Turning Point - Bradford

Turning Point – Bradford provides care and support to people living in 14 supported living settings across Bradford. These are adapted houses or bungalows in the community, arranged so that people can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. At the time of the inspection the service was supporting 59 people.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: People received care and support to promote their independence. Positive risks were taken to ensure people could access the community and do the things that were important to them. 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.

Right Care: People received care from staff who knew them well and had received the right training and supervision. Medicines were managed safely. Risks to people’s health and safety were assessed and appropriate plans of care followed to keep people safe. People were safe from abuse, staff understood how to keep them safe, and action was taken to fully investigate any concerns.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People received good outcomes from the service through staff working closely with a multidisciplinary team to meet peoples’ goals and aspirations. Staff took responsibility for ensuring the service worked to a high standard and managers regularly audited and checked service quality.

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

Rating at last inspection and update

The last rating for this service was good (May 2018).

Why we inspected

This inspection was prompted due to the age of the previous rating.

Follow up

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

Turning Point – Bradford provides care and support to people living in three ‘supported living’ settings. Due to the nature of this inspection, we visited one of the supported living settings where six people were supported at the time of the inspection.

Why we inspected

The Care Quality Commission (CQC) have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about safeguarding, medicines management and leadership of the service. A decision was made for us to inspect and examine those risks.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. For example, we found the model of care and setting maximises people’s choice, control and independence and care was person-centred and promotes people’s dignity, privacy and human rights.

We observed staff to be caring and compassionate who clearly knew people well. Staff were supportive, provided positive encouragement and treated people with dignity and respect.

Staff we spoke with clearly understood their individual and collective responsibilities around safeguarding. Staff told us they felt able to speak up and challenge and report poor practice and that management would take concerns seriously.

The registered manager acknowledged there had been some historical issues within the service primarily centred around ensuring a consistent positive culture amongst some staff and maintaining quality standards. However, we were satisfied the registered manager and leadership team had acted appropriately in addressing these issues. We found no evidence of wider systemic issues within the service.

Medicines were managed safely. Systems for ordering, storage, administration and disposal were safe.

People were protected from the risk of acquiring infections as far as reasonably practicable.

Rating at last inspection

The last rating for this service was good (published 08 May 2018).

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

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 last inspection took place in August 2016 where we rated the service as ‘Requires Improvement’ and found a breach of three regulations relating to Safe Care and Treatment, Safeguarding and Good Governance. At this inspection we found the service had made improvements in these areas and was no longer in breach of any regulations.

This service provides care and support to people living in three ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection the service was supporting 10 people.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in place alongside the service manager. ‘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 protected from abuse whilst using the service. Staff had received training in safeguarding and understood how to keep people safe. Where concerns had been raised, we saw these had been dealt with appropriately by the service. Risks to people’s health and safety were assessed and care plans put in place for staff to follow. People were supported to take positive risks to ensure they could access the community and achieve their goals.

Overall, there were enough staff to ensure people received safe care and support, although some concerns were raised about staffing levels at one of the supported living houses. We saw plans were in place to address this. Safe recruitment procedures were operated to help ensure staff were of suitable character to work with vulnerable people.

Staff received a range of suitable training relevant to their role as a learning disabilities support worker. Staff said they felt well supported by the management team and happy in their role.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were involved in decision making and staff maximised people’s choice and control over their lives.

The service worked with a range of health professionals to help ensure individual needs were met. Advice from professionals was embedded into plans of care and systems were in place to transfer care plans and other key information between services.

People and relatives said staff were kind and caring. We observed staff had built a good rapport with people and knew them well. People’s independence was promoted and the service worked with people to build their confidence.

People’s care needs were assessed and detailed care plans put in place for staff to follow. These were subject to regular review. People had monthly review meetings to discuss their goals; however, these had fallen behind in some cases due to team leader absence.

People had access to a good range of activities and social opportunities. People were enabled to undertake the things they wanted to do on a daily basis.

Relatives and staff told us people had achieved positive support outcomes since being supported by the service demonstrating that it was effective in its purpose, of providing assistance to live independently. We found a person centred culture within the service focused on meeting people’s individual needs and preferences.

Systems were in place to check how the service was operating to ensure it maintained safe and effective working practices.

Turning Point Bradford delivers up to 24-hour support for adults with learning disabilities, giving them the necessary support and encouragement enabling them to live happy and fulfilled lives. The service is run as a supported living service, with people having tenancy agreements. Currently the service is across two houses in the Bradford area.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run. The registered manager was on annual leave during the first day of inspection.

People told us they felt safe and had no concerns about the way they were treated or supported.

Staff were aware of the signs and indicators of abuse. However we found examples of staff not reporting potential abuse appropriately. We observed people were comfortable and relaxed around staff. We observed that staff interaction with people was friendly, encouraging and caring.

We found people’s medicines were not always managed in accordance with safe procedures and improvements were needed.

We noted a number of checks had been completed before staff began working for the service. However background checks on people should be completed periodically and we found checks were completed at long intervals increasing the risk of potential abuse.

People told us they were given support and encouragement from staff to clean and maintain their houses. Staff gave us examples of how they supported people.

Staff were knowledgeable about people’s individual needs, backgrounds and personalities. People told us they were given privacy when they wanted. People were supported to maintain and build their independence skills both within their own home and as appropriate, in the community.

There were sufficient numbers of staff to provide support flexibly. People told us there was always staff around and they were not restricted by staffing levels.

There were systems in place to ensure staff received training, ongoing development, supervision and support.

People said they had been involved in discussions about the support they needed and wanted and were aware of their support plans. Processes were in place to monitor and respond to people’s health care needs and people were supported with eating and drinking depending on their individual circumstances.

People were supported to participate in a range of appropriate activities and jobs and to pursue their hobbies and interests. Activities were tailored to the individual and people told us they were what they wanted to do.

People told us they were aware of who to speak to if they were unhappy and were confident they would be listened to. The service had a complaints procedure in place and management were aware how to act in response.

There were systems in place to monitor staff practice, review the quality of information in people’s records and to obtain people’s feedback about the service provided. However we found the monitoring and auditing systems needed further development.

People did not express any concerns about the management and leadership arrangements.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.