This inspection took place on 23 and 25 January 2018 and was announced. The inspection was undertaken by one inspector.

Turning Point-Hollygrove is a ‘care home’. People in care homes receive accommodation and personal care as a 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-Hollygrove accommodates up to nine people with a learning disability in one adapted building. At the time of our inspection there were seven people living at the home. The care service has been developed and designed in line with the values that underpin the Registering the Right Support CQC policy and other best practice guidance. These values include choice, promotion of independence and inclusion.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Good overall. 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 on-going monitoring that demonstrated serious risks or concerns.

At this inspection we found the service remained Good and improvements had been made to how the service was monitored to identify improvements. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection .

People continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

The premises continued to be appropriately maintained to support people to stay safe. Staff understood how to prevent and manage behaviours that the service may find challenging.

Staffing levels ensured that people's care and support needs were continued to be met safely and safe recruitment processes continued to be in place.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity.

People's needs and choices continued to be assessed and their care provided in line with up to date guidance and best practice. They received care from staff that had received training and support to carry out their roles.

Risks continued to be assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff continued to support people to book and attend appointments with healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

Medicines continued to be managed safely. The processes in place ensured that the administration and handling of medicines were suitable for the people who used the service.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided.

Staff had a good understanding of people's needs and preferences.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedbac

Turning Point – Hollygrove is a small care home, which provides care and support to up to nine people with learning disabilities. This inspection was unannounced and took place on the 3 August 2015.

The registered manager was on a period of leave and a acting manager was in post and participated in this inspection. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Quality assurance arrangements were in place to monitor the standards of care. Action plans were developed where standards were not being fully met. People’s views were sought through house meetings and during care plan reviews. However, internal audit systems were not in place to monitor that people’s care was consistent and met their current needs.

A person centred approach was used to meet people’s needs. Care plans were developed on how people liked their care needs were to be met by the staff. However, the care plans were not evaluated. This meant it was not possible to determine if the care plans were effective.

People were protected from abuse and were helped to understand all aspects of the safeguarding from abuse process. Members of staff knew the procedure for safeguarding people from abuse. They received refer training to ensure they knew how to identify the signs of abuse and the actions to be taken for suspected abuse.

Risk management systems ensured preventative action was taken to lower the level of risk. People’s dependency needs were assessed and action taken to lower the level of risk. Members of staff knew where risk to people’s wellbeing and safety was identified and action was taken to lower the level of risk.

Staffing levels were managed appropriately for people to participate in community based activities and to pursue hobbies and interests.

Medicine systems were improved in response to medicine errors which occurred in the last 12 months to ensure safe systems of medicine management were in place.

There were opportunities for staff to discuss their performance during regular one to one meetings with their line manager. Training attended helped them to develop their skills and knowledge to meet people’s needs.

People were helped to make decisions. Members of staff used people’s preferred form of communication such as easy read formats and pictures to ensure people understood the options available. People’s capacity to make decisions was assessed and where they lacked capacity, best interest decisions were made on their behalf.

Arrangements were made for people to receive ongoing healthcare where required. Health action plans were reviewed annually by a healthcare professional. Hospital passports were in place to ensure important information was available to medical staff in the event of an admission to hospital.

People were involved in the planning of their care and about living in a group environment. Members of staff respected people’s rights and developed positive relationships with people. People’s preferences were sought on how they liked their care needs to be met.

Arrangements were in place to manage complaints. The complaints procedure was on display and in an easy to read format which ensured people understood the procedure for making complaints.

Members of staff had a good understanding of the values of the organisation. They said the team worked well together and the manager was approachable.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. One person’s relative said ‘they support them well, it is an excellent place’. Another relative said ‘the rapport between staff and residents is really good’.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People were provided with a choice of suitable and nutritious food and drink.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People were made aware of the complaints system. This was provided in a format that met their needs. One person’s relative said ‘if I had a big issue I would approach staff and it would be listened to’.

During our inspection we spoke with two of the six people who used the service and two staff.

People who spoke with us were able to discuss their life at the home and what they enjoyed about living there. One person told us "it's nice here.” People told us they were fully involved in decisions about how their care was delivered. One person told us they "always felt listened to.”

We observed interactions 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 they used to support people to maintain activities relevant to them. Staff offered people choices and showed an understanding of how people communicated.

Records showed the home liaised with community health services. Staff kept full notes of changes in people’s wellbeing and requested medical attention for people in a timely way. Staff provided care and support in line with people’s care plans.

Staff told us they were confident in their understanding of and ability to work with people’s behaviours. They were clear about their safeguarding responsibilities and how they would respond to any suspicion of abuse.

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