Turning Point - The Cedars

Turning Point – The Cedars is a residential care home providing accommodation and personal care for up to 4 people. The service provides support to people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 3 people using the service.

People's experience of the service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood how to mitigate risks associated with people's care. They monitored people closely to identify any signs of deteriorating health and referred people to other healthcare professionals to improve their health outcomes. People received their medicines as prescribed from staff who were trained to administer them.

Right Care

People’s needs had been assessed and staff knew people well. Staff received regular training and support to ensure they had the skills and knowledge to meet people's needs safely and effectively. Staff had a good understanding of the Mental Capacity Act 2005 and their role in ensuring the voices of people with a learning disability were heard. They advocated on behalf of people to ensure decisions were made in their best interests. The registered manager and provider regularly checked the quality of people's care and used their findings to improve the quality of the service and to take learning from incidents.

Right Culture

The provider had systems to ensure people received person-centred care that achieved good outcomes. Staff had a good understanding of their role in ensuring people had a meaningful everyday life and were motivated to provide high standards of care. Staff felt supported in their role and were encouraged to give their feedback and make suggestions knowing they would be listened to. There was an inclusive culture where equality, diversity and inclusion were reflected and supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 1 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Turning Point – The Cedars on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People in care homes receive accommodation and nursing and/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.

There was a registered manager in post at the time of our visit. 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.

At our last comprehensive inspection in December 2015, we rated the service as Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager and staff assessed risks to people’s health and welfare and care plans provided accurate information for staff to minimise the identified risks. Staff and people had lived and worked at the home for a number of years and were familiar around each other’s company which helped people be relaxed with staff. We were confident staff knew people well and they continued to support and encourage people’s independence.

Staff knew how to keep people safe from the risk of abuse. There continued to be enough staff to meet people’s health needs and there continued to be flexibility in staffing levels, to make sure people received a safe, effective and responsive service.

People’s medicines were managed, stored and administered safely by trained and competent staff.

People continued to be cared for and supported by kind and compassionate staff. Staff understood people’s needs and abilities and they had the skills, training and experiences to do this effectively.

People were supported to have continued choice where possible, given their lack of capacity to make decisions. Staff offered people visual choice to stimulate and encourage people to make decisions. Staff respected people’s lack of capacity to make verbal decisions and always supported xxx (remove gap) them in the least restrictive way possible. Staff worked with each person to understand and improve their individual communication abilities.

Staff ensured people received support from other health professionals to maintain their physical and mental health and people were involved in how their care was delivered. Relatives were involved in care decisions with their family members and staff encouraged links with families.

Each person had a care and support plan with detailed information and guidance personal to them. Care plans included information on maintaining the person's health, their daily routines and preferences.

Staff told us they felt supported by the management team and by each other. The quality monitoring system demonstrated their systems continued to be effective and support good outcomes for people in their care. The provider, registered manager and staff’s focus was always to drive improvements within the service

Further information is in the detailed findings below.

The service had 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 refer to the registered manager as the manager in the body of this report.

During the day there were four members of staff on duty which meant people received one to one support with their individual needs. Staff told us the staffing levels enabled them to spend time with people inside and outside the home, and respond to requests for assistance without delay.

Staff had received training in safeguarding adults and were able to explain the correct procedure to follow if they had concerns. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with the people who lived there. Risk assessments around the provision of care and support had been carried out and action taken to reduce any identified risks. There were systems to ensure that medicines were stored and

administered safely.

New staff completed a thorough induction programme when they started work. Staff received training and had regular supervision and appraisal meetings in which their performance and development was discussed.

The provider understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority in accordance with the DoLS and at the time of our visit was awaiting the outcome of those applications.

People were encouraged to eat a varied diet that took account of their preferences and where necessary, their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals.

People were supported in a range of activities, both inside and outside the home. Activities outside the home enabled people to be part of their local community and to take regular holidays.

Staff were caring and encouraged people to be involved in decisions about their life and their support needs. People were supported to make decisions about their environment and choose how their room was decorated.

Each person had a care and support plan with detailed information and guidance personal to them. Care plans included information on maintaining the person’s health, their daily routines and preferences.

Staff told us they felt supported by the management team and by each other. Both staff and people were given opportunities to make suggestions on how the service was run. The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified, action plans were put in place to rectify these.

People living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences. We saw that people appeared comfortable and relaxed in their surroundings. We noted that staff had considered people's individual preferences whilst making sure that the service was homely for everyone.

People appeared at ease and relaxed around staff and approached them freely. A relative we spoke with told us they were happy with the care provided to their family member commenting, "She's been here a long time, they look after her very well."

People had care plans in place that contained information to assist staff with meeting their care and support needs. Staff we spoke with knew about people's needs and were able to tell us about them.

There were processes in place to ensure that medication was managed safely on people's behalf.

There were enough qualified, skilled and experienced staff who worked flexibly to meet people’s needs.

We saw that there were processes in place for monitoring and assessing the quality of the service provided for people.

The people who lived at The Cedars had complex needs which meant they were not able to tell us their experiences. We saw however people were relaxed and at ease with staff supporting them. We found that staff knew people as individuals and understood their personal needs and ways of communicating those needs.

We spoke to the relatives of two people who lived at The Cedars who told us they were happy with the care their family member received and had no concerns. They told us, “Care is very respectful” and “I can find no fault with the care.”

The home was warm and comfortably furnished with photographs displayed of people enjoying their holidays and other activities they did.

Each person had a care plan and these were written in a way that was easy for them to understand with the use of photographs and symbols.

Staff told us they felt supported by the manager and had the skills they needed to deliver the care people using the service needed.

We found procedures in place to protect people from harm and staff described how they would report any suspicion that a person who used the service had been at risk of harm.