Turning Point - Cumbria Learning Disabilities Supported Living

Turning Point Cumbria Learning Disabilities Supported Living Service provides personal care to people. At the time of the inspection the service was supporting 30 people with personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Records did not always demonstrate care was provided in the right way, including medicines records and consent records. Risk assessments were not always completed to assess known risks to people. People said they were encouraged to be as independent as possible. There had been improvements to the essential training of regular staff, but it was not clear if agency staff were sufficiently trained.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice but there were not always records in place to demonstrate this.

Right Care:

The service made sure there were enough regular and agency staff to support people and keep them safe. Regular staff knew people well and knew the most effective ways to communicate with people. Care was provided in a person-centred way although records did not always reflect outcomes for people. People said staff treated them with care and kindness and supported them to take part in their individually preferred activities and to follow their own lifestyles.

Right Culture:

The culture at the service was positive. People, relatives and staff said there had been improvements to the stability of the management of the service. Staff were complimentary about the values they share with their colleagues and the supportive team culture this created. The provider needed to improve record-keeping across a number of areas and to review quality assurance systems to support this going forward.

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 (published 27 August 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations but further improvements were needed to records.

This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 25 June 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staff training and skills.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Cumbria Learning Disabilities Supported Living Service on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about medicines records, consent and best interest records and ensuring identified actions are completed.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Some staff did not have enough training in essential and relevant areas. There were few staff deployed who could drive. People felt frustrated by this as it meant they did not have the independence to use their own mobility vehicles.

Infection control practices had improved since the last inspection, particularly relating to the COVID-19 pandemic. The management of medicines was now more closely scrutinised by the provider to ensure people received their medicines in a safe way.

People who used the service made positive comments about the improving management of the service and felt new seniors listened to them. They also said there had been so many changes in the past few months that they hoped for a period of stability now. People and relatives said there had been little opportunity to give their views over the past year and we have made a recommendation about this.

People said they felt safe with the support they receive. People had good relationships with senior staff and said they would raise concerns if necessary. Safeguarding processes were followed.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a focused inspection that considered Safe and Well-led areas. Based on our inspection of those areas the service was not fully able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People and staff said a small number of staff did not always support personalised care; and some people were disempowered by the lack of drivers. This was contrary to the provider’s own expectations and standards and they were looking at the culture and skill-mix within the services.

The provider was committed to improving the service. The provider had identified several areas that required remedial attention and there were action plans in place to achieve these.

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 (published 4 February 2021) and there were two breaches of regulation. We issued conditions on the provider’s registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and had met the conditions issued against their registration.

Why we inspected

We carried out a focused inspection of this service in December 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those 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 remained as requires improvement. This is based on the findings at this inspection. We have found evidence that the provider has made some improvements and taken action to address the previous breaches of regulations, but further time is required to fully address all areas and sustain good practice.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turning Point – Cumbria Learning Disability Supported Living on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Turning Point - Cumbria Learning Disabilities Supported Living is a supported living service providing personal care to people living with autism or a learning disability living in their own flats within five complexes. At the time of our inspection there were 31 people receiving support.

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

Infection control procedures, particularly related to Covid-19 were poor and immediate action needed to be taken.

Medicines management procedures needed to be improved. We were not assured that people received their medicines as prescribed.

Safeguarding procedures were embedded in the service and incidents and accidents were recorded and investigated. Recording systems were being reviewed as we found there had been a failure to notify the CQC of reportable incidents on some occasions.

There were quality assurance systems in place to monitor the service, including the support and care being provided were not robust and needed to be reviewed.

There were enough suitably recruited staff working at the service. It was recognised that a recent outbreak and ongoing Covid-19 restrictions had impacted on the service's staffing levels. We have made a recommendation regarding recruitment procedures.

Staff, particularly support staff, were reported to be kind and compassionate.

Communication throughout the service was described as very poor by staff, relatives and some healthcare professionals. This was raised with the senior management team to address.

People had been given the opportunity to feedback on their experiences, but it was not always clear if action had been taken. Relative feedback had not been sought for some time. We have made a recommendation in connection with this.

We expect health and social care providers to guarantee people living with autism or a learning disability have the choices, dignity, 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 assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

The provider had a model of support and care placing people at the centre of the choices and support they received. Relatives confirmed they were involved in decisions when people were less able to express choices themselves, although communication issues within the service had impacted on this. Staff told us the provider's ethos of maintaining people's privacy, dignity, human rights and choice were central to their daily procedures. However, the COVID-19 pandemic had placed limitations on practices because the provider was trying to follow government guidance to keep people safe but had not fully achieved this.

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 14 December 2017).

Why we inspected

We received concerns about infection control and a recent outbreak of Covid-19. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turning Point - Cumbria Learning Disabilities Supported Living on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions to keep people safe, and to hold providers to account, where it is necessary for us to do so.

We have identified breaches in relation to preventing and controlling infection, medicines and governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home 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.

This was an announced inspection that took place on 3 November 2017. The service was registered in October 2016 and this was the first inspection.

The service had a registered manager who was suitably qualified and experienced. 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.

Staff had received training on ensuring people were kept free from harm and abuse. They were confident in management dealing with any issues appropriately. Turning Point had a confidential phone line for staff to report any concerns.

Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and analysed and action taken to reduce risks.

We saw that staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had suitable disciplinary procedures in place.

Medicines were appropriately managed. People had their medicines reviewed by their GP and specialist health care providers.

Staff were trained in infection control and supported people in their own environment.

This new staff team had been supported to develop appropriately. Staff were keen to learn and we saw that induction, training and supervision had helped them to give good levels of care and support.

Staff received good levels of training around principles of care in relation to people living with a learning disability and/ or autism. They were trained in specific techniques to support each person. They also had general training on supporting people with behaviours that challenge. Restraint had not been used in this service.

Consent was sought, where possible. The manager and the local authority worked together to ensure the service operated within the Mental Capacity Act 2005. People were supported to have maximum 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.

People were supported to get good health care support from their own GP, specialist nurses and consultants. Staff worked with people to support and encourage them to visit dentists and other health care providers.

Staff supported people to shop, budget and cook. People were helped to take good nutrition and were encouraged to eat healthily

People in the service lived in their own flats that were secure and safe for people living with their particular disorder. Special assistive technology was used to ensure people were as safe as possible.

Staff we spoke to displayed a caring attitude. People in the service responded warmly to staff on duty. Staff understood how to support people to maintain their dignity and privacy. Staff showed both empathy and respect for people living with the symptoms of autism and learning disability. People in the service had access to advocacy but most people had a family member who took on this role.

Everyone supported by the service had been appropriately assessed. Each person had positive behavioural support plans in place as well as person centred plans that staff followed closely. These were created in an electronic format and staff changed them when needs and wishes changed. Very good reviews of care were in place helping people to get the best care possible.

People were encouraged to go out and to engage, where possible, with sport, learning and social events. Staff were aware of how difficult this was for some people and planning for activities was done at their own pace and in depth. We saw some good outcomes for people who were able to engage more with activities in the community.

Complaint procedures were in place. There had been no complaints received about the service.

The service had a suitably trained, qualified and experienced manager. Staff told us he was very visible in the service and easy to approach.

We judged that the registered manager had created a culture of openness and that staff worked in a non-discriminatory way. The atmosphere was one of enthusiasm and eagerness to give people the best care possible.

Turning Point had a suitable quality monitoring system used in all their services. This service used the quality assurance system. This was evident in internal audits and records of visits by senior officers of the provider. Good monitoring and analysis of the service was in place.

Staff and other people involved with the service were satisfied that the management arrangements were appropriate and that matters of governance were being followed to give good levels of care and support.