Turning point – Clarence House provides 24 hour care and support for one person with a learning disability in their own home.

We visited the offices of Clarence House on 13 October 2017. We gave the provider 24 hours’ notice of our visit due to the very small size of the service. The person who received care had communication difficulties and was not able to tell us about their experiences of care. We were invited to visit the person in their own home during the afternoon of our visit.

We last inspected this service in October 2015 when we rated it as Good. At this inspection we found the same levels of safe, effective and responsive care and the service continues to be rated as Good.

A requirement of the service’s registration is that they have a 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. The registered manager had been in post since September 2017. They had previously managed another home within the provider group so had a good understanding of their legal responsibilities. Staff spoke highly of the new registered manager and felt the changes in management had been implemented smoothly.

A dedicated staff team provided the person who used the service with consistent 24 hour care. All staff had worked with the person for a long time and knew them very well. They valued the person as an individual and were committed to supporting them to live their life as they wished to. Staff took time to listen to the person and supported them to express themselves.

The person who used the service received person centred care with the focus being on them as an individual. They were encouraged and supported to do thing that were important to them at home and in the local community. Records and documents were partly pictorial and accessible to the person so they could be involved in making decisions about their care.

Staff were strong advocates for the person and understood their responsibility to report any concerns they had about the person’s health or wellbeing. Staff worked in accordance with the person’s risk assessments to keep them safe at home and within the community.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the person’s rights were protected in accordance with the Act. Staff offered the person choice and respected their decisions.

With the assistance of staff, the person was able to eat the food they enjoyed and maintain a healthy diet. Staff monitored the person’s health and supported them to access other healthcare professionals when a need was identified. Trained and competent staff gave the person their medicines as prescribed.

Quality assurance systems helped ensure the quality of service was maintained. There was a system of internal audits and checks completed to identify any areas where improvements were required.

When we visited Clarence House we spoke with the area manager for Turning Point and the manager of the service. We also spoke with two staff members and met one person who used the service. Following our visit we spoke by telephone with a relative of one person who used the service.

A relative we spoke with told us that they were happy with the service provided for their family member. They said, "At the moment it's brilliant" and "The staff are great with X."

People had care plans in place which were person centred. They provided staff with information they needed to provide care and support that met people's needs. Potential risks had been considered and plans put in place to minimise them where possible.

Sufficient staff were employed to provide care and support for people. Systems had been put in place to ensure that staff were supported in their roles.

We identified concerns about staff training. We have made a compliance action in relation to this.

Systems were in place to ensure that the service was managed appropriately.

We visited Turning Point Clarence House offices on 5 September 2012. Our visit was unannounced which meant no one who worked there knew we were coming. The agency provided 24 hour care and support to the people using their service.

During our visit we met and spoke with one person who used the service, two members of staff and one relative. We also spoke with the area manager for Turning Point and the registered manager.

The person who used the service told us, “I like to have help; staff help me with my dinner, boiling the kettle and making cakes.”

A relative we spoke with told us, “The support care staff give to XX is wonderful; they are so good and kind.”

Care staff told us they liked working for the agency and they had regular opportunities to update their skills and knowledge so that they could understand and meet people's needs.

Each person had a care plan and these focused on the needs of the person from their point of view. Care plans were written in a way that was easy for people to understand with the use of photographs and symbols. Daily records we looked at told us that people were supported to enjoy a wide range of activities in the local community when they wished.

We read staff recruitment records and found these to be well maintained. We saw that all necessary checks had taken place before a staff member began their employment to be sure people were protected from possible harm.

Turning Point – Clarence House provides 24 hours care and support for one person with a learning disability in their own home.

We visited the offices of Clarence House on 12 October 2015. We were told the person receiving care had communication difficulties and would not be able to tell us about their experiences of care. On 15 October 2015 we were invited to visit the person in their own home.

We last visited the service in February 2014. After that inspection we asked the provider to take action to improve the training care workers received to ensure they had the necessary skills to provide effective care. At this inspection we found the provider had taken the required action.

The service has a 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.

When we visited the person in their home we saw warm and friendly relationships between them and the care workers providing their care and support. All the care workers had worked with this person for many years which meant the person was supported by care workers who knew them well, understood their needs and knew how to keep them safe.

Care workers were trained in safeguarding adults and understood how to protect them from abuse. There were processes to minimise risks to people’s safety; these included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Checks were carried out prior to care workers starting work to ensure their suitability to work with people.

The provider and registered manager understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). This ensured people were looked after in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority in accordance with the DoLS.

Care was delivered on a one to one basis from a consistent and established staff team. Care workers received a programme of training and support that ensured they felt confident in their role.

Care plans and risk assessments contained relevant information for care workers to help them provide personalised care to people. Changes in health were acted upon quickly and referred to external healthcare professionals.

Information about making a complaint was available, but independent advocacy help was sought when a need was identified.

There was a registered manager in post and care workers told us they felt well supported. Care workers were confident they could raise any concerns or issues with the provider and registered manager, knowing they would be listened to and acted on.