Turketel Road

Turketel Road is a residential care home providing personal care to six people with a learning disability.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were supported by staff who knew them well and who treated them with care and compassion. Staff were supported to spend time getting to know people and to build trusting relationships with them. People and their loved ones were partners in planning their care and staff worked with people to develop their communication skills to enable them to give their views.

People decided on a daily basis what they would like to do, and staff supported this. People took part in a range of activities which they enjoyed and were supported by staff to try new things. 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. Relatives told us, and we saw that staff persevered and were committed to people expanding their experiences no matter how long this took.

People were supported to manage their health and staff worked with health care professionals to meet people’s needs. People’s medicines were managed safely and in the way, they preferred. People were involved in planning and cooking their own meals. Staff worked with people to expand the foods they would eat whilst respecting their choices.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People were supported to be part of their local community.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The manger and staff had a shared vision and set of values which focussed on supporting people to achieve their fullest potential. The manager and provider’s quality team carried out a range of audits to monitor the quality of the service. Staff were recruited safely and there were enough staff to meet people’s needs.

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 04 May 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

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.

We previously inspected this service in January 2016 and found breaches in legislation regarding the supervision of staff, management and security of medicines, management of complaints and the effectiveness of quality monitoring. We asked the provider to send us action plans of how they intended to address these shortfalls; which they did. This inspection was to review that the actions taken had been sustained as well as to undertake a comprehensive inspection of the whole service.

There was a registered manager in post who was available in the service Monday to Friday and was included in a telephone on call rota at weekends and out of hours to advise staff if needed. A registered manager is a person who is 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.

We checked previous shortfalls and found that medicines were managed well and previous concerns regarding security, storage and handwritten changes on medicine administration records had been addressed. Complaints were handled sensitively and a detailed record made of the action taken. Staff felt supported and listened to. There were improved opportunities for staff to meet with their supervisors individually to discuss development and training and an appraisal system was in place. Staff meetings were comprehensive and held more regularly. The comprehensive audit system to monitor service quality was working well and implemented more robustly to identify and address shortfalls.

All safety checks and tests of equipment and installations were routinely completed. There were enough skilled staff to support people every day to lead a fuller life. Safe recruitment procedures helped to ensure the suitability of new staff. New staff were inducted into their role and received appropriate training for this. All staff received regular mandatory and specialist training to ensure they had the skills and knowledge to support people appropriately and safely. Staff understood how to keep people safe and protect them from harm from others or in emergency situations.

People’s mental capacity was assessed and there was a clear culture of least restrictive practice. People were encouraged and enabled by staff to make every day basic care and support decisions for themselves but staff understood and were working to the principles of the Mental Capacity Act (MCA) 2005. The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. A DoLS authorisation was in place for all the people supported; these were reviewed and kept updated. The registered manager had a clear understanding of the criteria for making an application and ensured the service was meeting the requirements of the Deprivation of Liberty Safeguards.

Risks were appropriately assessed to ensure measures implemented kept people safe. Strategies were in place to guide staff in their support of people whose anxiety affected their behaviour from time to time. People were supported and enabled to develop their independence and learn new things within the limitations of their abilities and at a pace to suit them.

People’s needs were placed at the centre of the service. Relatives were able to contribute their thoughts and views through reviews, surveys and informal discussion. People were treated with dignity and respect. Staff understood people’s methods of communication. Staff interactions with people were gentle, patient and respectful. People could not use the complaints procedure but staff understood how they expressed their sadness and unhappiness and would look for the causes of this.

People chose for themselves each day what they wanted to eat. Staff encouraged them to eat healthily where possible but respected peoples choices where this may not be the case. People’s health and wellbeing was monitored closely and referrals were made to health professionals as and when required. People were supported to maintain their relationships with the important people in their lives. An individualised activity planner was in place for each person based on their interests and preferences; staff supported people with regular opportunities to attend activities outside the home.

The provider ensured policies and procedures guiding the support of staff were kept updated. The Care Quality Commission was appropriately notified of events that occurred in the service.

We have made one recommendation:

We recommend that the provider seeks out a competent person to install a door guard as per a previous fire risk recommendation to ensure as far as possible fire arrangements are not compromised.

We carried out this inspection on 5 January 2016. Turketel Road is a service for people with learning disabilities and autistic spectrum disorder. It provides accommodation for up to six people. At the time of inspection the service was full. At a previous inspection on 3 March 2014 we found the provider was meeting the requirements of the legislation we checked at that time.

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.

Improvements were needed to the way in which surplus medicines were stored, the security of where medicines were kept, and how changes in administration instructions were recorded.

Complaints information was available for relatives, and they told us they felt confident about raising any concerns they might have and that these would mostly be addressed. Relatives concerns however, were not always recorded to show these had been addressed and resolved.

A range of quality audits were in place to help the registered manager and provider monitor service quality and ensure standards were maintained, but these had not been fully effective in identifying the shortfalls highlighted by this inspection. The organisation did undertake surveys but not all relatives had been asked to comment and those that had never received feedback about any comments they had made.

Staff felt supported and listened to but did not receive regular formal support. Opportunities for more frequent one to one meetings with the registered manager, and more regular staff meetings was an area both the registered manager and provider representatives had identified for improvement, and plans were in hand for this.

Fire detection and alarm systems were maintained; staff knew how to protect people in the event of a fire as they had undertaken fire training but fire drills were infrequent. Peoples individual evacuation plans needed review with the fire service to ensure these met the requirements of legislation, and we have identified these as areas for improvement.

People were happy and comfortable in the presence of staff and actively sought their attention if they wanted something. People received individual support from staff that interacted well with them and showed that they understood people’s individual needs.

Relatives told us they were kept informed and had been consulted about their family members care and treatment plans, and felt there were informal routes where they were able to give feedback and felt their views were taken account of at service level.

Staff monitored people’s health and wellbeing and supported them to access routine and specialist health when this was needed. People ate a varied diet and menus took account of peoples individual preferences and dislikes.

People were given individual support with their interests and hobbies and also had their own daily planner that took account of their activity and interest preferences.

Assessments of risk people might be subjected to from their environment, from activities or risks associated with their assessed support needs were developed and measures implemented to reduce the likelihood of harm occurring; these were kept updated.

Staff understood people’s individual styles of communication; some people used new technology to give them more independence in making decisions for themselves.

Accidents and incidents were monitored by the provider to see where improvements could be made to prevent future occurrence. Individualised guidance was available for staff to help them understand how to work proactively with people whose behaviour could be challenging to others. The Care Quality Commission was kept informed of notifiable events when they arose.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Everyone in the service was subject to a DoLS; the registered manager understood when an application should be made and involved relatives in discussions through best interest meetings. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained to recognise abuse and knew how to protect people. They understood how to report concerns about the practice of other staff through the whistleblowing policy. Staff showed that they understood the actions they needed to take to raise concerns with the registered manager or with external agencies if this was necessary.

There were enough staff to meet people’s needs. Staff recruitment procedures ensured that all the necessary checks were made to protect people from unsuitable staff. Staff were provided with a wide range of essential and specialist training to help them understand and meet people’s needs.

People lived in a clean, well maintained environment. Decoration and furnishings were to a good standard and had been selected to withstand the level of wear and tear they received. People bedrooms had been personalised to reflect to their own interests and tastes and contained a range of personal possessions. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. Guidance was available to staff in the event of emergency events so they knew who to contact and what action to take to protect people.

We have made one recommendation:

We recommend that the provider should consult the Fire Service regarding the frequency of fire drills for day and night staff and that evacuation plans for people who may refuse to leave their rooms meet current fire legislation Regulatory Reform (Fire Safety) Order 2005.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

At our inspection on 22 August 2013 we identified concerns that people and their families had not always been involved in making decisions about their care. Risk assessments were not always in place documenting decisions made to manage risks to people and they did not always show the known risks being managed. The guidance in place to support people was not always followed by staff. People did not always receive the one to one support they required from staff to ensure their safety and welfare. The provider wrote to us and told us they would undertake a number of actions to address these matters by 11 January 2014. At this inspection we found that people's care plans and risk assessments had been reviewed and updated, people's relatives were involved in this process and we saw examples where relative's had signed their relative's care records to show their agreement with the support being provided. We saw that staff followed the written guidance in place to meet people's needs and people received the one to one support they required from staff to ensure their safety and welfare.

At our inspection on 22 August 2013 and on 10 October 213 we identified concerns that the written guidance available to staff about reporting adult protection concerns was not always consistent. At our inspection on 10 October 213 we found that the reporting process staff told us they would follow reflected the inconsistent guidance in place. At both inspections we found that staff had delayed reporting potential safeguarding concerns. The provider wrote to us and told us they would undertake a number of actions to address these matters by 11 January 2014. At this inspection we found that the flow chart of action staff should take when reporting a concern had been reviewed and updated, it did not match the adult protection policy in place about who to report concerns to, however, staff told us they only followed the flow chart. We saw that a senior staff member had followed both procedures when reporting a recent medication error to a senior staff member on the day that it had happened.

At our inspection on 22 August 2013 we identified concerns that the systems in place to assess and monitor the quality of the service were not always used on a regular basis and areas identified as requiring improvement were not always addressed. The provider wrote to us and told us they would undertake a number of actions to address these matters by 11 January 2014. At this inspection we saw that the systems in place were now used regularly and areas requiring improvement were actioned.

At this inspection we found that written guidance for staff to follow about reporting adult protection concerns had been reviewed but still did not provide staff with consistent information. We saw that all staff had recently completed adult protection training and half the staff had completed a competency questionnaire. However, the reporting process staff told us they would follow reflected the inconsistent guidance in place and a senior staff member had not followed the reporting procedure in place when reporting a recent medication error.

We found that people and their families had not always been involved in making decisions about their care. Risk assessments were not always in place documenting decisions made to manage risks to people and they did not always show the known risks being managed. The guidance in place to support people was not always followed by staff. People did not always receive the one to one support they required from staff to ensure their safety and welfare.

Staff we spoke with knew how to recognise signs of potential abuse and told us the action they would take in response to such a concern. There was information available about safeguarding vulnerable adults for staff to be able to reference. However, we saw that the guidance available about reporting adult protection concerns was not always consistent. We found that procedures were not always followed when reporting a recent incident of potential abuse, and during the inspection we heard an incident of an adult protection nature, the matter was referred to social services under safeguarding guidelines. The response to these adult protection concerns by staff, at several levels of responsibility within the organisation, indicated a failing to make suitable arrangements to ensure that people were protected against the risk of abuse by failing to take reasonable steps to identify the possibility of abuse and prevent it before it occurs and responding appropriately to any allegation of abuse.

The systems in place to assess and monitor the quality of the service were not always used on a regular basis and areas identified as requiring improvement were not always addressed.

We saw that staff were supportive and considerate of people's different needs. They knew the people well and had developed communication methods which enabled people to make their wishes known and allowed them to be understood. People appeared relaxed and comfortable with the staff and enjoyed the interaction when staff supported them.

People and their families were involved in making decisions about their care and support. They were given choices about their daily routines, such as when to get up and go to bed, what to eat and what to do each day. We saw that they had opportunities to choose and take part in activities and events which helped to develop daily living skills and offered access to the community.

People enjoyed the comfort of their bedroom which were personalised and well furnished together with free access to the lounge and other communal areas.