This inspection took place on 11 and 12 September 2018 and was unannounced.

John Turner House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. John Turner House is registered to provide respite care to a maximum of seven people with a learning disability.

At our last inspection we rated the service good. 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 ongoing 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 service continued to protect people from the risks of abuse or avoidable harm and risks to people were identified and planned for. Medicines were managed and administered safely. The premises remained clean and there were procedures in place to reduce the risk of the spread of infection.

The service continued to ensure that there were enough staff to meet people’s needs in a timely way and that recruitment procedures were safe. The service continued to ensure staff had the training, support and development to provide effective and safe care to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service continued to support this practice. People’s independence was promoted by the service and they were enabled and encouraged to learn new independent living skills.

The service provided people with a choice of suitable food and drink. People were supported to make and prepare meals according to their ability. Support people required to maintain good nutrition and hydration was reflected in care planning. People were supported to visit other health professionals such as GP’s and dentists where required.

People and their relatives told us staff were kind to them. The service continued to promote a culture of kindness and all staff participated in creating a caring atmosphere.

People were provided with personalised care based on their individual preferences and they and their representatives were involved in the planning of their care.

People were supported to access activity within the service and to visit the community and day services. People told us they enjoyed the activities they were enabled to participate in.

The registered manager, team leaders and the provider continued to operate an effective system to monitor the quality of the service provided to people. Areas for improvement were identified and acted upon. People were involved in making plans for the future, such as holidays they would like to take. People and their relatives were supported to feedback their views and experiences through surveys in an easy read format. People were made aware of how they could complain.

Further information is in the detailed findings below.

John Turner House is a short break respite service providing care and support for up to 7 people with a learning disability. At the time of our visit there were 6 people staying at John Turner House.

The inspection was unannounced and took place on the 12 August 2015.

The home had a registered manager in place. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

People told us they felt safe and secure when they came to stay at John Turner House. There were systems in place to reduce the risks to people and protect them from avoidable harm.

The service had in place robust recruitment procedures which ensured that staff had the appropriate skills, background and qualifications for the role. There were enough suitably trained and supported staff available to support people during our inspection. There were effective systems in place to ensure that medicines were stored, managed and administered safely. People received appropriate support to take their medicines.

Staff told us they felt supported by the management of the service and that the training they received provided them with a good understanding of topics such as the Deprivation of Liberty Safeguards (DoLS). People and one relative spoke highly of the staff and told us they would have “no issue” raising concerns or issues with them.

The service was complying with the requirements of the Mental Capacity Act (2005) and the DoLS. Appropriate DoLS applications had been made where required and assessments of people’s capacity were completed appropriately. People were supported to make decisions independently and were encouraged to develop independent living skills.

People were encouraged and supported to take part in activities they enjoyed at the service and to access the community with staff. People told us about the things they enjoyed doing when they came to stay at the service.

People spoke positively about the care and support they received when they came to stay at the service. People and their relatives had input into the planning of their care and support. Staff demonstrated that they knew the people using the service at the time of visit well.

There were systems in place to monitor the quality of the service and to identify shortfalls or areas for improvement. There was an open culture at the service. People using the service, their relatives and staff were given the opportunity to express their views and these were acted on by the service. There was a complaints procedure in place and people told us they knew how to make a complaint if they weren’t happy.

We carried out this inspection to check that the provider had made the changes they told us they would implement to meet the standards that we found were not being met when we carried out an inspection on 1 May 2014.

The registered manager was away on training when we arrived to conduct a follow-up inspection on 30 September 2014. We spoke with the team leader, and subsequently with the registered manager on their return. We reviewed people’s care plans and other documents so that we could evaluate how effectively the improvements had been implemented at the service. We found that progress had been made, but that the service was still failing to meet the requirements of the Mental Capacity Act 2005 (MCA).

Our inspection on 1 May 2014 had found that the service was not following the principles of the Mental Capacity Act 2005 (MCA) where a person lacked the capacity to make decisions. During this inspection, we saw that staff training records confirmed that on 13 May 2014 nearly all staff, but not the registered manager, had undergone MCA training. Appropriate guidance regarding the implementation of MCA principles was in place. We saw that, where the service had concerns about the ability of a person to ensure their own safety, a risk assessment and action plan was put in place. However no mental capacity assessments had been carried out, and staff were unclear of the action that needed to be taken to secure formal Deprivation of Liberty Safeguards assessments.

Our inspection on 1 May 2014 had also identified issues regarding records related to the effective and efficient management of the service. During this inspection we found that these had been effectively tackled. The registered manager was able to provide the requested records. Where we had identified specific shortcomings in record keeping the necessary improvements had been made. The service was now meeting the legal requirements regarding records.

John Turner House provides short break respite for up to seven people with a learning disability. At the time of visit, there were six people using the service.

We looked at the care records for five of the six people who were using the service at the time of our inspection. In addition, we reviewed audit records, complaints records, incident records and staff records. We considered our inspection findings to answer five key questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? and is the service well led?

Below is a summary of what we found during our inspection;

Is the service safe?

We found that each person had detailed care plans setting out information about them, and instructions for staff on how to meet their needs. This meant we could be assured people were protected from unsafe or inappropriate care.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We asked the manager whether anyone currently using the service was subject to a Deprivation of Liberty safeguard. We were told this did not apply to anyone using the service at the time.

We found that the service was not following the principles of the Mental Capacity Act (2005), where a person lacked the capacity to make decisions. This meant we could not be assured that people were protected from the risk of unlawful decisions being made on their behalf.

We found that at the time of our visit, there were enough staff members available to meet people's needs in a safe way. We found that the service had a number of bank staff which they could call on in case of unexpected staff absence.

Is the service effective?

Audits carried out by the service were effective and picked up issues with service provision. We saw that actions were put in place following audits, and we saw evidence that these actions were completed. This meant we could be assured that the quality assurance processes in place at the service were effective.

People had been given the opportunity to take part in a survey of their views in 2014. We looked at some of the survey responses received, and found that they were mostly positive. At the time of visit, the survey was still ongoing. However, plans were in place to collate the responses in the near future to monitor them for negative trends which might indicate improvement is required. We saw evidence that where negative comments had been made in the surveys, action had been taken to respond to the person in the meantime.

Is the service caring?

We observed that staff interacted with people in a caring way, and were knowledgeable about their individual needs. One person we spoke with told us: "They are really nice."

Is the service responsive?

Records showed that people who used the service were supported to receive input from health professionals in a timely manner.

Is the service well-led?

During our visit, we observed that records we requested were not readily available and it took the manager and other staff some time to find records requested. These included policies and audits. This meant that at the time of visit, we could not be assured that the service was well led.

We spoke with two of the six people who used the respite service. One person told us, “I love it here, I do not want to go home.” Another told us, “They are all very nice to you here. I would like to stay here forever.”

We looked at the care records of two people who used the service. Care plans were comprehensive, containing details of the needs of people who used the service and how these needs were met.

We spoke with three staff members and the manager. We saw that the staff team had received a range of training to equip them to carry out their role and were well supported by the service.

We spoke with staff who told us that they had received training in safeguarding vulnerable people from abuse. They were able to explain to us the steps they would take to protect people and respond to any concerns that they might have.

We looked at the provider’s complaints process. We saw that people who used this service and those acting on their behalf could be confident that their comments and complaints were listened to and dealt with effectively.