We inspected this service on 4 July 2018.

Turning Point Marloes Walk is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is delivered from two connecting bungalows in a residential area and provides accommodation and nursing care for up to eight people with a learning disability or autistic spectrum disorder with complex physical and medical needs. Eight people lived at the home on the day of our inspection visit.

There was a registered manager in post at the service. 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.

At the last inspection in January 2016 the service was rated as Good. At this inspection we found the quality of care had been maintained and people continued to receive a service that was safe, caring, effective and responsive to their needs. The rating remains 'Good'.

There were enough staff with the appropriate level of skills, experience and support to meet people’s needs and provide effective care. Risk management plans were very detailed and contained specific guidance about potential risks to people's health and wellbeing and the action staff should take to minimise those risks. Staff understood how to protect people from avoidable harm and to keep them safe.

People were supported to maintain good health and information was shared effectively between staff and other healthcare professionals. Staff knew about people's nutritional risks and prescribed medicines were stored, managed and given to people safely and in accordance with best practice.

People, relatives and staff felt well cared for. Staff were empathetic and patient with people who responded positively and appeared comfortable with them. People's communication needs had been assessed and staff used different verbal and non-verbal communication methods to enable people to express themselves and make choices. Relatives valued their relationships with staff who supported them to maintain a central role in their family member’s life.

The registered manager understood their responsibilities under the Mental Capacity Act 2005. They had applied to the supervisory authority for the right to deprive a person of their liberty when their care and support included restrictions in the person's best interests.

Each person had a detailed care and support plan which provided staff with the information they needed to respond to people’s physical, emotional and social needs. Staff shared information about people at the start of each shift to maintain continuity of person-centred care. Staff recognised people’s differing abilities and interests and planned activities that would provide meaningful engagement for everyone, both inside and outside the home.

The registered manager and provider regularly checked the quality of the service to make sure people's needs were met safely and effectively. Relatives were encouraged to share their views and provide feedback about the service and felt they would be listened to. The provider and registered manager understood their regulatory responsibilities and worked with other organisations and healthcare professionals to ensure positive outcomes for the people who lived at Marloes Walk.

We conducted an unannounced inspection of Turning Point - Marloes Walk on 14 January 2016. The service provides nursing care and support for up to eight people with learning disabilities. There were eight people using the service when we visited. Each person had their own bedroom and there were two shared lounges and dining room areas at the home.

The service 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. We refer to the registered manager as the manager in the body of this report.

During the day there were four members of care staff on duty, a trained nurse, and a trainee nurse. Staff told us the staffing levels enabled them to spend time with people inside and outside the home, and respond to requests for assistance without delay.

Staff had received training in safeguarding adults and were able to explain the correct procedure to follow if they had concerns. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with the people who lived there.

Risk assessments around the provision of care and support had been carried out and action taken to reduce any identified risks. There were systems to ensure that medicines were stored and administered safely.

New staff completed a thorough induction programme when they started work. Staff received training and had regular supervision and appraisal meetings in which their performance and development was discussed.

The provider understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure 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 DoLS and the MCA, and at the time of our visit was awaiting the outcome of some of those applications. Some applications had already been approved by the local authority.

People were encouraged to eat a varied diet that took account of their preferences and, where necessary, their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals.

People were supported in a range of activities, both inside and outside the home. Activities outside the home enabled people to be part of their local community and to take regular holidays. Staff were caring and encouraged people to be involved in decisions about their life and their support needs. People were supported to make decisions about their environment and choose how their room was decorated.

Each person had a care and support plan with detailed information and guidance personal to them. Care plans included information on maintaining the person's health, their daily routines and preferences.

Staff told us they felt supported by the management team and by each other. Both staff and people were given opportunities to make suggestions on how the service was run. The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified, action plans were put in place to rectify these.

None of the eight people who lived at the home were able to tell us about their care because of their complex needs. We spoke with two relatives and observed how people were cared for. The relatives told us, “It’s like home. The care is really good” and “I trust them implicitly.” We observed that support workers involved people in everyday tasks and continuously explained what was happening.

In the two care plans we looked at, we saw that the manager assessed risks to people’s health and well-being. People’s care plans included instructions for staff that minimised the identified risks. A support worker told us, “The guidelines for each person are useful” and “We all have the same goal, that is, what’s best for each individual. It is person centred.”

On the day of our inspection we found the home was clean. Staff were trained in the prevention and control of infection. The two support workers we spoke with understood their responsibilities to prevent and control the spread of infection.

The provider took appropriate action to make sure that staff were suitable to work with vulnerable people. The two support workers we spoke with told us that their induction programme was effective and they felt well prepared. They said, “We have a brilliant staff team” and “It is a brilliant place to work. X is an excellent manager.”

The provider had an effective records’ policy. People’s personal records and staff records were kept securely and were accessible when needed.

When we visited Marloes Walk we met with each person using the service. We met and spoke with four members of staff and had telephone discussions with two relatives about the care their family member received at Marloes Walk.

The people using the service had complex needs, which meant they were not able to tell us their experiences. When we met with them however they smiled when we talked about their daily activities. We saw that people using the service were relaxed and at ease with staff supporting them and within the home environment. We found that staff knew people using the service as individuals and understood their personal needs and ways of communicating those needs.

We spoke to the relatives of two people, who told us, “We are lucky XX is at Marloes Walk. The staff are very good” and “I am absolutely satisfied with the way staff support XX.”

The environment was homely with framed photographs displayed of people enjoying some of the holidays and other activities they did. We saw each person's bedroom was clean, warm and well furnished and reflected the person’s individuality.

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.

When we visited Marloes Walk we found sufficient staff on duty to support the needs of the people using the service. Staff told us they felt supported by the manager and had the skills they needed to deliver the care people using the service needed.