About the service: The service provided accommodation for up to 22 persons who require nursing or personal care, all of whom were living with learning difficulties.

People’s experience of using this service:

¿ Our last comprehensive inspection was carried out on 13 and 14 July 2017, and we found that systems to monitor the quality and safety of the care provided were not always effective, there were not always enough staff and people did not always receive person-centred care. This had resulted in three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.

¿ Following the last inspection, the provider sent us an action plan outlining how they would make improvements to the service. At this inspection, we found that sufficient improvement had been made and there were no breaches.

¿ There were effective systems in place to monitor and improve the service.

¿ People received care according to their individual needs and preferences, and there was detailed guidance for staff in care plans.

¿ There were enough suitably qualified and competent staff to meet people’s needs.

¿ Risks to people were assessed and mitigated.

¿ Staff were knowledgeable about safeguarding people from abuse.

¿ People were supported to take their medicines safely, and had access to healthcare when they needed.

¿ Staff supported people to make choices around their diet.

¿ Staff asked people for consent and supported them to make decisions.

¿ Staff adapted communication to ensure people understood information and could communicate effectively, and people were involved in their care.

¿ People and staff had built positive trusting relationships, and staff respected people’s dignity and privacy.

¿ People were supported to make and achieve goals, maintaining and increasing their independence.

¿ There were trips and activities for people, and staff supported them to engage with the local community.

¿ Staff worked well as a team and were well-supported.

Rating at last inspection: Requires Improvement overall and in all areas (Published 29 November 2017).

Why we inspected: We inspected this service in line with our inspection schedule for services rated Requires Improvement.

Follow up: We will continue to monitor this service according to our inspection schedule.

We inspected Point House on 6 August 2014 and rated the home as Good. However, when we returned on 13 and 14 July 2017 we found some areas which required improvements to be made.

Point House is registered to provide care for up to 22 people. At the time of the inspection 20 people were living at the home. The home supports adults who have a range of different learning disabilities and mental health needs. Some people have lived at Point House for a long time and now have age related conditions. The accommodation comprised of a building over two floors.

There was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. For the purposes of this report the registered manager will be referred to as the manager. On the days we visited the manager was not present but we spoke with the senior staff in charge.

At this inspection we found three breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

People’s risk assessments were not always thorough enough and did not always include guidance for staff about how to mitigate the risks which some people faced. There were times when there was not a clear plan of action in place to manage these risks. People’s weight levels were not consistently monitored by the service to identify when people were at potential risk of unintentional weight loss. There was no system or plan in place to ensure the manager and provider had an up to date oversight on this issue.

There was a system of safety checks but these were not always effective in identifying risks. We found certain house hold cleaning products were being stored in a way which was not safe.

We found that people did receive their medicines as prescribed. However, people’s prescribed creams were not stored in a safe way in the home.

Staff had a full understanding about how to protect people against the potential for people to experience harm and abuse.

The staffing levels at the home were not always sufficient to meet people’s social and care needs at certain points of the day. The layout of the building had not been considered as part of the deployment of staff.

Staff received regular training, which was refreshed each year. Staff said they felt supported by the manager and they received regular supervision. However, we found that some of the competency checks relating to staff practice were not well evidenced.

People’s dietary needs were not always promoted and supported by the service. Staff did not spend time with people to promote healthy dietary alternatives. People who were at risk of poor health due to their relationship with food were not regularly supported to manage this issue. The service did not promote healthy alternatives or lifestyles. People were not fully involved in the cooking process in order to maximise their independence in this area.

Staff were gentle and kind with people, however the service and staff were not consistently caring towards people. We observed times when staff did not respond to a person who was distressed. Staff did not engage socially with people at the home. There were times the staff did not promote people’s dignity. The service was not promoting independent living skills in the home.

There was a lack of social opportunities and experiences taking place in the home when people were present. Staff did not spend time chatting or engaging with people. The service did not explore potential social opportunities and situations in the home.

Quality monitoring audits of the service were not always effective. There was no monitoring of the culture of the service, and whether the service was fully promo

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This inspection visit was unannounced. This meant the provider was not informed about our visit beforehand. The last inspection for this service was 8 October 2013. At that inspection we found no concerns and no regulations were breached.

Point House is a care home providing a service to a maximum of 22 adults who live with a learning disability. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Everyone we spoke with told us they felt safe and that they were supported and cared for by a good, skilled, caring team of staff. They also told us any concerns they may have would be dealt with quickly.

Staff we spoke with were able to tell us about their recruitment, induction and training that assured us they had the knowledge and understanding to support and care for the people safely. However, on discussing safeguarding further we found that staff were not clear on how to report concerns to professional organisations outside of the home such as the local authority safeguarding team. No issues of concern about people’s safety were brought to our attention prior to or during this inspection and all those spoken with said they were safe.

Staff had an understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). They told us they had received training and understood how people could be deprived of their liberty and how to act on any concerns if it was relevant to do so.

People had been assessed against potential risks that could affect them whilst living in the home. However, some of those risks were seen as institutionalised and required some changes to make them individualised. This would ensure the risks assessed were only relevant for those people who presented a risk.

Medication was managed, stored, administered and recorded safely. People told us they received their medication when they required it.

The home was clean and tidy in all the areas we visited. Procedures were in place to control any potential spread of infection. However, we found that hand wash soap and hand towels were not always available within the bathrooms to enable people to wash and dry their hands at all times.

Care plan records and methods of communication ensured staff had a current picture of the needs of each person living in the home. Medical needs were addressed and changes to people’s healthcare needs were acted upon by the staff in the home when required.

The meals provided were varied and enjoyed by the people living at the home. People who required support with their meals were assisted by staff in a sensitive manner.

We observed people being supported by staff in a caring and compassionate manner. They told us the staff encouraged them to be independent and yet supported them when they could not manage. Interactions between people and staff were seen to be caring and respectful showing that staff worked with the people they were supporting appropriately.

People living in the home told us they were consulted and listened to and carried out their day to day lives as they wished. Varied activities were available for people to enjoy within the home and within the community, such as horse riding and picnics.

The people we spoke with told us they had no problems with sharing their concerns or complaints with the staff or manager of the home. However, they were not certain how they would take their complaint to professionals outside of the home, if needed. The registered manager said they would improve this shortfall and would ensure the people had the information on how to complain in a suitable format that they could understand.

Staff told us they were fully supported to carry out their role. They told us the training, supervision and guidance offered by the home management enabled them to work well. Designated roles and responsibilities were shared within the staff team. This meant that the service was maintained and improvements were made as required.

People were asked their views on the quality of the service provided to ensure it met their individual needs. The service was being monitored and improved upon.

Four professionals spoken with were positive about the service provided by this home. We had not received any concerns or complaints.

We spoke with five people living at Point House and they all told us that they were happy living there. Each person we asked felt they had their privacy and dignity maintained. One person told us “I have been here for a while, and I wouldn’t want to be anywhere else”. A second person stated “I have no worries about that [privacy and dignity]”. A third person we spoke with gestured to us by smiling and nodding that they were happy living at Point House.

During our inspection we spent two and half hours observing and interacting with the people who used this service. We found that all staff interactions were appropriate and positive.

Appropriate arrangements were in place in relation to obtaining people's medication and medicines were prescribed and given to people appropriately.

People were cared for, or supported by, suitably qualified, skilled and experienced staff and records relating to the people and running of the service were accurate and fit for purpose.

During our inspection on 31 October 2012 we found that quality management systems were not in place to protect people in relation to their finances. At that inspection we found inaccurate records, people raised concerns with us about the management of their monies and that company policies and procedures were not being adhered to.

The purpose of this inspection, carried out on 27 February 2013, was to ensure that the necessary improvements had been made. We found that they had.

Since our last inspection, the provider had implemented a new financial management system. We found that all records were now up to date and that steps had been taken to ensure people were safeguarded in relation to their finances.

During our visit to Point House on 29 September 2011 we spoke with a number of people who live in this home. We gathered a picture of how the care and support offered to them is suitable for their needs and how much they are included in the plans that ensure those needs are met. We discussed how they express their views and how involved they are. We were told about how choices are offered and how support to live their lives to the full is given.

The people we spoke with gave numerous accounts of various ways they work on their life skills to promote independence. We were told about their involvement in shopping to choose the food for meals to cook that day and the support offered by the staff members that encourage healthy eating. On the day of this visit some people were about to go out for the day to the seaside and were planning the last minute items between them. ‘Who had the sun cream, where is your sun hat and who had the bus passes’ were all part of the discussions taking place. Everyone was happy and motivated to get going.

Throughout this visit one of the repeated phrases said by a number of people was how safe they felt living in this home. A number of these people had lived alone previous to their admission. All those spoken with gave nothing but praise for the support and the secure feelings that the home offers them. We were given words such as ‘much happier’ and ‘safe in this home’ during a number of conversations.

The body language observed, the conversations that took place and the calm atmosphere felt in the home told us that the experience people had is a positive one.

The people to whom we spoke gave a positive picture about the team of staff who support them. Comments such as, “We have such fun” and “Since I have lived here the staff have helped me and I am much happier,” were just some of the comments given.

Throughout the visit we noted the smiles and relaxed conversations that were taking place that were inclusive and, on occasions, making it difficult to identify who was staff and who was the person living in the home. This showed us how included and involved people are.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We reviewed the care plans of four people living at Point House. We found that in each care plan the people using the service had been asked to agree to their planned programme of care.

We spoke with five people living at Point House and the majority of these people expressed satisfaction with the service. One person told us “I like living here” and that the staff were all “good and kind”. Another person commented “I am happy here, I have my own room which is nice” and that the “staff really treat you well – I am being very well cared for”.

Our observations of the home demonstrated to us that it was clean, free from any unpleasant odours and that infection control risks were controlled. For example, we observed staff wearing disposable gloves and aprons and saw cleaners undertaking their duties.

However we found concerns with regards to the management of people's finances and have made referals to the local authority safeguarding team. An investigation is currently being undertaken and we will report on the findings once they have reached a conclusion.