We inspected Turning Point - Derby on 22 and 24 January 2018. We gave the service 3 days' notice of the inspection to ensure the registered manager would be in the office. We also needed to let people know we wanted to visit them in their homes to review their support.

Turning Point – Derby had 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.

Turning Point – Derby supports adults to live as independently as possible who have a learning disability and/or autistic spectrum disorder and whose behaviour may challenge. Staff provided personal care to eight people living in their own properties and to four people living in a single house of multi-occupation.

Turning Point – Derby was last inspected by the Care Quality Commission on 3 February 2016 and the report published on 22 March 2016. The overall rating for the service has improved from good to outstanding.

People receiving support from Turning Point –Derby received highly individualised person centred care. Support plans contained detailed and personalised care plans and we saw that people had been supported to have a full and meaningful life enjoying interests, taking part in new experiences and being active members of the local community. There was an emphasis on the need for good communication with a range of documentation being provided in way to assist people in accessing information.

The provider, registered manager and staff actively promoted a positive, inclusive and open culture, this approach has a positive impact on the quality of the service people received. The structure of the service worked for people, so that team leaders were always available to support staff and people when needed. The service worked in conjunction with other organisations to improve care for people with a learning disability. There were robust quality assurance systems in place which monitored the service, identifying potential areas for improvement, and actions were taken to improve these.

Staff were highly motivated and worked as a team and shared a common ethos of providing high quality, compassionate care with regard to people's individual wishes and support needs. Staff were valued, well supported and supervised by the management team.

Staff knew how to keep people safe, and how to report any concerns or incidents. The registered manager was proactive in learning from incidents and events, and had brought about changes to practices. There were enough staff to keep people safe, both within their home and the wider community.

Risks to people were identified promptly and effective and robust plans were put in place to minimise these risks, involving relevant people, such as people’s family members and other professionals. Comprehensive information was in place to guide staff, in the most effective approaches to use, which included Positive Behaviour Support, to enable staff to support people safely and reduce risk. Staff were knowledgeable about people’s support and care and we observed staff putting into practice a consistent approach to their care.

People were supported to take their medicine by staff. People's capacity to make informed decisions about medicines had been assessed and best interest decisions had been made. People received their medicines as they had been prescribed. The provider had committed the service to reviewing people’s medicine to decrease its use, in particular those used to manage people’s behaviour and emotions.

People’s needs were assessed and the assessment was used to develop comprehensive and individually tailored support plans. Staff took part in a robust induction programme with on-going training, which enabled them to provide effective care and support to peo

This inspection took place on 3 February 2016 and was announced.

Turning Point - Derby is registered to provide personal care and support for people with a learning disability and autism. At the time of our inspection there were 13 people using the service who resided within their own home. People’s packages of care varied dependent upon their needs, in some instances people were supported over a period of 24 hours.

People who used the service were unable to consent to our visiting and meeting with them to talk about the service due to their complex needs. We were advised that our visiting some people within their own home may cause people potential distress and anxiety, as people were not comfortable in the presence of people they did not know. We therefore spoke with a relative of someone who used the service and the staff who provided support.

Turning Point – Derby had 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.

The inspection was facilitated by the supported living manager and regional manager as the registered manager was not available on the day of the inspection.

People we consulted told us they believed people’s safety was promoted and recognised by the support workers. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. Where people were at risk, staff had the information they needed to help keep them safe.

People were supported by knowledgeable staff that had a good understanding as to people’s needs. Staff provided tailored and individual support to keep people safe and to provide support if their behaviour became challenging. People were supported to take ‘positive risks’ to promote their independence in leading a lifestyle of their choosing.

People were supported to take their medicine by support staff. People’s capacity to make informed decisions about taking some medicines had been assessed and best interest decisions had been made. This was to ensure people’s needs were met when they themselves were not able to promote their own safety and welfare by making an informed decision.

People using the service had a dedicated team of staff that provided support to them within their own home and the wider community. People’s views as to staff along with those of their relatives were considered to ensure the staff that supported people had the appropriate skills and were able to develop a positive and trusting working relationship.

People received an effective service as people’s support plans provided clear guidance about their needs. These were monitored and reviewed by the management team and team leaders through the supervision and appraisal of staff, staff meetings and quality monitoring audits.

People were provided and supported in line with legislation and guidance. Staff had received training on the Mental Capacity Act (MCA) 2005. We found that capacity assessments had been carried out on aspects of people’s care and support. Where these assessments had identified that people did not have the capacity to make an informed decision, then their relatives and others involved in their care had an agreed plan of action so ensure any decisions taken were in the person’s best interest.

People were supported with daily living tasks such as grocery shopping, meal preparation and cooking as part of their support packages. Staff encouraged people to eat a healthy diet. People’s dietary requirements along with their likes and dislikes with regards to food and drink were recorded within their records.

Records showed staff, where support was required, li

Due to people’s communication skills they were unable to communicate their experiences of care to us. We therefore contacted people’s relatives to get their views of the support and services provided to their family member.

To protect people’s identity we have used an x in place of names provided in quotes from relatives. Relatives we spoke with were positive about the support provided. Comments from relatives included “I think the staff are very good and encourage independence.” And “There are plenty of staff to support x and they are all very friendly and approachable, x seems very happy and we have regular contact.”

People’s method of communication was recorded in their support plans. This ensured staff could support people according to their preference and choice.

People’s preferences and the level of support they needed was delivered in line with their individual support plans

Records seen and discussions with the staff demonstrated that staff were supported in their job and provided with ongoing training to ensure they had the skills needed to support people effectively.

Systems were in place to monitor the care and services provided, and to identify and manage risks to ensure the service was run safely.

Relatives told us that they understood the care, treatment and support choices that their family received. One relative told us that “I tell the staff if I don’t think something is appropriate. Sometimes I might be in the wrong, but I am able to say what I think”. The care plans were all up to date with information. They were all centred on the people using the service as individuals and considered their individual circumstances as well as their immediate and long term needs. The care workers could describe different types of abuse and had a good knowledge of identifying possible signs of abuse as well as having a good understanding of how to report potential abuse both internally and externally. The provider has effective recruitment and selection procedures in place and carries out relevant checks when they employ staff. The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service. This shows that the provider was reducing the risks identified in order to prevent the service becoming non-compliant with the regulations.