This inspection took place on 28 November 2017 and was unannounced. When we last inspected the service in January 2017 we found that the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and the service received an overall, rating of Good. At this inspection we found the service remained Good.

Turning Point - Brickfield Cottage is a ‘care home’. People in care homes receive accommodation and nursing 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. Turning Point – Brickfield Cottage accommodates six people who have a learning disability in one adapted building and on the day of this inspection there were six people living there. The service is not registered to provide nursing care.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was 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.

People’s relatives told us that they were confident that people were safe living at Brickfield Cottage. Risks to people were appropriately assessed, planned for and managed. There were sufficient competent and experienced staff to provide people with appropriate support when they needed it.

Staff had received training, support and development to enable them to carry out their role effectively. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). 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 supported this practice. People received appropriate support to maintain healthy nutrition and hydration.

People were treated with kindness by staff who respected their privacy and upheld their dignity. People’s relatives were encouraged to be involved with people’s lives where appropriate, to provide feedback on the service and their views were acted upon.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People’s relatives told us they knew how to complain but had not had occasion to do so. They said they were confident they would be listened to if they wished to make a complaint.

The registered manager worked hard to create an open, transparent and inclusive atmosphere within the service. People’s relatives, staff and external health professionals were invited to take part in discussions around shaping the future of the service. There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

This inspection was carried out on 5 January 2016 and was unannounced.

Turning Point-Brickfields Cottage provides accommodation and personal care for up to 6 people with learning difficulties. There were 6 people living at the service on the day of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection on 22 July 2014, the service was found to not be meeting the standards in relation to safeguarding people from abuse due to an ongoing investigation into how the provider funded the use of the mini bus. At this inspection we found that the issue had been resolved and the home was meeting the standards.

People were protected from the risk of abuse. Staff had a good understanding of how to recognise and report concerns. Risks were assessed and monitored and action to mitigate risk was taken without limiting people’s right to live.

People were supported by appropriate levels of staff which met their care needs and enabled them to spend time in the community and participate in events and activities. Staff were recruited through a robust procedure and received the appropriate training and supervision.

People were supported to eat and drink sufficient amounts and had regular access to health care professionals. Care was person centred and the culture in the home was people first. This was shared by the manager and staff.

There was strong leadership in the home and staff were valued and given additional responsibilities to ensure the smooth running of the home. There were systems in place to monitor the quality of the service and address any issues.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

The inspection team was made up of one inspector. As part of this inspection we spoke with the manager, five members of staff, two people who used the service, two relatives, a visiting healthcare professional and a representative from the local authority who was visiting the home. We looked at two people's care records and checked the provider’s arrangements to safeguard people from abuse. We also checked how the provider obtained and acted in accordance with the consent of people who used the service.

We reviewed information about staff recruitment and training. We also confirmed how the provider monitored the quality of the service provided together with cleanliness and infection control. Below is a summary of what we found.

If you wish to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and we saw that procedures were in place that protected people from abuse. One person said, “Yes, I feel safe here”. A relative commented, “(Person) is safe here. We have never had any problems.” At the time of this inspection the provider was reviewing how people who used the service funded the home’s vehicles to ensure that they were paying a fair share and were properly protected from the risks of financial abuse.

Staff we spoke with demonstrated an awareness of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards which protect people who are unable to make decisions for themselves.

Is the service effective?

We observed good relationships between staff and people who used the service. Staff we spoke with demonstrated that they understood how to meet people’s individual needs. One relative commented, “I am very happy with the care and support that is provided.”

Care records we checked were regularly reviewed and up to date. One relative commented, “I am kept informed and am invited to an annual review meeting.” Care records contained risk assessments that promoted people’s independence and enabled them to access activities of their choice.

Is the service caring?

People who used the service were supported by staff who were kind and respectful. We observed that staff offered people a choice of appropriate activities during the day and that rapport was good. A relative commented, “The service is excellent. It’s very welcoming. It’s like a home from home.”

Care records contained information about people’s preferences and it was clear that people had been involved in planning their care. Staff were up to date with their annual mandatory training which demonstrated that people were supported by staff with the right skills and experience to ensure their needs were met.

Is the service responsive?

People and their relatives expressed high levels of satisfaction with the service and told us they could approach the team with any concerns. One relative commented, “The service is very good. I have no complaints.” We found that there had been no complaints about the service in the last few years.

Is the service well led?

Records relevant to the operation of the service were available on request and demonstrated that the provider had systems in place to ensure that the quality of the service was monitored.

We saw that the environment was visibly clean and tidy and staff demonstrated that they understood their responsibilities with regard to infection control.

During our inspection on 6 June 2013, we spoke with three members of staff, a visiting professional, two people who live at the service and we observed those who had little verbal communication to help us understand their experiences of using the service. The people we spoke with told us they were able to make choices about whether they wished to participate in activities. One person told us they enjoyed living at Brickfield Cottage.

We observed that, in their different ways, people showed they were content living at this home and that they had good relationships with the staff. They showed that they felt safe, and were satisfied with the service being provided. There was laughter and friendly banter between staff and people living in the home during our inspection.

Care records we looked at were well written and had pictures to help people understand the care and support being provided.

Medication procedures and records were well managed and thorough checks carried out to prevent any errors.

Staffing levels were adequate to meet people’s needs and the staff felt well supported and received appropriate training to ensure their skills and knowledge remained up to date and in line with best practice.

Of the six people living at the home, four did not communicate verbally. Two used verbal communiction at a basic level, but they had very limited comprehension of concepts and contexts, so conversation with them was limited.

We did not speak to people on this occasion about standards, but observed them closely, read detailed information about two people and talked with the manager and staff.

On 28 June 2011 we spoke with the relative of a person living in the home. They said that their relative is able to make their own decisions about their care and daily life in the home, and that all the staff support their relative's choices. They said that the staff at the home always provide alternatives to the meals provided if their relative changes their mind about the chosen meal. They also said that they had been involved in all their relative’s care planning and attend regular reviews at the home. The relative said that the care provided at the home is excellent in every way and that the staff have skilfully enabled their relative to successfully make the transition between living at home and living in residential care.They told us that the staff are all approachable and listen to any comments they or their relative might have and said they had no concerns about any aspects of the service but would not hesitate to voice a concern if they had one.The relative said that the staff are all very well trained and act in a professional way at all times and they praised the manager of the home and said the manager is always around speaking with people and always listens to people’s comments. They told us that regular meetings take place with families, when anyone can say what they think about the home.