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Archived: Turning Point - Wiltshire

Overall: Good read more about inspection ratings

1st Floor, 62 Stratford Road, Salisbury, Wiltshire, SP1 3JN (01722) 820950

Provided and run by:
Turning Point

All Inspections

9 November 2016

During a routine inspection

We carried out an inspection of Turning Point Wiltshire on 9 and 10 November 2016. This was an announced inspection where we gave the provider 48 hours’ notice. This was because the location provides a domiciliary care service and we wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

Turning Point Wiltshire is registered to provide personal care. The service provides 24 hour support to adults with learning disabilities and complex needs. The service operates from office premises in Salisbury. At the time of inspection there were 20 people using the service.

During the last inspection in August 2015, we found breaches of some of the legal requirements in the areas we looked at. Improvements were seen during this inspection which demonstrated the service had responded to our feedback and had implemented improvements in line with their action plan.

A registered manager was in place and available throughout the 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 2008 and associated Regulations about how the service is run.

People who used the service told us they felt safe. Staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were also aware of the whistleblowing procedure which was in place to report concerns and poor practice.

Staff and people’s relatives told us there were sufficient numbers of staff to provide people with the care and support they required. However, people’s relatives said staffing had occasionally been more difficult to cover at weekends where continuity of staff was not always possible when regular staff were not available.

People’s medicines were managed safely and Medicines Administration Records (MAR) completed accurately following administration of medicines. Staff received training in how to administer medicines and received regular assessments to ensure their competency was maintained.

Effective systems were in place to manage risk and ensure people were cared for in a safe way. Risk assessments had been completed and actions recorded to manage identified hazards and concerns.

Staff were knowledgeable about people’s needs and said they received training which gave them the confidence and necessary skills to provide the care people required. Staff received training around the Mental Capacity Act 2005. Details in people’s care plans regarding mental capacity assessments and best interest decision processes were well documented. Staff explained they understood the importance of ensuring people agreed to the support they provided.

Staff spoke fondly about the people they supported and gave good examples of how they developed positive relationships with them. Staff spoke about how they helped people retain their independence and encouraged them to be in control of their decision making and choices. People and their relatives told us staff were caring and regular staff had built good relationships with people they cared for.

A complaints procedure was available and people we spoke with said they knew how to raise a complaint if they needed to. Complaints and concerns were handled in an appropriate way.

Staff were passionate about providing good quality care and said they felt supported by the management team. There was an open door culture and staff said the management team were very approachable.

People had the opportunity to give their views about the service. There was regular consultation with staff, people and/or their family members and their views were used to improve the service. Regular audits were completed to monitor service provision and to ensure the safety of people who used the service.

25 and 27 August and 1 September 2015

During a routine inspection

Turning Point Wiltshire is registered to provide personal care. The service provides 24 hour support to adults with learning disabilities and complex needs. The service operates from office premises in Salisbury.

This announced inspection took place on 25 and 27 August 2015 and 1 September 2015.

People were placed at risk from unsafe care and treatment because risks were not reduced. Risk assessments were not reviewed following incidents and accidents to ensure that action plans were in place to lower the risk to people. Some people were at risk from poor moving and handling techniques. For example, one person was moved out of the bath by three staff following a seizure when this person was not able to bear their own weight.

People were placed at risk from unsafe medicine systems. Some repeat prescriptions were not requested in a timely manner and some people were not having their medicines at the prescribed times. Arrangements were not in place for staff to administer medicines at locations where lone working staff were not competent to administer medicines unsupervised. Staff were not signing medicine administration records (MAR) charts or food and fluid monitoring charts when prescribed thickeners were used in fluids.

The members of staff and relatives we spoke with raised concerns about the changes in staffing. Relatives were concerned the staff changes were having significant impact on their family members as changes in behaviours may not be recognised or activities that mattered to people were discontinued. Healthcare professional raised concerns about the lack of routine and changes in staff which meant appropriate guidance was not always followed on how to support people. For example, supporting people with eating and drinking.

Some people were placed at risk from the processes followed by staff when people’s capacity to make decisions was assessed. Some people were assessed as lacking capacity although they had fluctuating capacity to make decisions. Best interest decisions did not accompany mental capacity assessments.

People benefit from ongoing healthcare. People told us they were accompanied by the staff on healthcare appointments. Health action plans and hospital passports were developed to ensure important information was available to medical staff in the event of an admission. One epilepsy profile, we looked at, was not reviewed following epilepsy seizures and healthcare professional’s advice was not sought following an episode. This meant people may not be receiving the most appropriate care and treatment needed when they experienced an epilepsy seizure.

Members of staff attended training but one to one meetings were not always regular. This meant staff did not benefit from meetings with their line manager where they discussed training needs, concerns and their performance.

People were not supported with their preferences and the staff were not always respectful of people’s rights. For example, one person had to drink only decaffeinated coffee because they became “hyper.” We saw at one location only staff were able to lock the bathroom door. At another location we saw listening devices were left on in a communal area where people and visitors in the vicinity could hear.

Information recorded about people’s preferences was not always up to date. Support plans were not monitored or reviewed to assess the progress or effectiveness. Some staff said they read the most appropriate section of the support plans. They said when they arrived on duty they had "handovers" during which they were told about people’s daily health and wellbeing. On the first day of our inspection visit the registered manager said that we were "currently updating support plans, and that training on support plans had been completed by all staff."

The culture of the service was described by a visiting professional as 'transient' [lasting a short time] as staff were constantly changing. Staff said the culture was improving but more improvements were needed to enable them to have trust in the organisation. Members of staff said the morale was low as they were often moved  to different locations and people were not receiving consistent care by staff who knew them. They said there was a lack of leadership as team leaders were not designated to all locations. They said team leaders were shared in some locations.  The registered manager said staff were moved to locations were their strengths were needed and their preference of location was considered.

Staff helped people to understand the options available for example by using pictures and easy read formats. Day to day care was delivered with compassion. People were supported to maintain links with friends and relatives. Relatives said the staff were caring and their family members liked the staff. People had access to voluntary organisations to help them with the bereavements process and advocacy support.

People experienced a variety of activities mainly provided by their day care service. People knew who to approach with their concerns. Relatives said they felt confident to complain and their concerns were investigated. People were given easy read information on how to raise complaints.

People said they felt safe with the staff. Relatives said the staff reported allegations of abuse and statutory organisations had investigated the allegations. Members of staff knew the signs of abuse and the procedure for reporting abuse.

People’s views about the service were gathered through house meetings and surveys. Relatives said their views were gathered through forums and surveys. The agency received 10 surveys responses from people and their relatives. We saw from the responses that people were happy with the support they received from the staff.

We found breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

2 July 2013

During a routine inspection

We looked at six care records which confirmed people's mental capacity status had been reviewed. There was signed consent for information about the person's health to be shared with third parties, for example, their GP or other healthcare professionals in an emergency situation. There were also consent forms which covered personal care, support with medication and the use of photographs in care records.

We spoke with five relatives of people who used the service and they all told us their how staff were respectful and caring. One person said 'the staff are very professional and do a great job in quite difficult conditions'. Another relative told us 'my daughter has really come on leaps and bounds in the last two years thanks to the support she has had from staff'.

We saw evidence that there was a clear staffing structure in place with a good skill mix amongst staff on duty in each of the supported homes. We found people were supported by regular staff to ensure consistency of care.

The manager also described how senior care staff now worked 16 hours per week with people who use the service. This change had occurred since our last inspection and enabled the provider to get more feedback about how the service was provided.

Staff received training about the complaints process on an annual basis which was carried out by an external agency. We saw the records to verify this and staff we spoke with were clear about their responsibilities to help people using the service raise any concern or complaint.

28 January 2013

During a routine inspection

During the inspection we spoke with one person and two members of staff. As part of this inspection, shortly after our visit, we contacted three relatives.

Everyone we spoke withwas complimentary of the staff and were satisfied with the care and support provided.

Comments included: 'the staff are caring and experienced and know my relative very well. There is consistency in the staff which is very important for getting to know each other and reduces my relative's anxiety in not having to cope with changes.' Another relative said: 'I have plenty of opportunities to express my views regarding the care or treatment provided. I am kept very well informed of anything relevant to me regarding the health and welfare of my relative. The staff are well trained and aware of the importance of privacy and dignity, they are polite and respectful.'

People told us they were fully involved in decisions about how their care was delivered.

People told us they would speak to any of the staff if they had any concerns. In doing so, they were confident any concerns would be dealt with promptly and effectively. Two people told us they "always felt listened too.'

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