This inspection was carried out on 19 September 2017 and was unannounced. At their last inspection on 18 June 2015, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

Turning Point- Ambleside provides accommodation for up to six people with learning and physical disabilities. The home is not registered to provide nursing care. At the time of the inspection there were five people living there.

The service did not have a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The registered manager had recently left the home and the team leader was providing management cover to the home with the support of an experienced registered manager and the regional manager.

People were supported by staff who knew how to recognise and respond to abuse. Relatives felt people were safe and risks were assessed with plans in place to mitigate these. People were supported by staff who were recruited safely and received training and supervision. People’s medicines were managed safely.

People were supported to make choices were they could and the staff worked in accordance with the principles of the Mental Capacity Act (2005). People had a variety of foods and were supported to maintain healthy and balanced diet. There was regular access to health and social care professionals.

People were treated with dignity and respect. Relatives told us that staff were kind. People and their relatives were encouraged to be involved in planning and reviewing there care and care was provided in a person centred way. Care records were held securely.

People received care that met their needs and care plans were clear and detailed so staff were able to provide care appropriately. There were activities available that suited people’s needs and people had opportunities to go out in the community and attended day centres regularly. There had been no recent complaints but relatives were comfortable to raise anything that concerned them.

There were quality assurance systems in place and these were used effectively. There were meetings for the team to share practice and changes and surveys to obtain relatives views. The home provided regular updates for people and communicated well to keep relatives informed.

We considered our inspection findings to answer the five key questions we ask.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found during our inspection of Turning Point Ambleside on 23 April 2014.

Is the service safe?

People’s needs had been assessed individually and were reviewed regularly by staff. Staff we spoke with were knowledgeable about people’s individual requirements and how to support those needs. However we also found that the provider had not ensured people were protected from the risks of financial abuse. People who used the service may have been over charged for the purchase and use of a community mini bus under a lease scheme.

Health and safety audits were carried out by the manager on a regular basis as part of a system for monitoring people's safety. Where people had suffered an accident or been involved in an incident, the manager had reviewed these and implemented appropriate measures where necessary.

The home was welcoming and appropriately equipped to support the needs of people who lived there. We found the home was secure, and staff carried out a range of maintenance and safety checks frequently to ensure people’s safety. However we also noted that some of the lounge and garden furniture required updating and replacing, and rubbish required disposal.

Is the service effective?

Staff promoted people's independence and ability to make choices as much as possible. Members of staff described a person-centred approach to care and demonstrated a good working knowledge of the contents of people's support plans. Suitable equipment was provided and maintained in order to promote people's independence.

People were protected from the risks of inadequate nutrition and dehydration. Care records we looked at assessed routinely people’s fluid and nutritional intake, and where necessary people were referred for specialist professional support.

Is the service caring?

We observed that people were treated in a dignified and courteous manner by the staff. Staff we spoke with were aware of people’s individual needs and responded accordingly. Where possible, people were supported to live as independently as possible. For example we noted that at lunch time, people were supported to eat their meal with the use of equipment that promoted their independence.

Is the service responsive?

People's support plans carefully described their preferences, likes and dislikes and these were reviewed regularly. Where a person’s health needs had changed this prompted a review of their needs and referral to specialist health professionals where appropriate.

We found that when considering decisions for people who lacked capacity, staff had not followed the appropriate legal guidance. This meant that people’s needs had not always been considered when making decisions about complex matters.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. Members of staff were invited to attend meetings where they could raise any concerns and their feedback was listened to.

People who used the service were unable to provide their feed back to the provider in relation to the care they received. However the views of people’s relatives had been sought, and where appropriate the manager had implemented appropriate changes.

The manager carried out a range of audits to ensure the service was effective and an action plan was developed from these. The regional manager visited the service frequently and carried out a series of checks to ensure that the quality of care was maintained and any actions from the audits were remedied.

We noted that a complaints policy was available to both visitors and relatives, and also an accessible format procedure was available to people who used the service. We saw from records that no complaints had been received in the last twelve months.

On our arrival for inspection on 05 November 2012, all the people that used the service were getting ready to attend their planned daily activities. We observed all five people having their breakfast. We saw staff supporting some of them to get to the minibus.

None of people had the verbal ability to speak with us about their experience of living in this home, but we observed staff interactions with all five of them and checked documentation related to people’s support and care they received. This showed us that people were respected, that their preferences were known to staff and respected and that they were cared for safely.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2014 and to look at the overall quality of the service.

Turning Point - Ambleside is registered to provide accommodation and personal care for up to six people who live with complex learning disabilities. At the time of our inspection five people lived at the home. The manager had been registered with the Care Quality Commission (CQC) since February 2011. 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.

People were protected from abuse and felt safe at the home. Staff were knowledgeable about the risks of abuse and procedures for reporting any concerns.

We found there were sufficient staff available to meet people’s individual care and support needs and safe and effective recruitment practices were followed.

There were suitable arrangements for the safe storage, management and disposal of medicines.

We found that where people lacked capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005. The CQC is required by law to monitor the operation of the MCA 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection one application had been made to the local authority in relation to people who lived at Turning Point – Ambleside.

Staff received appropriate professional development, training and support to enable them to provide effective care.

People had access to healthcare professionals such as GP’s, community nurses and mental health specialists when needed. People were given appropriate levels of support to maintain a healthy balanced diet.

People’s relatives told us that staff treated people with kindness, dignity and compassion. We saw that staff knew people well and met their needs in a patient, individual and caring manner.

People were supported to take part in a wide range of meaningful activities both at the home and in the local community. People were free to decide where and with whom they spent their time.

People had been involved in discussions about how their care was assessed, planned and delivered. People’s relative and health professionals were positive about the management of the home and felt the manager was receptive to suggestions for improvement.

We saw that a system of audits, surveys and reviews were also used to good effect in monitoring performance and managing risks. The manager had developed a clear set of values based on person centred care, independence and choice.