Archived: Turning Point - Derby

Turning Point – Derby supports adults to live as independently as possible who have a learning disability and/or autistic spectrum disorder and whose behaviour may challenge. At the time of our inspection, 11 people were receiving personal care and lived in their own properties or supported living accommodation.

People’s experience of using this service and what we found

People were protected from avoidable harm by care staff who were safely recruited and had sufficient training. People’s needs were assessed, and risks, including catching infections were managed safely. People received their medication safely by suitably trained staff. Audits ensured medication errors were quickly identified and rectified.

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. People were treated with dignity and respect. Staff spoke about people in a dignified way and knew their individual needs and preferences.

People received care that was kind, caring and compassionate. Staff promoted people's independence and maintained their privacy as much as possible.

When complaints were received, they were thoroughly investigated in a timely way by the provider. Actions were taken to resolve concerns. People had end of life care, staff and management had procedures in place to be able to support people with end of life care, including training and support from other professionals.

The registered manager and the management team understood their responsibilities in relation of their regulatory requirements. There was a honest and transparent culture and staff found the management reliable and supportive. Following incidents, lessons learnt were identified and shared to help make improvements. The provider was in a process of making good monitoring processes to continue to drive further improvements. The provider worked well with others involved in people's care to help ensure good outcomes for them. Peoples received individualised person-centred care.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 12 April 2021) and there were breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance.

At this inspection found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Turning Point – Derby supports adults to live as independently as possible who have a learning disability and/or autistic spectrum disorder and whose behaviour may challenge. At the time of our inspection, 11 people were receiving personal care and lived in their own properties or supported living accommodation.

People's experience of using this service and what we found

People were not always protected from harm, incidents and risks were not effectively reviewed to ensure that safe care could be provided in future.

At our last inspection staff had not received training, at our recent visit this had improved. Risk assessments and care plans had not always been effectively reviewed to ensure staff guidance was in place.

People in the main received their medicines safely. We identified that some improvements were needed to the written medicine guidance in place for staff.

There were sufficient staff employed and safe recruitment checks were completed, before staff commenced their employment at the service

Infection prevention and control best practice guidance had been implemented by the provider, including COVID-19 training being made available for staff.

The previous inspection identified concerns with the oversight of the service. This poor oversight had resulted in care not being provided in line with current standards. This inspection identified that required improvements had not been made. This was due to ineffective oversight at the service.

Rating at last inspection

The last rating for this service was requires improvement (published 23 October 2020).

Why we inspected

We inspected this service on 23 and 24 September 2020, we found breaches of regulation 12, 13 and 17. This resulted in a warning notice for the service. We returned to the service to follow up the breaches of regulation and see if sufficient improvement had been made.

We undertook a focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turning Point- Derby on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified an ongoing breach in relation to governance at the service. Full information about CQC's regulatory response to the more serious concerns found during inspections, is added to reports after any representations and appeals have been concluded.

Turning Point – Derby supports adults to live as independently as possible who have a learning disability and/or autistic spectrum disorder and whose behaviour may challenge. At the time of our inspection, eleven people were receiving personal care and lived in their own properties or supported living accommodation.

People’s experience of using this service and what we found

People were not always protected from harm, as safeguarding concerns were not always reported or analysed in an effective way. Not all staff had up to date safeguarding training. Medical advice was not consistently sought when injuries occurred.

There were risk assessments in place, however these had not always been updated when changes occurred and not all risks had been identified or mitigated effectively. This included people’s personal evacuation plans not being sufficiently detailed.

Gaps in staff training impacted on quality, safety and individual care needs being effectively and safely met.

The systems and processes in place to assess, manage and review quality and safety were not effective in mitigating and managing risks.

People in the main received their medicines safely. Hand written medicine records did not follow best practice guidance, of having two staff signatures. Whilst action was taken internally when medicine errors occurred, this had not always included a safeguarding referral to the local authority.

There were sufficient staff employed and safe recruitment checks were completed, before staff commenced their employment at the service.

Infection prevention and control best practice guidance had been implemented by the provider, including Covid 19 guidance made available for staff.

Rating at last inspection

The last rating for this service was Outstanding (published 20 February 2018).

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risks associated with choking. This inspection examined those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Outstanding to

Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has begun to take action to mitigate the risks we found and have provided CQC with an action plan.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turning Point Derby on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safeguarding, risk management, governance and how the provider notified CQC of reportable incidents.

Full information about CQC’s regulatory response to the more serious concerns found during inspections, is added to reports after any representations and appeals have been concluded.

Turning Point – Derby had 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.

Turning Point – Derby supports adults to live as independently as possible who have a learning disability and/or autistic spectrum disorder and whose behaviour may challenge. Staff provided personal care to eight people living in their own properties and to four people living in a single house of multi-occupation.

Turning Point – Derby was last inspected by the Care Quality Commission on 3 February 2016 and the report published on 22 March 2016. The overall rating for the service has improved from good to outstanding.

People receiving support from Turning Point –Derby received highly individualised person centred care. Support plans contained detailed and personalised care plans and we saw that people had been supported to have a full and meaningful life enjoying interests, taking part in new experiences and being active members of the local community. There was an emphasis on the need for good communication with a range of documentation being provided in way to assist people in accessing information.

The provider, registered manager and staff actively promoted a positive, inclusive and open culture, this approach has a positive impact on the quality of the service people received. The structure of the service worked for people, so that team leaders were always available to support staff and people when needed. The service worked in conjunction with other organisations to improve care for people with a learning disability. There were robust quality assurance systems in place which monitored the service, identifying potential areas for improvement, and actions were taken to improve these.

Staff were highly motivated and worked as a team and shared a common ethos of providing high quality, compassionate care with regard to people's individual wishes and support needs. Staff were valued, well supported and supervised by the management team.

Staff knew how to keep people safe, and how to report any concerns or incidents. The registered manager was proactive in learning from incidents and events, and had brought about changes to practices. There were enough staff to keep people safe, both within their home and the wider community.

Risks to people were identified promptly and effective and robust plans were put in place to minimise these risks, involving relevant people, such as people’s family members and other professionals. Comprehensive information was in place to guide staff, in the most effective approaches to use, which included Positive Behaviour Support, to enable staff to support people safely and reduce risk. Staff were knowledgeable about people’s support and care and we observed staff putting into practice a consistent approach to their care.

People were supported to take their medicine by staff. People's capacity to make informed decisions about medicines had been assessed and best interest decisions had been made. People received their medicines as they had been prescribed. The provider had committed the service to reviewing people’s medicine to decrease its use, in particular those used to manage people’s behaviour and emotions.

People’s needs were assessed and the assessment was used to develop comprehensive and individually tailored support plans. Staff took part in a robust induction programme with on-going training, which enabled them to provide effective care and support to people. Staff’s performance was regularly reviewed through on-going assessment and supervision.

People were supported with daily living tasks such as grocery shopping, meal preparation and cooking as part of their support packages. Staff encouraged people to eat a healthy diet. People's dietary requirements along with their likes and dislikes with regards to food and drink were recorded within their records. People were supported to access a range of health care professionals and staff worked in partnership with external agencies to ensure and promote people’s well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible; the policies and systems in the service supported this practice. Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA). We observed staff treated people as equals and individuals, offering them options whenever they engaged with them. Staff always endeavoured to enable people to maintain their independence and to make their own decisions.

People were supported by a consistent group of staff, in some instances staff had been specifically recruited to reflect people’s preferences, which included common areas of interest. Positive and caring relationships between people using the service and staff were evident, which had a positive impact on people’s quality of lives. People’s wishes and views were acted upon, and people were supported by family members and others involved in their lives to assist them in making decisions about their care.

Turning Point - Derby is registered to provide personal care and support for people with a learning disability and autism. At the time of our inspection there were 13 people using the service who resided within their own home. People’s packages of care varied dependent upon their needs, in some instances people were supported over a period of 24 hours.

People who used the service were unable to consent to our visiting and meeting with them to talk about the service due to their complex needs. We were advised that our visiting some people within their own home may cause people potential distress and anxiety, as people were not comfortable in the presence of people they did not know. We therefore spoke with a relative of someone who used the service and the staff who provided support.

Turning Point – Derby 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.

The inspection was facilitated by the supported living manager and regional manager as the registered manager was not available on the day of the inspection.

People we consulted told us they believed people’s safety was promoted and recognised by the support workers. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. Where people were at risk, staff had the information they needed to help keep them safe.

People were supported by knowledgeable staff that had a good understanding as to people’s needs. Staff provided tailored and individual support to keep people safe and to provide support if their behaviour became challenging. People were supported to take ‘positive risks’ to promote their independence in leading a lifestyle of their choosing.

People were supported to take their medicine by support staff. People’s capacity to make informed decisions about taking some medicines had been assessed and best interest decisions had been made. This was to ensure people’s needs were met when they themselves were not able to promote their own safety and welfare by making an informed decision.

People using the service had a dedicated team of staff that provided support to them within their own home and the wider community. People’s views as to staff along with those of their relatives were considered to ensure the staff that supported people had the appropriate skills and were able to develop a positive and trusting working relationship.

People received an effective service as people’s support plans provided clear guidance about their needs. These were monitored and reviewed by the management team and team leaders through the supervision and appraisal of staff, staff meetings and quality monitoring audits.

People were provided and supported in line with legislation and guidance. Staff had received training on the Mental Capacity Act (MCA) 2005. We found that capacity assessments had been carried out on aspects of people’s care and support. Where these assessments had identified that people did not have the capacity to make an informed decision, then their relatives and others involved in their care had an agreed plan of action so ensure any decisions taken were in the person’s best interest.

People were supported with daily living tasks such as grocery shopping, meal preparation and cooking as part of their support packages. Staff encouraged people to eat a healthy diet. People’s dietary requirements along with their likes and dislikes with regards to food and drink were recorded within their records.

Records showed staff, where support was required, liaised with people’s health care professionals to ensure they had access to appropriate medical care and support.

People were supported by staff who knew them well and had developed positive and trusting relationships that been established between the people receiving a service, their relatives and staff. Staff told us that part of their role was to support people to access the wider community and to encourage social interaction and independence. In discussion staff told us how they supported people’s privacy and dignity within the wider community and worked with them to promote their independence.

People’s support plans were tailored and individualised to meet their needs and reflected all aspects of their lives, including information and guidance as to the support they required within their own home and the wider community. People’s preference as to their hobbies, interests, goals and aspirations were also reflected.

Support plans were comprehensive and focused on the views of the person and how they wanted their support to be provided. There was an emphasis on the need for good communication to ensure people’s views were clearly understood which included information for when people’s behaviour was challenging.

Staff spoke positively of the management team in the support they provided to them. Staff said issues were effectively managed to ensure people received a good service. Staff said there were effective systems which enabled them to communicate well with their colleagues to ensure that people received the support they needed.

The managers who facilitated the inspection had a comprehensive understanding as to the needs of people and were able to tell us how staff provided support.

The provider had a robust quality assurance system which assessed the quality of the service. Information gathered as part of the quality audits was used to continually develop the service and looked for ways in which people using the service could achieve greater autonomy.

To protect people's identity we have used an x in place of names provided in quotes from relatives. Relatives we spoke with were positive about the support provided. Comments from relatives included 'I think the staff are very good and encourage independence.' And 'There are plenty of staff to support x and they are all very friendly and approachable, x seems very happy and we have regular contact.'

People's method of communication was recorded in their support plans. This ensured staff could support people according to their preference and choice.

People's preferences and the level of support they needed was delivered in line with their individual support plans

Records seen and discussions with the staff demonstrated that staff were supported in their job and provided with ongoing training to ensure they had the skills needed to support people effectively.

Systems were in place to monitor the care and services provided, and to identify and manage risks to ensure the service was run safely.