An unannounced inspection visit took place on 1 May 2018. The Cedars provides accommodation, personal care and support for up to four people, with physical and / or learning disabilities. At the time of this inspection, four people lived at the home. Each person had their own bedroom and there was a shared lounge, bathrooms and a dining room area that people used.

People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post at the time of our visit. 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 our last comprehensive inspection in December 2015, we rated the service as Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager and staff assessed risks to people’s health and welfare and care plans provided accurate information for staff to minimise the identified risks. Staff and people had lived and worked at the home for a number of years and were familiar around each other’s company which helped people be relaxed with staff. We were confident staff knew people well and they continued to support and encourage people’s independence.

Staff knew how to keep people safe from the risk of abuse. There continued to be enough staff to meet people’s health needs and there continued to be flexibility in staffing levels, to make sure people received a safe, effective and responsive service.

People’s medicines were managed, stored and administered safely by trained and competent staff.

People continued to be cared for and supported by kind and compassionate staff. Staff understood people’s needs and abilities and they had the skills, training and experiences to do this effectively.

People were supported to have continued choice where possible, given their lack of capacity to make decisions. Staff offered people visual choice to stimulate and encourage people to make decisions. Staff respected people’s lack of capacity to make verbal decisions and always supported xxx (remove gap) them in the least restrictive way possible. Staff worked with each person to understand and improve their individual communication abilities.

Staff ensured people received support from other health professionals to maintain their physical and mental health and people were involved in how their care was delivered. Relatives were involved in care decisions with their family members and staff encouraged links with families.

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. The quality monitoring system demonstrated their systems continued to be effective and support good outcomes for people in their care. The provider, registered manager and staff’s focus was always to drive improvements within the service

Further information is in the detailed findings below.

We conducted an unannounced inspection of Turning Point - The Cedars on 11 December 2015. The service provides care and support for up to four people with learning disabilities. There were four people using the service when we visited. Each person had their own bedroom and there was a shared lounge and dining room area 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 staff on duty which meant people received one to one support with their individual needs. 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 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 the DoLS and at the time of our visit was awaiting the outcome of those applications.

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.

When we visited The Cedars we did so unannounced which meant that no one who lived at or worked at the service knew we were coming. During our visit we met all of the people that lived in the home and a visiting relative. We also spoke with the team leader and four members of support staff.

People living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences. We saw that people appeared comfortable and relaxed in their surroundings. We noted that staff had considered people's individual preferences whilst making sure that the service was homely for everyone.

People appeared at ease and relaxed around staff and approached them freely. A relative we spoke with told us they were happy with the care provided to their family member commenting, "She's been here a long time, they look after her very well."

People had care plans in place that contained information to assist staff with meeting their care and support needs. Staff we spoke with knew about people's needs and were able to tell us about them.

There were processes in place to ensure that medication was managed safely on people's behalf.

There were enough qualified, skilled and experienced staff who worked flexibly to meet people’s needs.

We saw that there were processes in place for monitoring and assessing the quality of the service provided for people.

When we visited The Cedars we met with the four people who lived there. We met four staff members and spoke with three staff members about the care they delivered to people who lived at The Cedars. We spoke with the registered manager and had telephone discussions with two relatives about the care their family member received at The Cedars.

The people who lived at The Cedars had complex needs which meant they were not able to tell us their experiences. We saw however people were relaxed and at ease with staff supporting them. We found that staff knew people as individuals and understood their personal needs and ways of communicating those needs.

We spoke to the relatives of two people who lived at The Cedars who told us they were happy with the care their family member received and had no concerns. They told us, “Care is very respectful” and “I can find no fault with the care.”

The home was warm and comfortably furnished with photographs displayed of people enjoying their holidays and other activities they did.

Each person had a care plan and these were written in a way that was easy for them to understand with the use of photographs and symbols.

Staff told us they felt supported by the manager and had the skills they needed to deliver the care people using the service needed.

We found procedures in place to protect people from harm and staff described how they would report any suspicion that a person who used the service had been at risk of harm.

This was the first visit to this service since the transfer to the new provider ‘Turning Point’.

On the day of the visit on 30 November 2011, we spoke with the staff on duty and we spent time observing the support given to people and how they spent their day. This was because people living at the home were unable to verbally share their experiences,

We observed how staff offered people care and support and how staff spoke with them to ensure that they were treated with dignity, were able to stay as independent as possible and if they were offered privacy.

We found that staff knew people as individuals and understood their personal needs and ways of communicating those needs. Staff treated people kindly and respectfully and included them in conversation, asking for their input.

We looked at the care planning documentation to see what guidance was given to staff, to ensure that people received their care as they required to meet their needs. We looked to see if systems were in place to offer this in a safe way. We found that care plans were very detailed and contained the kind of information that would ensure staff understood aspects of each person as an individual and would be able to meet their needs effectively and safely.

Risk areas were identified, with plans in place and guidance to staff on how to minimise and manage these.

Some people living in this service also had challenging health needs. We looked at records maintained and saw that people’s health needs were managed well and they received care from a range of health care professionals. We saw that they received their medication as prescribed.

We spoke with staff about training to ensure that they had the skills to meet the needs of people living in the home. Staff spoken with told us that they were well supported by senior staff. They felt that they received a good level of training to ensure that they knew how to deal with incidents and understood how to keep people safe in emergencies.

We looked at the quality of the food provided, how staff ensured that people received correct nutrition and how preferences were taken into consideration in menu planning. We saw that people received a balanced menu of home cooked food and that people were involved in shopping and cooking to the best of their abilities.

We saw that the home provided a small, comfortable living environment for the four people that lived there. We saw that the correct equipment was available to allow staff to handle people safely and that the environment was clean and well maintained.