Turning Point - City of Manchester Learning Disabilities Supported Living

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service registered in July 2024. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The management team took responsibility for reporting and investigating incidents, accidents, and near misses. They ensured lessons were learned, which helped keep people safe. Policies and procedures were in place for managing accidents, near misses, and complaints.

Staff completed accident and incident forms when needed and sought guidance from professionals where required. Any advice received was shared as appropriate. Managers monitored all incidents for themes, trends, emerging patterns of behaviour, or any increase in frequency.

Staff understood how and when to report accidents and incidents. They felt confident raising concerns and said they would be listened to. Managers shared advice and strategies with staff through daily discussions, electronic systems, team meetings, care plans and notes, and staff supervision to support safe practice.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The registered manager carefully assessed people’s care needs before admission to assess if the provider could meet their needs, if the person was a suitable match for existing residents, and to plan for a smooth transition.

Where a person was considered suitable for the service, the manager arranged pre‑admission visits. A social worker praised the service for a recent transition into the service from an outside borough, they told us; “[Registered manager] created a plan that would suit the person… in aiding in the transition from [previous placement] to Manchester… the manager created a plan that benefitted all, ensuring this was person centred”. The social worker added “Following the transition the quality of support remained, the manager and team worked on creating a new life for this person with enjoyable activities, plans and routines. This person now has a better quality of life residing with others in which they get on well with, making lasting friendships and relationships”.

The provider prioritised continuity of care during hospital admissions. People had clear hospital passports to support them and clinical staff during hospital stays. To reduce distress and maintain safe continuity of care, the provider assigned staff to remain with individuals in hospital when necessary.

Staff acted quickly when making referrals to external professionals and arranging health appointments. They documented referrals, prepared people for appointments, and made reasonable adjustments in line with the Equality Act 2010.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Deprivation of Liberty Safeguards (DoLS) are a legal framework designed to protect people who lack capacity to consent to their care arrangements, and ensure any deprivation of their liberty is necessary, proportionate, and in their best interests. Providers are required to submit DoLS applications to the local authority where people lack capacity and are being deprived of their liberty in some way, for example, not being able to leave their home without support. DoLS applications had been submitted by the provider where needed and logs were in place within the home to help with monitoring applications and expiry dates.

Staff completed safeguarding training and accessed safeguarding policies and procedures. Staff understood their responsibilities and knew how to report concerns.

The provider promoted a safe environment, and all people and families told us they felt safe. One relative told us they felt “very confident” that their relative was kept safe.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

The provider maintained highly individualised and detailed risk assessments. These covered risks such as choking, financial exploitation, travelling, relationships, activities, and behavioural needs. Risk assessment included past behaviours and past histories that were relevant to current risk. Staff followed clear instructions within these assessments to manage risks while supporting people’s preferences. Where potential risks to others were identified, assessments included specific strategies for staff to follow.

People on modified diets had clear guidance outlining how staff must prepare and serve all foods and drinks. Epilepsy care plans were detailed and explained when escalation was required.

There was good evidence of well‑documented referrals and communication with external professionals, highlighting identified risks, the strategies in place, and whether these were effective. Staff followed up and escalated concerns when necessary.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider implemented systems to ensure the home environment was safe. They completed regular checks, including up‑to‑date safety certificates for gas, electric, and water, as well as routine checks of fire safety equipment. Appropriate equipment and evacuation plans were also in place.

When the provider identified issues, they raised these promptly with the housing provider and followed up to ensure the work was completed. They escalated outstanding repairs, and these were chased, recorded, and documented. The housing provider reported feeling confident that managers would raise relevant issues with them.

The manager had secured two separate amounts of additional funding to update outdoor spaces, so they were safe and accessible for everyone.

The provider worked closely with agencies and people to ensure the care home remained safe, habitable, and suitable for people’s needs. All areas of the home were well maintained, clean, and provided a safe, homely environment for people.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The provider operated a safe recruitment process and completed all required checks on new staff before they started work. These checks included confirming identity, obtaining references, and carrying out Disclosure and Barring Service (DBS) checks to help prevent unsuitable individuals from working with vulnerable people.

There were no staff vacancies, and staff retention was good. Regular staff provided consistent support for people who knew them well. Bank staff were employed, and agency staff had recently been used, although this was kept to a minimum. Agency staff worked only in the bungalows where several regular staff members were present to maintain continuity of care.

Senior staff spent part of their day working as part of the core staff group, undertaking support worker roles alongside their management responsibilities. This gave them direct insight into the needs of people and the staff they managed.

The provider used electronic recording systems to ensure training remained up to date and staff were supported through induction, supervision, and ongoing development. New staff completed an induction programme that included shadowing, getting to know the people supported, and completing mandatory training both face‑to‑face and online. Staff told us the training was good. Staff also received additional specialist training to support people’s individual needs. The registered manager had secured further specialist training as required; an external provider had provided training to staff to support safe romantic relationships for people and to encourage open dialogue between staff and people to ensure safety.

People and families we spoke to were overwhelmingly positive about staff and managers and expressed confidence in their abilities. One relative told us, “[support worker] is exceptional, no matter what the issue or the matter they are receptive and caring, they do the job because they love the job”. Another said, “They [staff] are very thoughtful and very decent people and it’s not just a job for them, I know people and I know it’s genuine”.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The first day of the assessment was unannounced. The home we visited that day was clean and odour‑free. On each visit to the bungalows, we found them clean with infection prevention and control (IPC) processes in place. Staff and people safely managed laundry, and people received support where required. Audits were in place to ensure IPC and cleaning was carried out.

Staff followed checklists to ensure the home remained clean. Bathrooms and toilets contained necessary products and equipment to ensure good cleanliness and hand‑hygiene. People also supported with cleaning tasks in their homes.

Personal protective equipment (PPE) was available for staff when needed. Staff underwent checks on practical skills and IPC knowledge to maintain safe practice.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff demonstrated safe medicines practice. All care staff had completed medicine awareness training, and staff and managers confidently explained the processes for medicine administration, ongoing training, and competency checks, including spot checks.

The service had an up‑to‑date medicines policy, and managers and staff carried out regular audits. These confirmed medicines were administered correctly and monitored the use of PRN medicines—those given only as needed, such as paracetamol. Some PRN medicine protocols were found in paper files, but most were online. Paper copies were removed to ensure consistency. Prior to this assessment manager audits had identified minor recording errors relating to creams, and these were promptly rectified. Evidence we reviewed confirmed good topical cream recordings.

Records we reviewed were clear and accurate. Medicines were stored safely, medicine quantities and stock checks were correct, and there had been no recent errors. Where medicine errors had occurred historically, appropriate actions were taken and staff were retrained.

The provider adhered to the NHS Stopping Over‑Medication of People with a Learning Disability and Autistic People (STOMP) programme. This national initiative ensures people receive psychotropic medicines only for the right reasons, at the lowest effective dose, and for the shortest appropriate duration. Care plans included STOMP reviews where needed, and staff held regular discussions with health professionals regarding medicines. Annual health and medication checks were completed with people.