Archived: Turning Point - Follybridge House

We carried out an unannounced comprehensive inspection of this service on 18,19 and 20 February 2019. Breaches of legal requirements were found. We issued two warning notices, which instructed the provider what areas and by when we expected improvement to made to the service.

We undertook this focused inspection to check they had made the necessary improvements and to confirm they now met legal 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 not changed from requires improvement. 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-Follybridge House on our website at www.cqc.org.uk.

Enforcement

During this inspection we have identified a breach to Regulation 18: (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 during this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

At the last inspection in February 2019 we found areas of concern relating to the safety and management of the service. We issued two warning notices. During this inspection we found improvements had been made to meet the requirements of the warning notices. However, some areas required further improvements. We found a breach of Regulation 18: (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 at this inspection. This was because the provider failed to inform the Commission of an accident a person experienced. The Commission is unable to monitor how care is provided in services if we do not receive notifications.

During this inspection we also made two recommendations this was because we found although improvements had been made to the cleanliness of the service this could be enhanced further. The second recommendation was in relation to the speed and efficiency of responses when there were problems with equipment or the environment. For example, although Legionella tests had been completed in March 2019 the results weren’t provided until July 2019. The provider failed to check on the results, which placed people at risk.

The service didn’t apply the full range of principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, due to the service’s location there were limited opportunities for independence and community inclusion.

The service was situated on a busy main road, there was no pavement and no local amenities. This resulted in people not being supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service has a registered manager in place, who was not present during the inspection. An acting manager was covering in their absence. They had brought about improvements throughout the service with the support of the provider.

We found the environment had been decorated throughout, minus the laundry room, the spare bedroom and the office. The service felt homelier and more attractive than at the previous inspection.

Staff recruitment practices had improved which meant people were protected from the risk of being cared for by inappropriate personnel.

People’s care plans had improved, and guidance was available to staff about how to care for people with diabetes. We discussed how these could be developed by including a description of hypoglycaemia (low blood sugar levels) and what action staff should take.

Medicines were managed and stored safely. Quality assurance audits had been completed and action plans recorded who was responsible and when the completion date was for any improvements.

Staff had received training in duty of candour this would enable them to comply with the regulation and to uphold an open and honest relationship with those they cared for.

The service worked in partnership with professionals and organisations to enhance the care they provided to people. For example, the local clinical commissioning group (CCG) supported the service and provided training and advice.

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 Requires Improvement report published (published 22 May 2019).

Following the previous inspection, we took enforcement action and issued two warning notices to the provider in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found some improvements had been made and the provider had met the requirements of the warning notices but was in breach of a Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Turning Point-Follybridge House is a residential care home registered to provide personal care up to six people who have a learning difficulty. At the time of our inspection five people lived at the service. The service was a large home, bigger than most domestic style properties. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where appropriate, advocates were employed to support people with making choices about their lives.

However, whilst people had individual support to exercise choice and control, this was limited by the wider environmental factors which inhibited people being included and playing an active role in their local community. The service was located on a busy main road with no pavement. There were no local amenities apart from a pub. This did not fully reflect the principles and values of Registering the Right Support. This meant the people living in the service experienced limited independence, and inclusion.

There was insufficient management input into the service to guarantee positive outcomes for people. The unsatisfactory management presence meant the service had not maintained its rating of good. This was because the provider had failed to monitor and review how care was provided, the performance of staff and the environment in which people were living. We have made a recommendation about staffing levels.

The environment had not been maintained in a way that reflected respect for the people living in the service. This was highlighted when labels were placed on people’s bedroom furniture to direct new staff where their clothes were stored. Inadequate maintenance had put people at risk of harm. The unhygienic environment meant people and staff were placed at risk of infection. Equipment had not been maintained in such a way as to be safe to people. In parts the environment of the building was unsafe, for example no window restrictors on one set of upstairs windows. We have made a recommendation about the premises.

Fire precautions were not all suitably maintained to ensure people’s safety was protected. Due to a lack of response from the provider we were not assured people were kept safe from the risk of legionella. Records related to the safe administration of medicines were not always accurate.

Medicines were not always stored securely.

Records related to the care of people were not always up to date or accurate. People’s health needs were not always documented.

Systems to ensure the safe employment, training and support for staff were not always followed. Gaps in candidate’s employment histories were not always investigated, staff training and competency assessments were not always completed.

People’s care plans reflected how they wished to be cared for, information included their personal preferences.

The registered manager knew what was required of them but had not been supported to carry out their role effectively. During our visit the team manager took immediate action to rectify as many things as was practicable. We found the registered manager and the team manager to be honest and open and they were cooperative with the inspection process. We have made a recommendation about the duty of candour, to ensure staff understood their responsibility to apply this to their work.

Information was being recorded in a respectful and dignified way about the people being cared for. Where records were up to date they were clear in their content and provided appropriate direction for staff in how to care for people. Where required assistance from external professionals was requested.

People’s health care needs were monitored. People had Health Action Plans in place which highlighted all their health needs.

Staff told us they felt supported by senior staff, even though they were disappointed at the amount of time the senior staff spent in the service. We observed the registered manager and the team manager had a strong working relationship and supported each other well. Overall the staff in the service were caring. They told us they worked well as a team. Mostly they respected each other and supported each other.

Rating at last inspection:

The previous inspection was carried out on the 26 May 2016. (Published on 30 June 2016). The service was rated Good at that time.

Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

We found a number of 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.

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

Turning Point – Follybridge House provides accommodation and personal care for up to six people. The service supports people of a variety of ages, who have learning disabilities. At the time of inspection, five people were living at the service.

There was 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.

People felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient numbers of staff available to meet people’s care and support needs

Effective recruitment processes were in place and followed by the service.

Medicines were stored, handled and administered safely within the service.

Staff members all had induction training when joining the service, as well as regular ongoing training.

Staff were well supported by the manager and had regular one to one time.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were able to choose the food and drink they had and staff were able to support people with this.

People were supported to access health appointments when necessary.

The staff supported people in a caring manner. They knew the people they were supporting well.

Where possible, people were involved in their own care planning and were able to contribute to the way in which they were supported.

People’s privacy and dignity was maintained at all times.

People were supported to take part in a range of activities and social interests.

The service had a complaints procedure in place and people knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action needed to be taken.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, their relatives, the staff who supported them and by looking at records.

We found that the home met the essential standards of quality and safety in all areas.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We found that the people were cared for in a relaxed, comfortable and well planned environment by caring staff. We observed staff care for people and saw that there was sufficient numbers of trained staff on duty. We saw affection between the staff and the people. There was a homely atmosphere, with the people at the centre of all activities.

Is the service responsive?

The people who lived in the home did not have verbal communication. However, we saw that they communicated with the staff effectively. We saw that staff understood their non-verbal requests easily. We saw that the people were comfortable with the staff and throughout the visit we saw that they made requests in a non- verbal manner for their needs to be met. All of the people attended day services during the week with one day off. On their day off staff took them on outings of their choice.

Is the service safe?

We saw that there was sufficient appropriately recruited staff to meet the needs and wishes of the people. We saw that staff were aware of risk management and the balance between promoting independence and keeping people safe. We saw that the premises were secure. Staff had been trained to recognise and respond to signs and allegations of abuse. We saw that great care had been taken to ensure people had free safe access to the gardens when they choose.

Is the service effective?

We looked at the care plans of two of the six people and found that people or their families had been involved in establishing what care was needed and how the people wanted it delivered. We saw that care plans gave detailed directions to staff to ensure the care they gave was effective. People’s body language was explained to staff and also what the people liked and disliked. All of the people had lived in the home for many years and there was a very low turnover of staff. The home had arranged for health professionals to visit and attend to people who were anxious about healthcare visits, such as a visit to the dentist, outside the home.

Is the service well led?

The home was managed in the best interests of the people who lived there. Staff told us that the manager was available to them should they need assistance. The manager supervised the staff while they are delivering care and if there were issues they were addressed. Staff were well trained in all aspects of care delivery. The manager was proactive in ensuring people in the home had optimum care and were offered stimulation and comforted by the staff who cared for them. Staff were supported in a relaxed manner and had time to spend with the manager so that they could raise issues that may impact on how they cared for people.

We saw that the people were treated with respect and that the staff attended to the people in a kind and caring manner.

The home had been refurbished and all the peoples’ bedrooms had been re-decorated. The rooms were personalised, large and airy.

There were sufficient staff on duty to meet the peoples’ needs and to ensure they had a good quality of life that included outings outside the home.

We saw care plans were pictorial as well as written and were person centred. They gave clear information on individual's preferences, choices and needs. For example we were told one person enjoyed being outside and had recently planted trees in the garden, alongside gardening in the greenhouse. Consideration had been given to identifying risks and appropriate risk assessments were in place.

There was a statement of purpose in place. This provided all required information about the service and would be useful to people looking for a care home placement.

We observed sufficient staff to meet the needs of the residents.

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 able to tell us their experiences. We spoke to the relatives of two people, who told us they were satisfied with the care provided. Their relatives were settled which indicated they were happy living there. They also said the staff kept them up to date with care arrangements, and staff responded quickly and appropriately to changing health needs. One person said they were pleased the residents were able to go out in the evenings and weekends in the minibus.