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Inspection carried out on 15 May 2017

During a routine inspection

Bull Point House and Annex is a residential care home for up to five people. It specialises in the care of people who have a learning disability and associated conditions such as autism. Each person has their own self-contained living accommodation within the home.

Some of the people who lived in the home had limited communication and used other methods of communication, for example pictures. We therefore used these and observations to understand people.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

People remained safe at the service. There were sufficient staff available to meet people's needs and support them with activities and trips out. Risk assessments had been completed to enable people to retain their independence and receive care with minimum risk to themselves or others. This is particularly important for people who may challenge others. People received their medicines safely.

The Provider Information Return (PIR) recorded; “Each individual has a Positive Behaviour Support Plan which is compiled on an individual basis, looking at behaviours specific to that individual, what their triggers are, signs for staff to look out for in advance and what staff can do at each level to either prevent the individual from escalating further, or how to keep the individual and those around them safe.”

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff were competent and well trained. People had the support needed to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals according to their individual needs.

The staff were very caring and people had built strong relationships with the staff. We observed staff being patient and kind. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices as much as possible in their day to day lives. Complaints were fully investigated and responded to. People were supported to take part in a wide range of activities and trips out according to their individual interests.

The service continued to be well led. Staff told us the registered manager was approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below

Inspection carried out on 27 February 2015

During a routine inspection

The inspection took place on 27 February 2015 and was unannounced. Bull Point House and Annex provides care and accommodation for up to five people with learning disabilities who each have their own self-contained living accommodation within the home. On the day of our visit four people were living in the service.

The service had a registered 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.

We visited each person during the inspection. We observed people and staff were relaxed in each other’s company and there was a calm atmosphere. When asked, people said; “yes - staff are kind.” Some of the people who lived in the service were not able to fully verbalise their views so people used other methods of communication, for example signs, symbols and pictures to aid communication and make choices. People told us they liked living in the home. One person was able to say they spoke with to the registered manager and staff and were happy to talk to them about any concerns. Staff had the knowledge of the various communication aids used by people to support them effectively.

Staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff felt confident any incidents or allegations would be fully investigated.

People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff were appropriately trained and understood what the medicines were for. They understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, consultant psychiatrists and social workers. People were also supported by Modus’s positive behavioural support team.

When people were asked about the care and support they received, they responded positively. People responded with a “yes” or “no” to questions asked or indicated with a smile that they were happy with the staff support. Care records were comprehensive and personalised to meet each person’s needs. Staff understood people’s individual needs and responded quickly when a person required assistance. People were involved as much as possible with their care records to say how they liked to be supported. People were offered choice and their preferences were respected.

People living in the service could be at high risk due to their individual needs and each person had two to one staff support. People’s risks were well managed and they were monitored at all times to help ensure they remained safe. People lived full and active lives and were supported to sample a wide range of activities. Activities were discussed and planned with people’s interests in mind.

People enjoyed the meals and they had access to snacks and drinks at all times. People were involved in planning menus and were able to say if meals were not to their liking.

People did not all have the capacity to make decisions for themselves, therefore staff made sure people had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff said the registered manager and management of the company were supportive and approachable. Staff talked positively about their roles. Comments included; “They (Modus management and registered manager) always put people first.”

People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in a variety of activities inside and outside of the home. Staff received a comprehensive induction programme. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs.

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as Psychiatrists and GPs. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

There were effective quality assurance systems in place. Any significant events were appropriately recorded and analysed. Evaluations of incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the home. People met with staff on a one to one base and were able to raise concerns. Feedback was sought from people living in the home, relatives, professionals and staff.

Inspection carried out on 3 July 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service because some people had complex needs which meant they were not all able to tell us their experiences.

We met most of the people who used the service and were able to speak with two people about the care they received. We checked the provider's records. We spoke to staff about the care given, looked at the care records of two people using the service. We looked at other records and observed staff working with them. We were able to discuss the care provided with two professionals. One professional said, “Best service I have ever seen for people with complex needs”.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. Staff introduced us and supported people to meet with us.

The staff demonstrated they had a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home.

We saw that people's care records described their needs and how those needs were met. We saw records that showed that best interest meetings had been held and people's mental capacity to make decisions had been assessed.

Inspection carried out on 1 December 2012

During a routine inspection

We met people who used services, talked with staff and checked the provider's records. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

All the people living in the home require a high number of staff to meet their needs; some people have two to one staffing at all times. We saw that staff treated people with consideration and respect. For example, we saw that staff responded to people’s needs to ensure that they were kept safe and informed about what was happening such as asking people if they wished to speak with us.

Care plans that we saw reflected people’s health and social care needs and demonstrated that other health and social care professionals were involved. We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to these three people, met with them, and observed staff working with them.

One person said, “The best home I have ever stayed in”.