We carried out a review of the data available to us about Turning Point - Russell Terrace on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Turning Point - Russell Terrace, you can give feedback on this service.
Turning Point – Russell Terrace is registered to provide accommodation and personal care for up to 6 people. The service provides support to people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 4 people using the service.
People's experience of the service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
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 received their medicines as prescribed.
Right Care
People received safe care where their individual needs and preferences had been assessed. There were enough staff who knew people well and encouraged people to live the life they wanted.
Right Culture
The provider promoted a person-centred culture where people achieved good outcomes. Specialist support was accessible to ensure risks were managed and the regulations were met. This included Positive Behaviour Support practitioners and a clinical team including medical, pharmacy and psychology. Systems were operated effectively to ensure people were receiving care and support in line with Right Care, Right Support, Right Culture.
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 13 February 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Turning Point – Russell Terrace on our website at www.cqc.org.uk.
Follow Up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Turning Point Russell Terrace is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service is delivered from a large detached house near the town centre. The house is a two storey building and provides accommodation and personal care for up to six people with a learning disability or autistic spectrum disorder. Five people lived at the home on the day of our inspection visit.
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.
At the last inspection in December 2015 the service was rated as Good. At this inspection we found the quality of care had been maintained and people continued to receive a service that was safe, caring, effective and responsive to their needs. The rating remains 'Good'.
The care service had 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.
People and relatives had no concerns about safety or the security of the home. Staff understood their responsibilities to protect people from harm and challenge poor practice. Staff had a good understanding of the risks to people’s health and followed risk management plans to keep people safe without restricting them unnecessarily.
There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to help the registered manager determine their suitability to work with people who used the service. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively. People received their medicines as prescribed and staff maintained the cleanliness of the home to prevent the risk of infection.
Managers and staff worked in accordance with the Mental Capacity Act 2005. People’s ability to make specific decisions had been assessed and where they lacked capacity, staff made decisions on their behalf based on their knowledge of people’s preferences, likes and dislikes. More complex decisions involved families and other healthcare professionals involved in the person’s care.
Staff supported people to stay as healthy as possible. They ensured people had routine appointment to maintain their health and referred them to other healthcare professionals if their health fluctuated or deteriorated.
Staff were kind and patient with people and offered support when necessary. Staff knew how to communicate effectively with people and knew what was important to them. Staff valued each person’s individuality and personality and respected their diverse needs. People were supported to follow their interests and take part in social activities.
People and their relatives were involved in planning and reviewing their care. Information in care records ensured staff had the detail needed to ensure all care and support provided was based on the individual needs and preferences of each person.
Staff enjoyed working in the home. They described an open culture, where they communicated well with each other and had confidence in their colleagues and in the management team.
People and relatives were encouraged to provide feedback about the care they received and were confident action would be taken if they raised any issues or concerns.
This inspection took place on 7 December 2015 and was unannounced.
Russell Terrace is registered to provide accommodation and personal care for up to six people who have a learning disability or autistic spectrum disorder. The home has a lounge, kitchen, dining area, communal shower room and two bedrooms on the ground floor. The rest of the bedrooms are located on the first floor. There were four people living in the home at the time of our inspection.
At our last inspection in January 2014 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found there was no documentation in people's care records which confirmed the provider had assessed people's capacity to make their own choices and decisions about the care and support they received. The provider sent us an action plan telling us the improvements they were going to make by March 2014. At this inspection we found improvements had been made.
The service did not have a registered manager in post since 31 July 2015. A team leader managed the service and told us they would make an application to be registered with us. 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.
During the day there were three members of staff on duty and one person living at the home required one to one staff support. Staff told us the staffing levels enabled them to spend time with people in and away from the home, as well as being able to respond to requests for assistance without delay.
Staff received training in safeguarding adults and were able to explain the correct procedure to follow if they had concerns. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were suitable to work with the people who lived there. Risk assessments around the provision of care and support had been completed and reviewed regularly. Staff were proactive in reducing any identified or potential risks to people’s safety. There were systems to ensure that medicines were stored and administered safely.
New staff completed a thorough induction programme when they started work. Staff received training and had planned supervision and appraisal meetings to raise any issues, or discuss their personal objectives, training and performance.
Each person had a comprehensive care plan with detailed information and guidance that was personalised around their needs. Care plans included personal information, detailed life stories and information on maintaining the person’s health, their daily routines and preferences.
The provider understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority for four people living at the home, in accordance with the DoLS legal requirements. At the time of our visit, the manager was waiting for the outcome of those applications to be determined.
All four people at the home lacked capacity to make some decisions, however staff supported people to make day to day choices. Staff were caring and encouraged people to retain some of their independence, although this was limited, given people’s complex health needs.
People were encouraged to eat a balanced diet that took into account, their preferences and where necessary, their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of external healthcare professionals.
People were supported in a range of activities, both together and on an individual basis that matched their personal choices. Activities outside the home enabled people to be part of their local community.
Staff told us they felt supported by the management team and each other. Both staff and people were given opportunities to make suggestions about how the service was run. The team leader and the provider completed regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified, action plans were put in place to rectify these.
We looked to see if consent to care had been obtained for people who lived at the service. We found there was a lack of signed documentation in place to confirm this.
We saw that care staff knew people well and spoke with them in a friendly, respectful way.
We saw that staff were sensitive to people's needs and offered them support when assistance was requested or indicated.
A family member we spoke with told us, "On the whole the family are very happy.'
People were supported to take part in recreational activities that were interesting and stimulating so that they had a meaningful lifestyle. People were able to choose what activities to be involved in. This included shopping, outings and swimming.
Systems were in place to ensure that medicines were managed safely on people's behalf.
Staff told us they were supported well and were positive about working for the organisation. They told us they had received the relevant training to provide effective care for people who used the service.
We saw that complaints processes were in place for people to use if they were not happy with the service provided.
Staff demonstrated that they understood people's personal needs and the ways they communicated those needs.
We saw that the home was clean and well maintained. We saw that people's bedrooms were personalised and had pictures and photos of them on the wall.
On the day of our visit a family cupcake and coffee Christmas celebration was being held in the home. All the people who lived in the home took part in the event and some relatives attended. Everyone who lived at the home enjoyed the celebration.
We spoke with a relative who told us they thought their family member was 'really well looked after' and that they were 'happy here'.
There were no visitors, either relatives or health care professionals, in the home on the day of the visit but we met an assessor from the local college who had been observing a member of staff working towards an NVQ qualification. This person told us that the home was 'lovely' and offered 'very good care.'
We asked people about the care and support provided to them and looked at the care planning documentation to see what guidance was given to staff, to ensure that people received their care as they required to meet their needs and identified ways, where appropriate, to promote them being independent.
Due to the needs of some people living at the home who were unable to verbally share their experiences, we spent some time observing the support given to people and how they spent their day. We joined them for breakfast and observed how staff offered people care and support, how they offered them choices and how staff spoke with them.
We observed that staff treated people kindly and respectfully and demonstrated that they knew them as individuals and understood their personal needs. We found that wherever possible people were encouraged to be independent and were offered personal choice.
We saw that care planning documentation focused on the person as an individual and identified areas of personal concerns, things that were important to people and identified strengths as well as support needs. We looked specifically at a person's care plan who required specific support, to see what guidelines there were for staff to follow. We found care plans identified areas of risk and guidance where people required urgent intervention to keep them safe.
We looked at the food available and the choices people were given over what they ate. People spoken with said that they enjoyed the food. We saw that people were able to choose but were guided towards making healthy choices. We saw that arrangements were made for people who required a special diet.
We saw that the staff team was very stable and able to offer continuity of care to people. Two of the staff on duty had worked there for a number of years and one staff member had worked there for a few months. We saw that this person had been inducted well into the home and told us that she felt well informed.
Staff spoken with told us that they would recommend working there and that they were offered training and support from managers. One staff member said 'Support is very good; if I have doubts I discuss them. She (the manager) says how I am getting on and where I need to be better.'