Archived: Turning Point - Wiltshire

Turning Point Wiltshire is registered to provide personal care. The service provides 24 hour support to adults with learning disabilities and complex needs. The service operates from office premises in Salisbury.

This announced inspection took place on 25 and 27 August 2015 and 1 September 2015.

People were placed at risk from unsafe care and treatment because risks were not reduced. Risk assessments were not reviewed following incidents and accidents to ensure that action plans were in place to lower the risk to people. Some people were at risk from poor moving and handling techniques. For example, one person was moved out of the bath by three staff following a seizure when this person was not able to bear their own weight.

People were placed at risk from unsafe medicine systems. Some repeat prescriptions were not requested in a timely manner and some people were not having their medicines at the prescribed times. Arrangements were not in place for staff to administer medicines at locations where lone working staff were not competent to administer medicines unsupervised. Staff were not signing medicine administration records (MAR) charts or food and fluid monitoring charts when prescribed thickeners were used in fluids.

The members of staff and relatives we spoke with raised concerns about the changes in staffing. Relatives were concerned the staff changes were having significant impact on their family members as changes in behaviours may not be recognised or activities that mattered to people were discontinued. Healthcare professional raised concerns about the lack of routine and changes in staff which meant appropriate guidance was not always followed on how to support people. For example, supporting people with eating and drinking.

Some people were placed at risk from the processes followed by staff when people’s capacity to make decisions was assessed. Some people were assessed as lacking capacity although they had fluctuating capacity to make decisions. Best interest decisions did not accompany mental capacity assessments.

People benefit from ongoing healthcare. People told us they were accompanied by the staff on healthcare appointments. Health action plans and hospital passports were developed to ensure important information was available to medical staff in the event of an admission. One epilepsy profile, we looked at, was not reviewed following epilepsy seizures and healthcare professional’s advice was not sought following an episode. This meant people may not be receiving the most appropriate care and treatment needed when they experienced an epilepsy seizure.

Members of staff attended training but one to one meetings were not always regular. This meant staff did not benefit from meetings with their line manager where they discussed training needs, concerns and their performance.

People were not supported with their preferences and the staff were not always respectful of people’s rights. For example, one person had to drink only decaffeinated coffee because they became “hyper.” We saw at one location only staff were able to lock the bathroom door. At another location we saw listening devices were left on in a communal area where people and visitors in the vicinity could hear.

Information recorded about people’s preferences was not always up to date. Support plans were not monitored or reviewed to assess the progress or effectiveness. Some staff said they read the most appropriate section of the support plans. They said when they arrived on duty they had "handovers" during which they were told about people’s daily health and wellbeing. On the first day of our inspection visit the registered manager said that we were "currently updating support plans, and that training on support plans had been completed by all staff."

The culture of the service was described by a visiting professional as 'transient' [lasting a short time] as staff were constantly changing. Staff said the culture was improving but more improvements were needed to enable them to have trust in the organisation. Members of staff said the morale was low as they were often moved  to different locations and people were not receiving consistent care by staff who knew them. They said there was a lack of leadership as team leaders were not designated to all locations. They said team leaders were shared in some locations.  The registered manager said staff were moved to locations were their strengths were needed and their preference of location was considered.

Staff helped people to understand the options available for example by using pictures and easy read formats. Day to day care was delivered with compassion. People were supported to maintain links with friends and relatives. Relatives said the staff were caring and their family members liked the staff. People had access to voluntary organisations to help them with the bereavements process and advocacy support.

People experienced a variety of activities mainly provided by their day care service. People knew who to approach with their concerns. Relatives said they felt confident to complain and their concerns were investigated. People were given easy read information on how to raise complaints.

People said they felt safe with the staff. Relatives said the staff reported allegations of abuse and statutory organisations had investigated the allegations. Members of staff knew the signs of abuse and the procedure for reporting abuse.

People’s views about the service were gathered through house meetings and surveys. Relatives said their views were gathered through forums and surveys. The agency received 10 surveys responses from people and their relatives. We saw from the responses that people were happy with the support they received from the staff.

We found breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.