Gloucestershire Learning Disabilities Supported Living Service

Following an outbreak of COVID-19 at two of the four supported living settings we visited one setting which had not experienced an outbreak.

We were assured the service was following safe infection prevention and control procedures across all settings to keep people safe.

Turning Point is a supported living service. This service provides care and support to people living in four separate supported living settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. There were 30 people receiving the regulated activity of ‘personal care’ from Turning Point at the time of the inspection.

The care service has 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.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in June 2017 and the service was rated ‘Requires Improvement’ overall. At that inspection we found two breaches of the regulations. The registered person was not operating effective recruitment procedures. They did not ensure all the required information was obtained before appointing new staff. Risk assessments did not consistently provide clear guidance about the hazards people faced and how these were managed. Quality assurance systems had not always identified these shortfalls.

At this inspection, we found improvements have been made and the service has been rated ‘Good’ overall.

People received safe care and treatment. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, themes and trends had been analysed, and action had been taken to ensure people were safe. Arrangements were in place to minimise the risk of re-occurring risks.

Staff had received training appropriate to their role. People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities.

People were supported in a personalised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and could describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. Where required, people were supported to make decisions about end of life care which met their individual needs and preferences.

The service was well led. People, staff and relatives spoke positively about the registered manager. Quality assurance checks were in place and identified actions to improve the service. The registered manager sought feedback from people and their relatives to continually improve 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 were not always safeguarded against the risk of harm or injury. Risk assessments did not consistently provide clear guidance about the hazards people faced and how these were managed. Recruitment procedures were not as effective and robust as they could be as the provider had not always checked the reason why staff, who had previously worked in social care, had left their previous employment. Quality assurance audits had failed to identify these issues. Audits, both internal and external, had identified actions to be addressed to improve the service provided. This was work in progress and the registered manager and staff were making improvements to meet the recommendations identified.

People, overall, were supported with kindness and compassion. Staff understood their needs well and anticipated their emotions and wellbeing. They knew what would upset people and effectively used distraction to help them to stay calm. People communicated in a variety of ways and staff knew how to interpret this and how to communicate with them. People responded positively to staff and enjoyed spending time in their company. People were supported by enough staff who knew them and understood their care needs. People’s needs were complex and staff had received the appropriate training to help them support people. People’s changing needs were responded to and they had access to health care professionals to help them to stay well. People received their medicines safely and as prescribed.

People were supported by staff who had access to training to equip them with the skills and knowledge to meet their individual needs. Individual, group and annual performance meetings assisted staff in their professional development. Team meetings were used to pass on good news, best practice and information about the service. There were enough staff to meet people’s needs. Bank staff and the same agency staff were used to provide continuity of care. There were sufficient staff to ensure people had the appropriate support to access a range of community activities.

The registered manager was supported by three managers who were accessible and open. Staff were confident they would deal with any concerns they raised and the appropriate action would be taken. Staff knew how to recognise and report suspected abuse. Lessons had been learnt as a result of accidents and incidents and changes made to the systems in place. The provider closely monitored the quality of care provided through internal audits and reviews of accidents or incidents. Relatives were kept informed and involved about people using the service and had confidence in the management team.

We found two 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.