The visit took place on the 31 August 2016 and was unannounced.

Turning Point - Timberlea provides personal care to 12 adults with learning disability and mental health needs in a supported living environment.

There was a manager in post who had 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.

Staff received training in how to safeguard people from abuse and knew how to report any concerns that arose both internally and externally. Relatives and health care professionals told us that people were kept safe at the service and when out and about in the community.

Safe and effective recruitment practices were followed and there were sufficient numbers of suitable staff available at all times to meet people’s individual care and support needs. Information from incidents was used to good effect in reducing identified risks and keeping people safe.

There were effective plans and guidance in place to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained.

People were helped to take their medicines safely by trained staff who had their competences assessed and checked in the workplace. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

Relatives and health care professionals were positive about the skills, experience and abilities of staff who worked at the service. Staff received training and refresher updates relevant to their roles and the needs of the people they supported.

Staff regularly worked with the registered manager and had opportunities to discuss any concerns they had, issues about their personal development and performance and how the service operated. Formal ‘one to one’ supervisions and annual appraisals were up to date.

People were supported to maintain good physical and mental health and well-being. They had access to health and social care professionals when necessary and were supported to eat a healthy balanced diet that met their individual needs.

We saw that staff obtained people’s consent and agreement before providing personal care and support, which they did in a kind and patient way. People’s individual plans of care and support accurately and consistently reflect that consent had been provided.

Arrangements were in hand to ensure that people were supported by advocacy services where appropriate to help people them access independent advice or guidance. People and their relatives were involved in the planning and reviews of care wherever possible.

We saw that staff had developed positive and caring relationships with the people they cared for. The confidentiality of information held about people’s medical and personal histories had been securely maintained throughout the service.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their individual needs and took account of their preferences. Staff knew the people they looked after very well and were knowledgeable about their background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests, hobbies and meaningful activities relevant to their needs, both at the service and in the local community. Relatives told us that staff listened to them and responded to any concerns they had in a prompt and positive way. Complaints were recorded and investigated thoroughly by the registered manager with learning outcomes used to make improvements where necessary.

What people told us and what we found.

This is a very small service one inspector from the Care Quality Commission (CQC) conducted this inspection. We looked at care records and other records pertaining to the safety of the people who lived in the home. We saw eleven of the twelve people who were supported by Timberlea and we spoke to four of them. All of them showed signs of wellbeing and looked well prepared for the day. All of them were socialising except one person who because of their physical frailty had been confined to bed.

We inspected this home on the 04 and 05 January 2014 and we found that they were

not meeting the standards in relation to care and welfare of the people, safeguarding the people, nutrition and staffing levels. On this occasion all outcomes were met.

Is the service responsive?

We did not look at this aspect of care on this occasion.

Is the service safe?

We found and we were told that the people who were supported by the service felt safe. Staff were aware of their duty of care to the people and were trained to recognise and respond to signs of abuse. The people who used the service told us that the staff were easy to talk to and they were able to discuss problems with them.

Is the service effective?

We found the people who used the service were supported to have the lifestyle they wished to have. One person told us that they were feeling “Grown up and independent, I am now a safe and confident person. I am proud of my flat.”

Is the service well led?

At our last inspection we had concerns that the home did not have an auditing system in

place that ensured accountability of how peoples’ money was spent. We saw that this was now in place and was reviewed on a regular basis.

The staff and the people who used the service told us that they were happy with the service and that they had the opportunity to give their views on the service and that these views were taken into consideration. As it was a small service there were also informal lines of communication. We observed many of the people coming into the manager’s office for a chat we saw that they were made welcome.

We found the service to be well managed and run in the best interests of the people who used the service. Staff were well supported and well managed and directed.

We spoke to people who used the service and staff members. We were told that the staff were very 'nice' and people told us they were 'happy living' at the service. They said staff assisted them with everyday tasks and helped to promote their independence. While we were at the service we saw people were well looked after and happy. Staff were visible and at hand to assist people if needed.

We observed the home to be visibly clean on the day of our visit. All the people who lived at Turning Point – Timberlea that we met appeared to have had their personal care needs met. We observed that people were relaxed in the company of staff and were able to communicate their wants and needs. People told us that they were often bored and that there was not much to do when they were not attending the day centre or out shopping.

We reviewed records and found that not all of the people had a care plan in place and care plans which were in place had not all been updated with recent changes. This meant people were at risk because staff may not know how to support someone in accordance with their needs.

Nutritional arrangements were not adequate, people were not supported to ensure food was in date and suitable for their needs. This meant that people were at increased risk of eating something which may have made them unwell.

Safeguarding arrangements were not effective, procedures were not always followed and concerns raised were not always acted upon. This meant that service users were at increased risk of being subject to abuse.

We also found that staff were not adequately supported because supervision and appraisals were not held regularly and because mandatory training was overdue for most staff.