About the service:

Thorndene is a residential care home that was providing personal care for seventeen people living with severe healthcare needs, learning disabilities, autism spectrum disorder and behaviour that challenges. The home has been developed and designed in line with 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. These values were seen in practice at the home. For example, the building was like any other on the road with no signs to show

it was a care home. Staff did not wear uniforms and people lived their lives in the ways they wanted.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of Good and Outstanding in responsive. The overall rating is Good.

What life is like for people using this service:

• The home has shown continuous improvement following our previous inspection in August 2016. For a home which supports people with multiple and complex needs and with behaviours that challenge, there have been remarkably positive and consistent outcomes for people.

• Staff had an excellent awareness of individuals' needs and treated people in a warm, loving and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

• The registered manager and staff went above and beyond what was expected of them to ensure people received personalised and responsive care and support. Everyone including those with limited verbal communication could express an opinion about the care provided and contributed to their care plans.

• The provider promoted a good quality of life for people. People were happy living at the home, were able to express themselves and engage with staff, participate in activities they enjoyed within the home and in their community and develop their skills and independence.

• People were supported to maintain relationships with those important to them and to develop new relationships.

• The registered manager had inspired and supported the staff team to improve people's lives, had achieved good outcomes for people, ensured people were kept safe and received high quality, person centred care and support in line with all their individual needs.

• The registered manager and their team provided excellent support to staff; and were open and transparent in their management. The management team put people at the heart of what they did, and were well supported by the provider in their quest to deliver a good service.

More information is in Detailed Findings below.

Rating at last inspection:

Good (Report published August 2016)

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

This inspection took place on 22 July 2016 and was unannounced.

Thorndene is a residential service for 22 people living with a learning disability. People also had communication and mobility needs. There were 21 people living at the service at the time of inspection. The service offers spacious accommodation. It is a large country house, arranged in small homely groups, with a separate, smaller bungalow in the grounds providing accommodation and support for five people. The bungalow is designed to promote increased independence.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 30’s and the oldest in their 80’s.

There was a new registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. On the day of the inspection the registered manager was not available. The previous registered manager who recently retired from the post supported us throughout the day. The previous registered manager continued to support the new registered manager and was also a director of the company. There were also two duty managers who oversaw the day to day management of the main house and a manager who oversaw the management of the bungalow. There was duty manager on site seven days a week.

Staff had received safeguarding training to protect people. They said that they would report any concerns to the registered manager and felt confident that the correct action would be taken to keep people safe and protect them from abuse. Some staff were unsure where to report any concerns of abuse to outside the company, like the local authority safe guarding team. This is an area for improvement. Systems were in place to ensure that people’s finances were protected.

Risks to people were identified and there were measures in place to reduce risks to keep people as safe as possible. There was guidance in place for staff on how to care for people effectively and safely and keep risks to a minimum without restricting their activities or their lifestyles. People received the interventions and support they needed to keep them as safe as possible. Accidents and incidents were recorded and the majority were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively to ensure their safety. Some of the accident and incident reports lacked detail. When people had unexplained bruising these were recorded but no analysis or cross referencing had taken place to investigate how the bruising might have occurred and how to reduce it in the future. This was an area for improvement.

Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills so people knew how to leave the building safely. Safety checks were carried out regularly throughout the building and the equipment to make sure they were safe to use.

Staff told us how they always asked people for their consent as they provided the care. They described how they supported people to make their own decisions and choices. Some people chose to be supported by their relatives when making more complex decisions. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made, involving people who know the person well and other professionals, when relevant. The manage

People told us staff had talked to them about the care and support they needed when they first came to Thorndene. Most people spoken with did know about their care plan (a plan of care outlining how staff will support them), felt they had been involved in reviewing it and that they had signed it in agreement.

We spoke with several of the people who used the service. Those spoken with were happy with the care and support given and had no concerns with regard to the quality of care. One said "I enjoy living here. Staff treat me well and help me. If I am unhappy I talk to the manager". Another person said "Staff help me and talk to me if I am worried". Through observation during the inspection, we were able to observe staff supporting people who used the service in a respectful way and observed staff taking time to explain, where possible, the options available whilst involving people in making choices.

Through direct observation, discussions with staff and records we viewed, we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills.

We made an unannounced visit to the service and spoke to people who use the service, the manager and to staff members. There were twenty one people using the service at the time, four people were on holiday and others were at home or college and work placements. We spoke to all of the people who were at home and everyone we spoke to said or expressed that they were very happy living at Thorndene.

People told us or expressed that they felt safe and well looked after. People said they would talk to staff about any problems and the staff would sort it out for them.

People told us that there were enough activities going on and people told us that they enjoyed going to local clubs and visiting friends. People told us about their holidays and about the wide range of activities they took part in that they enjoyed.

Staff interacted and engaged with people in a warm positive way. People said “All the staff are nice”.