Turning Point - Avondale

Turning Point is a residential home for adults with learning disabilities. It provides accommodation for up to eight people. At the time of the inspection eight people were living there. People had their own bedrooms. There is a large communal dining/lounge area, garden and spacious corridors. The home is a purpose built building and offers ground floor accommodation only.

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

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes.

The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People were supported by staff who were trained effectively and recruited safely. Staff were knowledgeable about safeguarding practices and how to recognise the different types of abuse.

Medicines were managed, administered and stored safely. There were safe processes in place for the overall management of medicines. People had their medicines regularly reviewed which included the reduction in the use of psychotropic medicines to manage complex behaviours.

Risks were identified and risk management plans were in place and regularly reviewed.

People had their health and social care needs holistically assessed by a team of professionals. Care and support plans were individually developed, reviewed and audited by the management team. Care and support plans were detailed, contained people’s preferences and were developed in a pictorial format.

There were robust systems in place to monitor the quality of the service and make improvements where they were needed. The provider had good oversight of the service and the monitored outcomes.

People enjoyed a variety of activities, outings, holidays and community social networks. This had improved since the last inspection.

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 this practice.

There was a registered manager in post who had made significant improvements to the care and support of people living at Avondale. They had developed good relationships with staff and relatives and close working partnerships with professionals from the community disabilities service. We received very good feedback from everyone contacted.

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 21 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection took place on the 14 and 15 February 2017 and was unannounced.

There was a registered manager in post at 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.

Staff had the knowledge and confidence to identify safeguarding concerns and who to report these to. Staff told us they had received safeguarding training and we confirmed this from training records. Staff were aware of different types of abuse people may experience and the action they needed to take if they suspected abuse was happening.

Medicines were managed safely. We observed medicines being administered. Staff knew what medicines were for and explained to people what they were taking.

The ordering, storage and disposal of medicines was well managed. Stock levels were regularly checked to ensure there was sufficient medicines available to people according to what they had been prescribed.

Risk assessments had been completed and guidance on how to provide care in response to these were available in people’s care records.

Staff received regular supervision and annual appraisals which staff said were helpful and productive. Actions identified during these meetings were followed up as appropriate.

The service worked within the requirements of the Mental Capacity Act 2005. Where decisions were made in people’s best interests, documentation to support this was available in people’s care files.

People had access to health and social care services as required. Referrals were made as appropriate in response to changes to people’s needs. For example, GPs, physiotherapists, occupational therapists and speech and language therapists.

There were positive caring interactions from staff towards people using the service. Staff knew how to support people to be independent; giving them choices. People’s care records had details of their preferences, likes and dislikes. Staff were also aware of these and knew people well.

People participated in activities such as arts and crafts, puzzles and visits to day centres. People’s relatives told us there was sometimes a lack of interaction and stimulation for their family members and that very little happened at weekends. The registered manager told us they were currently in the process of improving activities within the home with a particular focus on encouraging people to be engaged with more routine day to day activities as well as improving and enhancing social activities.

Staff spoke highly of the registered manager and told us they were positive about some recent improvements such as the recent recruitment of new staff.

Systems were in place to track when staff training was due and to ensure this had been completed. Where staff were due training, this had been scheduled accordingly. Quality assurance processes were in place and action plans written and responded to following identification of shortfalls or issues.

The manager asked permission of two of the people living there for us to look at their bedrooms. This was willingly given and we could see their rooms were decorated and furnished to an individual taste with many personal items and photographs.

When we spoke with relatives, they told us that they were happy with the numbers of staff in the home and thought their training and experience levels were sufficient to meet the needs of their sons and daughters. One person told us 'all the staff here care and we are so lucky to have found a home like this'.

Three relatives told us they attended annual reviews with staff and relevant healthcare professionals. They confirmed this enabled them all to discuss the care and treatment provided and how effective it had been. One relative told us they could speak to any of the staff anytime to give feedback, and offer suggestions about what could be done better.

The manager explained to us the provider had engaged the services of an external advocacy group to support people who used the service or their relatives, should they wish to make a complaint or concern. They told us she preferred to have an open dialogue with all the relatives of people in the home to enable any comments or concerns to be dealt with on an informal basis. All three of the relatives we spoke with confirmed this was correct and any comments they had made were all acted upon.

The relative we spoke with was very satisfied with the care and support provided. They told us they were fully involved in their relative's care, staff kept them informed of anything relevant regarding the health and welfare of their relative. 'The staff are caring and experienced and know my relative very well.'

We observed interaction between staff and the people who were at the home during our visit. We found staff had a wide knowledge of people's interests and abilities, which was used to support people to maintain activities relevant to them. Staff offered people choices and showed understanding of how people communicated.

Staff kept full notes of changes in person's wellbeing and requested medical attention for people in a timely way. We observed staff provided care and support in line with people's care plans.

Staff told us they were clear about their safeguarding responsibilities and how they would respond to any suspicion of abuse.

People told us they would speak to any of the staff if they had any concerns and were confident any concerns would be dealt with promptly and effectively.

Staff told us they received training on a regular basis that enabled them to carry out their job and they had opportunities to express views and opinions about how the service was run.