Options Thorpe House is a residential care home for eleven people who may have learning difficulties and/or Autism. It is one of a group of homes owned by Wider Options Ltd. The home is situated approximately five miles from the centre of Scunthorpe and close to the village of Roxby. The accommodation is provided over two floors. There are five single occupancy flats on the ground floor and two flats on the first; one for two people and one for four people. The property has extensive grounds to the front and side, in which other functional buildings have been sited.

At the last inspection in April 2015 the service was rated Good.

At this inspection we found the service was Outstanding.

The service employed life skills instructors (LSIs) to support people with daily needs and a vocational life skills instructor for supervising and facilitating activities. These employees are referred to as instructors throughout the report.

Qualified and competent instructors were employed and supervised. Their personal performance was checked at an annual appraisal. Testimony of their extensive knowledge and skills was given by everyone we spoke with, without exception. People were outstandingly well supported to have maximum choice and control of their lives and instructors supported them to ensure their independence was promoted in the least restrictive way possible; the policies and systems in the service supported this practice.

People received excellent support with their nutrition and hydration to maintain their health and wellbeing. The premises were very well designed, furnished and equipped to support people with a learning difficulty or Autism, to the extent that each person’s flat was extremely well planned and fitted out to meet their individual and specific needs for privacy, space, occupation and social and personal care. The provider maintained their ‘outstanding’ rating for this area.

Extremely effective person-centred support plans reflected people’s needs very well and these were regularly reviewed. Those professionals we spoke with felt support plans were exceptionally effective at meeting people’s needs, without exception. People were outstandingly well supported with pastimes, activities and, if people wished it, living skills. The high level of encouragement provided by instructors was very important when engaging with people to achieve their full potential. People were supported to have extremely positive family connections and support networks. An effective complaint system was available and used when necessary although this had been rare. The provider had improved the service in this area so that they now achieved a rating of ‘outstanding’.

People were protected from the risk of harm. Safeguarding concerns were managed and instructors were trained in safeguarding adults from abuse and understood their responsibilities. Risks were reduced so that people avoided injury or harm. The premises were safe and there was documentary evidence to show this. Instructor numbers were sufficient to meet people’s need. Recruitment systems ensured instructors were suitable to support people. Medicines were safely managed.

Instructors were kind and caring and they knew about people’s needs and preferences. People and their relatives were involved in their care and instructors gained consent before undertaking any support tasks. People’s wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.

The culture and management style were positive. The service was well-led by a registered manager who was highly respected by everyone we spoke with. An effective system was used to check the quality of the service through audits, satisfaction surveys and meetings. People’s privacy and confidentiality were protected, as records were held securely on the premises.

Further information is in the detailed findings below.

We used a number of different methods to help us understand the experiences of people who used the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

During the inspection we spoke to three members of staff, two relatives and one person using the service. People spoke positively about the care and support their relatives received, comments included: "The changes in him have been amazing, they have really transformed him “, “They understand him, and I don’t worry about him now as I did in previous placements." “Staff will ring me and explain what is going on; they have a really good understanding of autism.”

Other comments included” The staff are very aware of his needs and his boundaries.” “He now has his own flat and can access communal areas when he wishes to. Everything in his flat is geared up to his needs.”And”How he presents when we visit and how he interacts with staff, shows us that he is happy.”

Relatives told us that they attended reviews, spoke to staff on a regular basis and were consulted and involved in all decision making. They told us they felt that their relatives care was very much a joint approach with the service in order to meet their identified needs.

We found that people were involved in deciding their care plan. We observed one person preparing a meal in their kitchen with support from staff. One person told us, "I like cooking and watching football." They told us they went shopping for food supplies and subscribed to a number of magazines. They said that they liked the home and staff helped them to keep in touch with family by writing letters and arranging visits. One person said they would like to go to watch a rugby match. The manager said this was something they were trying to arrange for the person.

Records looked at showed us people had their health needs met. One person spoken with told us the staff were "OK." The person said, "They helped me when I fell on the trampoline and banged my elbow." The person told us they visited the doctor and went to the hospital for appointments. We observed staff spoke to people in a kind and patient way. We heard them explaining things to people and checking out they understood.

We found that staff were knowledgeable about how to safeguard vulnerable people from the risk of abuse and poor practice. Staff were supported by management and had received training to equip them with the skills and knowledge required to fulfil their roles.

We found the provider monitored the quality of the service provided to people and when any shortfalls were identified, these were addressed.

During the site visit on 6 May 2011 one person living in the service agreed to discuss their experiences. We were told that they are offered different choices in their daily living routines and gave examples of the activities that they chose to participate in and food choices, that they wanted to have included on the menu.

People living in the service told us that as well as staff speaking to them and seeking their views, they were also completed questionnaires about their experiences and attended regular house meetings: minutes from these meetings were available.

People told us that, the staff were helpful and interested in helping in any way that they could.

We undertook the inspection on 21 and 22 April 2015 and the inspection was unannounced, which meant the registered provider did not know we would be visiting the service.

The service was last inspected on 10 July 2013 and was meeting all the regulations assessed during the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 7 November 2011. 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.

Thorpe House is one of a group of homes owned by Wider Options Ltd. The home is situated approximately five miles from the centre of Scunthorpe and close to the village of Roxby. The home is registered to provide personal care up to a maximum of 11 young people with Autism and other learning disabilities. The accommodation is provided over two floors. There are five single occupancy flats on the ground floor and two flats, one for two people and one for four people, on the first floor

Each person received continuous support from staff and needed to be supervised whenever they went out. The service promoted an ethos of learning and individuality. They worked with people to develop and equip people with skills for life. This was based on the philosophy of the organisation of fitting a service around each individual, not fitting people within a service.

The people who used the service had complex needs and were not all able to tell us fully about their experiences. We used a Short Observational Framework for inspection (SOFI) to help us understand the experiences of the people who used the service. People’s language difficulties meant we were only able to speak with two people who used the service and have limited discussions with them.

People’s relatives praised the way staff cared for their family members. They told us the service was exceptional with everyone going the extra mile and delivering excellent care. We were told of numerous examples of young people being supported to develop life skills and independence, far beyond their families’ expectations.

There was a strong person centred culture apparent within the service (person centred means care is tailored to meet the needs and aspirations of each individual). Personalised programmes and flexible staffing enabled people to learn how to live as independently as possible with the minimum of support. Staff described working together as a team, how they were committed to providing person centred care and supporting people to achieve their potential. Staff told us the registered manager led by example and was supportive of them in their roles.

The registered provider had policies and systems in place to manage risks, safeguard vulnerable people from abuse and the safe handling of medicines. Care plans had been developed to provide guidance for staff to support the positive management of behaviours that may challenge the service and others. This was based on best practice guidance and least restrictive practice to support people’s safety. Staff were supported by implementing this approach, to provide consistency to situations that may be presented, which protected people’s dignity and rights.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, when they lacked capacity, these had been made in the person’s best interests.

Recruitment practices were safe and relevant checks had been completed before staff commenced work.