This inspection took place on 5 April 2018 and was announced. The inspection continued on 6 April 2018. The second day was also announced.

2 Thornhill Close is a small residential care home without nursing that is registered to provide support for up to three people aged 18-65 with complex medical, physical and learning needs. It is located in a bungalow with an enclosed rear garden. At the time of our inspection the home was providing support to three people. People in care homes receive accommodation and nursing or 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.

The service had a registered manager. 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 care service at 2 Thornhill Close 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. Registering the Right Support CQC policy

There was enough staff to keep people safe and meet people’s individual needs. There was a safeguarding policy and procedures in place to protect people from abuse and harm. Staff understood their responsibilities to safeguard people and knew how to raise concerns both internally or externally if required. Staff had a good understanding of people’s individual risks and how to manage them positively without being unduly restrictive. There were processes in place to ensure safe recruitment of staff to reduce the risks to people living at the home. Checks were also made of volunteers that worked with the people when doing community activities.

People were supported by staff with the skills, experience and knowledge to meet their individual needs. Staff had an induction into the service. Staff competency was monitored on an ongoing basis through competency checks, appraisals and supervision. The service had a matrix for tracking when staff had last received supervision and when the next one was scheduled. Three staff had supervision frequencies that fell outside the provider’s quarterly target. Two of these staff only worked at weekends. When this was raised with the registered manager invites were immediately sent to the respective staff. Staff received mandatory training alongside specific training that enabled them to meet people’s complex needs for example epilepsy, Pica (an eating disorder where people will try to ingest items that are inappropriate and have no nutritional value) and autism. Staff understood the principles of the Mental Capacity Act 2005 (MCA 2005) and how it applied to the people there. This provides protection for people who do not have capacity to make decisions for themselves.

Staff interacted with people with kindness, compassion and humour. There was a relaxed and homely atmosphere with staff observed consistently giving their time and responding to people in a patient and timely way. People were supported to maintain relationships with relatives and friends and actively participate in a wide range of community activities. Until recently the service had its own minibus but due to a provider decision to make more efficient use of the fleet of vehicles at its disposal the service were now sharing a minibus with another of the provider’s services. This impacted on the ability for people to do community activities spontaneously or individually if it involved the need for a vehicle. Due to the experience of the staff they were able to demonstrate a good understa

People who use the service had profound learning disabilities and were unable to speak to us directly. During our visit we observed people in their home environment, looked at records both in the home and in the provider’s local office, and spoke with staff. Within this report we have stated when we have spoken directly with the manager.

We observed people being treated with respect and dignity. Staff demonstrated that they understood people’s health and social care needs well. We found that people had well organised, detailed, support plans and daily monitoring records. Records had been up-dated to reflect people's mood, nutritional intake and visits with professionals. We found that one person had not been weighed in line with their individual support plan. Whilst their weight was stable this could have led to staff not promptly identifying weight loss in this person.

We found that the home was clean and odour free and there were effective systems in place to protect people from the risk of the spread of infection. Staff had received training in infection control and food hygiene.

Effective recruitment and selection processes were in place. Records showed that staff had been subject to reference, identity and Criminal Records Bureau or Disclosure and Barring Service checks.

Whilst people were unable to speak to us directly we gathered evidence from observation of people in their day to day environment, discussion with staff and speaking to the registered manager as well as inspecting records. We found that the people living at this location received safe and effective care and support in an environment that they found satisfying and which enabled them to live their life as they wished.

Vulnerable people who used the service were kept safe by staff who understood their responsibilities and had an understanding of safeguarding people.

We found that appropriate arrangements were in place to manage medicines so that people received required medication in a timely and safe manner.

Staff received appropriate professional development and had access to support through supervision and performance reviews.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

The three people living at the home at the time of our visit were unable to speak with us. However, we saw that staff knew people well and had developed methods of communicating and understanding their wishes. For example one person used an adapted form of Makaton to indicate yes or no in answer to everyday questions. Staff also encouraged people to indicate their wishes through behaviour, for example physically taking staff to the kitchen to show them what they wanted. We observed that staff respected and treated people sensitively and as individuals.

We saw that people had individual, personalised bedrooms. They were encouraged to be as independent as possible. For example one person was encouraged to help lay the table, another was encouraged to take their cup to the kitchen sink when they had finished

Staff were very supportive to people and provided them with regular reassurance that they would always make sure they were safe. Staff had been well trained and knew how to recognise safeguarding situations and how to report concerns to the local authority safeguarding team.

The inspection took place on 8 December 2015 and was unnanaunced. The inspection continued on 11 December.

The service is registered to provide personal care with accommodation for up to 3 adults. The service has 3 bedrooms. The service has an open plan living and dining area that people are free to use at any time. There is a shared bathroom, a staff sleep in room/office and kitchen. The dining area overlooks a patio area which leads into a level access garden. The is outdoor seating and a summerhouse with level access to it.

The service has 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.

People who use the service have complex health needs and use non-verbal methods of communication. For example body language, facial expression, gestures and visual prompts.

Staff were able to tell us different forms of abuse for example, financial, physical and neglect. They were able to tell us how they would recognise if people were subject to these forms of abuse and how they would raise their concerns with the manager. Staff were also aware of external agencies they could contact. We noticed that in the staff office there were contact numbers for the local authority Safeguarding team and the Care Quality Commission. The Registered Manager told us that if they are ever in doubt they always call the safeguarding team. Staff told us that they had received safeguarding training. We looked at the training records which confirmed this.

All three people who used the service had a Personal Emergency Evacuation Plan in place which were up to date and reviewed annually. These plans detailed how people should be supported in the event of a fire during the day and at night. There was also a Service Emergency Plan in place which detailed; peoples profiles and emergency contact numbers. The plan covered emergency situations for example missing persons, failure of electric, water or gas leaks.

Each person had an Individual Support Plan (ISPs) in place which detailed the care and support people needed to remain safe and as independent as possible. The plans included risk assessments, guidelines for staff, personal profiles and review reports. The service was in the process of updating these ISPs and will be replacing them with Person Centred Plans (PCPs). These will be more person centred and will support people who use the service and or families to be more involved in the planning and review of their care and support.

Medicines were managed safely. Medication was only administered by trained staff.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training which was more specific to their roles for example autism awareness and epilepsy. A staff member told us, “We receive regular training; I have recently done a refresher in food hygiene and infection control

People who use the service have complex health needs and use non-verbal methods of communication. For example body language, facial expression, gestures and visual prompts. All three people lack mental capacity to make complex decisions about their health and care needs however, capacity assessments and best interest decisions were not always recorded or reviewed effectively. The Registered Manager told us that she is aware that capacity assessment, best interest decisions and consent is an area that they need to improve upon. Following the inspection visit the Registered Manager arranged a best interest meeting with relevant professionals.

All three people have had a Deprivation of Liberty Safeguards (DOLs) application completed and sent to the local authority. One persons had been returned and authorised. This is up for review in March 2016.

A therapist told us, “Staff are caring and kind. They treat people as individuals. They are all very passionate about their roles”.

Staff were polite and treated people in a dignified manner throughout the inspection. If people required support with personal care they were discretely supported back to their room or to the toilet and doors were closed behind them.

One person’s epilepsy was deteriorating and they were undergoing a medication review. Both the care file and medication file reflected this and staff we spoke to were aware. We reviewed the seizure chart which staff used to record seizures on identifying the date, time, type, duration and other comments. This information was then shared with the epilepsy nurse and neurologist during meetings to monitor their progress and identify any patterns or trends.

The care files we reviewed identified people’s care and support needs whilst out in the community. We reviewed two peoples activity records which showed us that people have regular access to the cinema, library, recycling centre and bowling to name a few. A staff member told us, “We regularly support people to cafes and restaurants”.

The staff we spoke to all said that they felt the service was well managed. A therapist told us, “The Registered Manager is ultra-organised and is always 10 steps ahead”.

We reviewed how the service monitors quality care and support. There was evidence of an out of hour’s visit which took place by the Registered Manager on a Saturday in September 2015. This report reflected outcomes of staffs conduct, environmental checks, general observations and other comments. The overall outcome of this visit was positive.

We reviewed the services end of month paperwork quality monitoring checks which are completed by the Registered Manager and senior support worker. These checks covered medication, maintenance, record keeping and cleaning charts to name a few. There were areas to log comments and actions.