spoke with told us they used the support plans as working documents and the information provided enabled them to carry out their role effectively and in people's best interest.

People’s nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness and respect and promoted people’s independence and right to privacy. People received care that was personalised to meet their needs. People were supported to maintain their health and received their medicines as prescribed.

There were a sufficient number of staff employed for operational purposes and the staff recruitment process ensured only people suitable to work in the caring profession were employed.

The registered manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People told us they felt able to raise any concerns with the registered manager and felt these would be listened to and responded to effectively and in a timely manner.

There was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in service provision. Leadership within the service was well structured, open and transparent and promoted strong organisational values. This resulted in a caring culture that put people using the service at the centre. People, their relatives and staff were complimentary about the management team and how the service

The inspection took place on the 7 and 8 December 2015 and was announced. Our last inspection of this service was on 23 June 2014. We found they were compliant with the legal requirements reviewed during that inspection.

Stonham Bradford provides support within the home environment and wider community to enable people to live independently in their own homes. At the time of this inspection the service supported eight people with personal care. Most people who used the service were adults who lived with a learning disability, some also lived with dementia. The service also provided assistance to other people to enable them to access the local community, such as supporting them to do their shopping. However, this does not fall under the regulated activity of personal care and regulatory remit of the Commission.

The manager had registered with the Care Quality Commission (CQC) during the week of our inspection. This means that they were the registered manager. A registered manager is a person who has registered with the CQC 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 information kept in relation to people’s medicines was not always complete and up to date. This meant the systems for the management of medicines were not always safe.

Potential risks to people’s safety and wellbeing had been assessed and plans were in place to ensure they were effectively managed. Our review of records indicated a low level of accidents and incidents which suggested that risk was being effectively managed.

Care records contained detailed information about how to manage risk and were person centred. Minor improvements were needed to ensure the information within them was fully person centred. The manager had already recognised this and was in the process of reviewing and revising all care records. Staff had a good knowledge and understanding of the people they supported. People told us they received personalised care and that staff were responsive to their individual needs.

There were sufficient staff employed to ensure the safe operation of the service and to cover people’s visits. At the time of our inspection the service was not able to provide consistent weekend support. However, the manager told people about this before they began to use the service so that an informed decision could be made about whether the service was right for them.

The provider had procedures in place to help protect vulnerable people from the risk of harm. They used creative ways to ensure people who used the service and staff were educated about safeguarding and provided out of hours support so that people who used the service and staff had the ability to raise concerns with a manager at any time.

Staff received effective training, development and support to ensure they had the skills and knowledge to care for people. This included training on people’s specific health needs. Our discussions with people and staff showed us this training was translated into effective care to ensure people were kept safe and maintained good health. Staff actively sought opportunities to learn and amend their practices so that the quality of care provided was continually improved.

Where people were supported with meals staff ensured people consumed a varied diet and where possible encouraged people to maintain independence through planning and preparing their own meals and drinks.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and had a good knowledge of the people they supported and their capacity to make decisions.

The feedback we received about the standard of care was consistently good. People told us staff were kind, caring and treated them with dignity and respect. The service actively sought opportunities to help promote people’s independence and life skills.

People were involved in planning and reviewing their care to ensure the support they received met their needs and requirements. People told us staff regularly offered them choice and respected their opinions.

The provider had a variety of methods to seek the views of the people who used the service. This included care reviews, feedback questionnaires and a robust complaints procedure. Where people raised issues they were listened to and staff tried to make improvements to the quality of care they received. We saw examples where the service had used the feedback of people who used the service to help improve the quality of care provided. Staff were committed to ensuring the people who used their service had a voice and were listened to.

The provider had comprehensive governance systems and processes in place. We saw evidence some audits helped to identify and address areas where improvements were needed. However, some quality assurance processes needed to be refined to ensure they were consistently robust.

Staff were knowledgeable, confident in their role and responsibilities and demonstrated a strong awareness of how they applied the values of the organisation to their day to day work. Staff achievements were recognised and celebrated which helped to contribute to maintaining good staff morale. This showed us that the overall leadership of the service was effective.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take in relation to this at the back of the full version of the report.