Turning Point Avondale is registered to provide care without nursing for up to 8 people with varying degrees of learning disability. At the time of the inspection there were 8 people using the service. People had their own bedrooms and there were spacious shared areas within the home and gardens. The home is purpose built and offers only ground floor accommodation. The home was last inspected on 10 February 2015 and was rated of ‘Good’ overall.

The inspection took place on the 14 and 15 February 2017 and was unannounced.

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.

Staff had the knowledge and confidence to identify safeguarding concerns and who to report these to. Staff told us they had received safeguarding training and we confirmed this from training records. Staff were aware of different types of abuse people may experience and the action they needed to take if they suspected abuse was happening.

Medicines were managed safely. We observed medicines being administered. Staff knew what medicines were for and explained to people what they were taking.

The ordering, storage and disposal of medicines was well managed. Stock levels were regularly checked to ensure there was sufficient medicines available to people according to what they had been prescribed.

Risk assessments had been completed and guidance on how to provide care in response to these were available in people’s care records.

Staff received regular supervision and annual appraisals which staff said were helpful and productive. Actions identified during these meetings were followed up as appropriate.

The service worked within the requirements of the Mental Capacity Act 2005. Where decisions were made in people’s best interests, documentation to support this was available in people’s care files.

People had access to health and social care services as required. Referrals were made as appropriate in response to changes to people’s needs. For example, GPs, physiotherapists, occupational therapists and speech and language therapists.

There were positive caring interactions from staff towards people using the service. Staff knew how to support people to be independent; giving them choices. People’s care records had details of their preferences, likes and dislikes. Staff were also aware of these and knew people well.

People participated in activities such as arts and crafts, puzzles and visits to day centres. People’s relatives told us there was sometimes a lack of interaction and stimulation for their family members and that very little happened at weekends. The registered manager told us they were currently in the process of improving activities within the home with a particular focus on encouraging people to be engaged with more routine day to day activities as well as improving and enhancing social activities.

Staff spoke highly of the registered manager and told us they were positive about some recent improvements such as the recent recruitment of new staff.

Systems were in place to track when staff training was due and to ensure this had been completed. Where staff were due training, this had been scheduled accordingly. Quality assurance processes were in place and action plans written and responded to following identification of shortfalls or issues.

This was an unannounced inspection which took place on 10 February 2015.

Turning Point-Avondale is registered to provide care without nursing for up to 8 people with varying degrees of learning disability. People have their own bedrooms and one bedroom has en-suite facilities. The home is purpose built and offers only ground floor accommodation. There are spacious shared areas within the home and gardens.

There is a registered manager running 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.

The service had a variety of ways to keep people as safe as possible. Care workers were trained in and understood how to protect people in their care from harm or abuse. People’s families told us they were totally confident that their relatives were safe. People interacted with staff in a relaxed way. They constantly approached them to indicate they needed assistance or just to spend time with them.

Individual and general risks to people were identified and managed appropriately. The service had a recruitment process which tried to ensure the staff employed in the home were suitable and safe to work there. There was a stable staff group who had built strong relationships with people who lived in the home and their families. Staff members had an in-depth knowledge of people and their needs. The staff team were well supported by the registered manager to ensure they were able to offer good quality care to people.

The service had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.

People were supported and encouraged to look after their health. Care staff were skilled in communicating with people and in helping them to make as many decisions for themselves as they could. People were encouraged to be as independent as they were able to be, while being kept as safe as possible.

People were given the opportunity to participate in a variety of activities both individually and with others. People were treated with dignity and respect at all times. They were involved in all aspects of daily life and helped to meet any spiritual, behavioural or emotional needs.

The house was well kept, very clean and comfortable. People’s rooms reflected their individual preferences and tastes, as did the communal areas of the home.

Staff and family members told us the home was very well managed with an open and positive culture. Families and staff told us the registered manager was committed, very much respected and always available.

We spoke with three visiting relatives of the people living in the home. They all told us that the care given was excellent. They explained that they had been involved in planning the delivery of care and were invited to attend reviews where this was discussed. One relative told us “this is a really great home and I doubt we would have ever found a better one”. Another relative said “the staff here are really professional and when we visit at any time of the day or night they are all excellent”.

The manager asked permission of two of the people living there for us to look at their bedrooms. This was willingly given and we could see their rooms were decorated and furnished to an individual taste with many personal items and photographs.

When we spoke with relatives, they told us that they were happy with the numbers of staff in the home and thought their training and experience levels were sufficient to meet the needs of their sons and daughters. One person told us “all the staff here care and we are so lucky to have found a home like this”.

Three relatives told us they attended annual reviews with staff and relevant healthcare professionals. They confirmed this enabled them all to discuss the care and treatment provided and how effective it had been. One relative told us they could speak to any of the staff anytime to give feedback, and offer suggestions about what could be done better.

The manager explained to us the provider had engaged the services of an external advocacy group to support people who used the service or their relatives, should they wish to make a complaint or concern. They told us she preferred to have an open dialogue with all the relatives of people in the home to enable any comments or concerns to be dealt with on an informal basis. All three of the relatives we spoke with confirmed this was correct and any comments they had made were all acted upon.

During the inspection we spoke with one person who lived at Avondale, one relative and two members of staff.

The relative we spoke with was very satisfied with the care and support provided. They told us they were fully involved in their relative’s care, staff kept them informed of anything relevant regarding the health and welfare of their relative. “The staff are caring and experienced and know my relative very well.”

We observed interaction between staff and the people who were at the home during our visit. We found staff had a wide knowledge of people’s interests and abilities, which was used to support people to maintain activities relevant to them. Staff offered people choices and showed understanding of how people communicated.

Staff kept full notes of changes in person’s wellbeing and requested medical attention for people in a timely way. We observed staff provided care and support in line with people’s care plans.

Staff told us they were clear about their safeguarding responsibilities and how they would respond to any suspicion of abuse.

People told us they would speak to any of the staff if they had any concerns and were confident any concerns would be dealt with promptly and effectively.

Staff told us they received training on a regular basis that enabled them to carry out their job and they had opportunities to express views and opinions about how the service was run.

People and their relatives told us that they were very pleased with the service provided. Members of staff understood people's diverse care and support needs and how to meet them.

People were supported to access a range of local activities and events. Members of staff support people to achieve their goals and improve their daily living skills.

People's medicines were being appropriately managed.

Members of staff were well supported by the manager and had access to training relevant to the work that they do.

The manager was new to post but had worked at the home for some time and was well known to the people who lived there.