The Turrets Residential Care Home

We found the following examples of good practice.

People we spoke with told us, "I feel safe. I am not frightened” and “I stay in my room at the moment by choice due to the outbreak. I feel safe in here” and “When I am able to go out, I wear a mask in public to try and keep us all safe”. The staff that were spoke with told us, “Yes I am ok. We just have to pull together like we are doing and support each other” and “We have a good team and support each other. I do feel supported”.

Staff followed safe infection prevention and control procedures, including the safe wearing and disposal of personal protective equipment (PPE). The home had a good level of cleanliness and was hygienic throughout. Domestic and care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was cheerful and calm. We observed staff were attending to people's needs throughout our visit.

There was a clear process for visitors. Visitors were required to wash their hands as they entered and left the home. Visitors were required to have their temperature taken and were asked if they had any symptoms. A Covid risk assessment was completed. They were asked to wear PPE which included a face mask.

Visitors were required to sign in and they had to show a negative lateral flow test. The vaccination status was checked for health and social care professionals and contractors. This was in line with legislation that had come into effect in November 2021.

People were supported to see friends and family in accordance with government guidance. At the time of the inspection the home was closed due to a Covid outbreak. Five people were isolating in their rooms. People were supported to maintain contact with relatives by the telephone and video call. The home used a social media messaging system which people could access. Some people had their own mobile phones and tablets.

The registered manager told us people’s significant others had been asked if they wanted to become the essential carer giver for their relative. This meant they will still able to visit during an outbreak at the home. In order to become an essential care giver, set procedures were to be followed. This included participating in regular testing for Covid.

Lounge chairs were distanced from each other. The middle seats on lounge sofas had been taped up so people were not able to sit close to each other. These social distancing measures were in place to help protect people.

Staff had received training in COVID-19, and infection prevention and control. Information and ongoing government guidance in the management of COVID-19 was shared with staff.

Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate in line with current guidance to reduce the risk of introducing infection. People's health and well-being was carefully monitored during this time. A regular programme of testing for COVID-19 was in place for staff and people living in the home. This meant swift action could be taken when any positive results were received.

The registered manager told us they were not experiencing any workforce pressures and that staffing was manageable. The home was advertising for support staff. We were told the staff team picked up extra hours as overtime, but this was monitored to ensure staff were not over worked. The registered manager and deputy worked flexibly to ensure shifts were covered.

The Turrets Residential Care Home is a care home providing personal care to a maximum of 19 people with a physical disability, learning disability or mental health diagnosis. The home was located within a community setting. Each person had they own room, shared bathroom facilities and communal areas. A small enclosed garden was situated within the grounds. At the time of our inspection, 19 people were living at the home.

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

The safety of people who lived at the home was taken seriously and the registered manager and staff were aware of their responsibility to protect people's health and wellbeing. People were confident to raise any concerns they had with staff and the registered manager. Risk assessments had been developed to minimise the potential risk of harm to people.

Staff's suitability to work with vulnerable adults at the home had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken. Staffing levels were sufficient to meet people’s needs and protected them from harm. People received their medicines as required, from trained and competent staff. Staff ensured people were protected from the risk of acquiring an infection during the provision of their care.

Staff had received training to meet the needs of people who lived at the home. They had also received regular supervision and an appraisal of their work performance. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The home 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's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff were kind, understanding, and compassionate. People had good relationships with staff. They told us the staff were kind and caring. Staff were non-discriminatory towards people in the home and treated them with dignity and respect.

People were supported by a registered manager and staff who knew people's personal and individual needs well. Care was personalised with people’s communication needs met.

The registered manager understood their role to promote a positive culture which was person-centred and empowering. Staff commented that the registered manager was supportive and open. Quality monitoring systems were in place, and the provider completed various audits to assist them in monitoring and helping them to identify how to improve people's experiences.

Rating at last inspection: The last rating for this service was good (published August 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Turrets Residential Care Home provides accommodation and personal care for up to 17 people. At the time of our visit there were 17 people living at the home. The home is also registered to provide personal care to people who lived nearby in a supported living service. At the time of our inspection no persons received the regulated activity of personal care at the supported living service.

There was a not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. At the time of our inspection the manager had applied to the Care Quality Commission to become the homes registered manager.

People told us they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse.

People were provided with safe care by adequate numbers of appropriately skilled staff being made available. Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only the appropriate people were employed to work at the home

The manager and staff understood their role and responsibilities to protect people from harm. Risks had been assessed and appropriate assessments were in place to reduce or eliminate the risk.

Medicines were handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people's prescribed medicine had been given.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aimed to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. Staff had an understanding of the Mental Capacity Act 2005 (MCA) and how it applied to their work. Records showed appropriate mental capacity assessments had been carried out.

Staff had the right skills and training to support people appropriately. People told us they felt there were enough staff available on each shift to care for them well. Staff felt well supported by the manager and received regular supervision sessions and appraisals.

Staff ensured people's privacy and dignity was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed atmosphere which resulted in a calm and friendly culture in the home.

People had access to a range of healthcare professionals when they required specialist help. Care records showed advice had been sought from a range of health and social care professionals.

People had their nutritional needs assessed and monitored and were supported to enjoy a range of food and drink of their choice throughout the day.

People were actively encouraged to provide feedback. Any complaints were investigated and action taken to address concerns when needed. People and their relatives told us they had no complaints.

The home was well led and the management promoted a positive culture that was open and transparent. The manager demonstrated good visible leadership and understood their responsibilities. Quality assurance practices were robust and used to make improvements.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We spoke with eight people who used the service and with three people's relatives as part of our inspection.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people were treated with respect and dignity by the staff at The Turrets. People told us they felt safe and well cared for. Some of the people we spoke with told us, 'it is very nice, the staff are very good to me', 'the staff are all very kind to us they are all so caring'.

The environment looked satisfactorily maintained throughout. Equipment was properly maintained and we saw that it was serviced regularly. This was to ensure that people were not put at unnecessary risk from unsafe equipment in the home. For example we saw that the hoist that was used to assist one person with their mobility was serviced regularly.

There were effective systems in place to ensure that the provider, manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This keeps people safe because risks are identified and actions taken to minimise them.

The provider had a recruitment procedure in place that was robust .This meant people were protected because the risk of unsuitable staff being recruited were minimised

Is the service effective?

Peoples nutritional needs were properly met. Care records included suitable plans of care in place for people who were assessed as being at nutritional risk.

Staff understood that one of the aims of the home was to promote and encourage people to live as independently as possible. Each person we spoke with told us how much they enjoyed living at The Turrets. People told us they were able to do what they wanted to do at the home. People also went out into the community on a daily basis. We observed people who were going into town independently on the day of our inspection.

Is the service caring?

People had very positive comments to share with us about the staff and life at the home. One person told us, 'they are all lovely, they actually care about people'. Another person said, 'the staff are very good to me I would give them a 100 out of 10'.

We saw that the staff had a caring and attentive manner when they assisted people with their needs. We saw people being effectively supported with their range of needs. These included their mobility needs, nutritional, needs and prompting with personal care needs.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. The results from the survey were analysed by the provider. If there were shortfalls or concerns raised these were addressed by them.

People's preferences, interests and diverse needs had been set out in their care records. We saw that people received support from the staff in accordance with their wishes in their care records.

Is the service responsive?

People took part in a range of activities in and outside the home on a regular basis. People told us they were supported by the staff to be involved with their local community.

People knew how to express their views if they were unhappy. Everyone we spoke with said that the manager was always available and they could see them at any time if they had any concerns or complaints.

A representative of the provider visited the service regularly and consulted people to find out their views. They also worked shifts there to monitor the standards in the home.

Is the service well-led?

All of the eight people who used the service who we spoke with praised the kindness of the manager and the way the service was run. Examples of comments people made included 'the home is very well run', and 'the manager is lovely and very kind'.

The service has an effective quality assurance system in place. We saw information that showed that action was taken to address shortfall in the service promptly. This meant that the quality of the service was improving and developing.

Staff told us they had a good understanding of their roles and responsibilities. Staff also demonstrated that they had a good understanding of the philosophy of the home. This meant people who supported by staff who knew how to help them meet their needs.

Every person we spoke with told us how happy they were living at the Turrets. Examples of the comments people told us about what life was like for at the home included, 'the staff are very nice, they help us to go on holiday, the food is very nice and it's a very nice home ', and 'it's lovely here , the staff are lovely and I've got quite a few friends here'.

People who used the service were supported and encouraged to live an active fulfilling life at the Turrets and in the community.

People were able to eat a varied and nutritious choice of meals at the home. Menus were planned based on the choices and preferences of people who used the service.

People were assisted with their needs by staff who were who were effectively supervised to make sure ensure they were providing suitable care and assistance.

The provider had a suitable system to quality check the service people were receiving. People who used the service were actively involved in the quality checking process.