This inspection took place on 24 October 2018 and was unannounced. A second day of inspection took place on 29 October 2018 which was announced. We also spoke to relatives on 6 November 2018.

14 Thornhill is a ‘care home’ located in the Ashbrooke area of Sunderland. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. 14 Thornhill provides care for up to six people who have autistic spectrum conditions. The service does not provide nursing care.

14 Thornhill has been developed and designed in line with the values that underpin 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.

At our last inspection we rated the service good. 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 ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Some issues were found in relation to management of over the counter medications, food hygiene practices, storage of hazardous household materials and safety of windows in the premises. The registered manager took immediate action to address these issues throughout the inspection.

Relatives we spoke with told us they felt their family members were safe living at the service and staff knew their family members very well. They also told us that staff knew about autism and said this was paramount to caring for people with autism.

Safeguarding issues were logged and reported and staff we spoke with were confident in their understanding of safeguarding and were able to tell us how they would action any safeguarding concerns.

Staff were subject to a robust recruitment process, including pre-employment checks. Newly recruited staff had a period of induction which included shadowing existing members of staff.

People were supported and encouraged to eat a healthy and balanced diet. People were involved in the creation of their weekly menus, buying the ingredients and preparing, (where possible,) their own meals.

People had access to a variety of healthcare professionals, including GPs, dieticians and consultants. Relatives we spoke with confirmed their family members attended regular check-ups and annual healthcare appointments.

Staff were seen to treat people with great care and kindness and relatives we spoke with confirmed this also.

Prior to admission to the service, a detailed pre-assessment was carried out to ensure that the service could meet the needs of that person. Care plans contained lots of detailed information about how staff should care for that person, including their likes and dislikes, what made them happy or sad and what kind of activities they enjoyed and chose to do. Staff were able to tell us how they would ensure that people’s dignity was maintained during personal care and every-day tasks and this was evidenced during the inspection.

Care plans seen included ‘goals’ that people were working towards. These goals included, enhancing people’s social skills, building upon their personal confidence and expanding people’s life skills.

People had access to a range of activities which included attendance at college and farm as well as a local friendship group.

Relatives and healthcare professionals confirmed that the service was well-managed. The registered manager is supported in their role by an area manager who visited the service regularly.

Staff told us they felt supported and valued in their

The last inspection of this care home took place on 15 April 2014. The service met the regulations that we inspected at that time.

This inspection took place on 31 May 2016 and was unannounced.

14 Thornhill provides care and support for up to six people who have autistic spectrum conditions. The service is situated near other care homes operated by the same provider. The home does not provide nursing care.

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.

During this inspection we found that the service had not told us about two incidents that had been referred to the safeguarding team at the local authority. Although these were low level events, it is a legal requirement that registered services inform CQC of any alleged safeguarding events. This had been a management oversight, as similar incidents had been reported the previous year and the correct notification had been submitted to the Care Quality Commission (CQC). We have written to the provider about this outside of the inspection process.

The people who lived at the home had complex needs that meant they were unable to fully express their views. We saw people were relaxed and comfortable in the presence of staff and actively sought out staff members to spend time with them.

All staff had training in safeguarding and understood how to report any concerns. Relatives and staff felt there were enough staff on duty at all times to make sure people were safe.

Staff were vetted before they started work at the service to make sure they were suitable to work with vulnerable adults. The staff managed people’s medicines in a safe way for them.

Relatives said the staff were well trained in autism and said their family members’ “complex, specific needs are met”. New staff received induction training when they started work. One staff commented, “We get all the up to date training we need.”

Staff had training in the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. People’s lack of capacity to consent to care was clearly outlined in their care records.

People were supported to maintain a balanced and healthy diet. People's health and well-being was kept under continuous review by the service with input from external healthcare professionals.

Relatives told us their family members were cared for at the service by staff who were “respectful and kind”. A relative commented, “Our [family member] is very happy at number 14 and has a very good relationship with staff as do we.”

Staff members felt their colleagues were caring and committed to supporting people who lived there. Staff spoke about people in a way that valued them as individuals. Staff supported people in a friendly and encouraging way that met their individual communication needs.

People had been individually assessed and their care was planned to make sure they got the right support to meet their specific needs. Records described how people were not fully involved in their support plans because of their complex needs. Relatives felt they were able to discuss their family member’s support at any time.

Staff members were clearly knowledgeable about the specific and individual ways of each person. One staff member commented, “We work very closely with each person so we know their ways and what it means. I know the things they like and don’t like and can spot the slightest change in them.”

Staff were also familiar with how people might show if they were unhappy with a situation. Relatives had up to date information about how to make a complaint or comment. They said they would

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and the staff supporting them, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We inspected the premises and saw that there were systems and safety precautions in place to protect staff and people using the service. Staff had safeguarding training and relatives we spoke with told us they thought 14 Thornhill was a “safe” place for their family member to live. A relative told us, “We think our son is very well cared for.”

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had applied for DoLs authorisations for two people living at this home, and the staff were clear about their responsibilities in this area.

Is the service effective?

People’s health and care needs had been assessed before they moved to the home. Relatives said they were “fully consulted” in the planning of care and were involved in assessment meetings. We saw that support plans and risk assessments were person centred, up to date and reflected people’s individual needs.

Is the service caring?

People told us they “liked” the staff. There were enough staff to make sure people had one-to-one support at the times they needed this. Relatives told us, “We are really pleased with the staff. There are a number of young staff who are keen to ensure that our son has an active and fulfilled day.”

Is the service responsive?

People were encouraged to make their own choices, such as activities and menus. Care records showed that each person’s likes and dislikes were explored. We saw their preferences and abilities were supported and encouraged. Relatives told us that people had “fulfilled” lives. Relatives said they knew how to raise any concerns and felt that staff were “always willing to listen”.

Is the service well-led?

The provider made regular checks of the safety and quality of the service at 14 Thornhill. The service had a registered manager, deputy manager and senior staff to oversee the day to day management of the service. People and their relatives were asked for their views and opinions on how the service was run.