Archived: Turning Point - Hampshire

Updated 2 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced comprehensive inspection took place on 7, 11 and 13 September 2018 and was carried out by one inspector. On 7 September 2018 we completed a site visit at the service registered office. On 11 and 13 September 2018 we completed site visits at the supported living settings in the south and north of Hampshire, respectively.

Before the inspection, we reviewed all the information we held about the service including reports and notifications received by the Care Quality Commission (CQC). A notification is used by registered managers to tell us about important issues and events which have happened within the service. Due to CQC technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We obtained this information during our inspection. We also reviewed information contained within the provider’s website.

During our inspection we spoke with four people using the service, who had limited verbal communication, and six relatives. We used a range of different methods to help us understand the experiences of people using the service, who were not always able to tell us about their experience. These included observations and pathway tracking. Pathway tracking is a process which enables us to look in detail at the care received by an individual in the home. We pathway tracked the care of six people.

Throughout the inspection we observed how staff interacted and cared for people across the course of the day, including mealtimes, during activities and when medicines were administered. We spoke with the registered manager, the provider’s locality manager, quality contract manager and 17 members of staff, which included five agency and one bank staff.

We reviewed ten people’s care records, which included their daily notes, care plans and medicine administration records (MARs). We looked at ten staff recruitment, supervision and training files. We examined the provider’s records which demonstrated how people’s care reviews, staff supervisions, appraisals and required training were arranged.

We also looked at the provider’s policies and procedures and other records relating to the management of the service, such as staff rotas covering August and September 2018, health and safety audits, medicine management audits, infection control audits, the service improvement plan, emergency contingency plans and minutes of staff meetings. We considered how people’s, relatives’ and staff comments were used to drive improvements in the service.

Following our visit, we obtained feedback from twelve health and social care professionals who had engaged with the service in the previous year regarding the quality of care people received.

This was the first inspection of this service.

Updated 2 November 2018

This announced inspection took place on 7, 11 and 13 September 2018.

Turning Point Hampshire provides care and support to people living in four different 'supported living' settings, 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. At the time of the inspection the service was supporting 10 people with their personal care needs. The service supported people living with learning disabilities, autistic spectrum disorder, physical disability, sensory impairment, older people and younger adults.

At the time of inspection the service had an interim manager who had applied to become the registered manager. 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. Prior to the completion of this report the CQC registration process had been completed and they will be referred to as the registered manager throughout this report.

The registered manager was supported by two supported living service managers who managed two supported living settings each. These settings were located in the north and south of Hampshire respectively. The services in each area were close enough to provide mutual support whenever required.

In March 2017, Turning Point Hampshire began to provide the supported living service, having taken over from another care provider. Some people and staff experienced a process where their respective contracts, either for services delivered or terms and conditions of employment, were moved from another care provider.

People, relatives, staff and professionals consistently provided feedback that this transfer initially had had a negative impact on the quality of care and support people received. In 2018 the management structure of the service was reorganised and a new management team were appointed. Feedback from people, relatives, staff and professionals consistently reported that there had been significant improvements in the quality of care people experienced and an up serge in team morale, since the appointment of the new management team.

Safeguarding professionals consistently reported there had been a significant improvement in the service performance relating to unsafe care, which was now quickly recognised and responded to effectively. When concerns had been raised the provider had carried out thorough investigations, in partnership with local safeguarding bodies.

Risks to people's safety had been identified and management plans gave staff the required guidance to manage these risks. Staff understood people’s risk assessments and the action required to keep people safe.

The management team completed regular staffing needs analyses which ensured there were always enough suitable staff deployed, with the right mix of skills to deliver care and support to meet people’s needs safely. The provider completed relevant pre- employment checks to assess the suitability of prospective staff to support people using the service.

Staff managed prescribed medicines consistently and safely, and involved people and their families, where appropriate, in regular medicines reviews and risk assessments. Staff maintained high standards of cleanliness and hygiene in people’s homes, which reduced the risk of infection.

Staff had completed the provider’s required training, which had been refreshed regularly to keep their knowledge and skills up to date. Where people had more complex needs staff training was developed and tailored around their individual needs.

Staff applied their learning effectively in accordance with best practice, which led to good outcomes for people’s care and support and promoted their quality of life. Staff training was developed and delivered to meet individual needs.

People were protected from the risk of poor nutrition, dehydration, swallowing problems and other medical conditions that affect their health.

The service had clear systems and processes for referring people to external healthcare services, which were applied consistently, and had a clear strategy to maintain continuity of care and support when people transferred services.

People and relatives were involved in decisions about their health and encouraged to make choices, in line with best interest decision-making.

People’s human rights were consistently protected by staff who understood the need to seek lawful consent and followed the Mental Capacity Act 2005 (MCA) legislation and guidance.

People were consistently treated with kindness and compassion, which was reflected in positive feedback from their families, friends and professionals. Staff supported people to express their views and be actively involved in making decisions about their care as far as possible. People were treated with dignity and respect and without discrimination.

Staff enabled people to carry out person-centred activities and encouraged them to maintain relationships that were important to them.

People knew how to give feedback about their experiences, including how to raise any concerns or make a complaint. The registered manager used the learning from complaints and concerns to drive improvement in the service.

People’s needs assessments considered their protected equality characteristics and the accessible information standards.

Staff sensitively supported people and their families to explore and record their wishes about care at the end of their life.

The service was consistently well-managed and led. The provider had a clear vision to deliver high-quality care and support, and promote a positive culture that was person-centred and achieved good outcomes for people.

The provider’s systems identified and managed risks to the quality of the service. Quality assurance arrangements were robust and identified potential concerns and areas for improvement.

The registered manager was transparent, open and honest with all relevant external stakeholders and agencies and worked collaboratively in partnership with key organisations.