This inspection took place on 29 November, 1 and 7 December 2017 and was announced. We gave the provider short notice of our inspection due to the nature of the service. This was so the registered manager could be available to assist us with our inspection.

Thorndale is a 'care home'. 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. Thorndale provides personal care for up to six people with a learning disability and/or autistic spectrum disorder. At the time of our inspection there were five people living at the home. The home is located next door to another of the provider’s services, both of which are managed by the same registered manager and deputy manager.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

We last inspected this service on 3 September 2015 when it was rated 'Good' overall. During this inspection we found the service remained good and rated the key area of responsive as 'Outstanding.'

Relatives described the care at Thorndale as ‘Outstanding.’ Relatives told us how the service had made a huge impact on their family members by enabling them to lead full and rewarding lives and be as independent as possible. Staff did not view the complex needs of the people who used the service as a barrier to them participating in similar activities to those of their peers. Relatives told us people had access to a fantastic range of activities.

People had made substantial progress due to the use of the SMART (specific, measurable, achievable, realistic and timely) target system. These targets were a way of setting goals for people to work towards in areas that really mattered to them and which improved their quality of life. These targets and other positive proactive support strategies had resulted in a reduction in the number of incidents that could be challenging for people. The strong focus on person-centred care had an extremely positive impact on people.

People received care which was exceptionally person-centred and responsive to their needs. Staff had an excellent understanding of people’s needs and how they preferred and needed to be supported. Staff were innovative at responding to changes in people's needs and identifying new support strategies for people.

Relatives told us they were very satisfied with the service and felt their family members were safe and happy at Thorndale.

Risk assessments about people's individual care needs were in place, for example in relation to nutrition and epilepsy. Control measures to minimise the risks identified were set out in people's care plans for staff to refer to. There was a positive approach to risk management.

Each person had an up to date personal emergency evacuation plan (PEEP) which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

There were enough staff on duty to meet people's needs. Essential staff training was up to date. Staff received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

There were appropriate systems in place to record and respond to complaints. Relatives we spoke with said they had not needed to complain and felt any concerns would b

The inspection took place on 24 September 2015. The last inspection of this home was carried out on 7 August 2013. The service met the regulations we inspected against at that time.

Thorndale provides care and support for up to six people who have autism spectrum conditions. At the time of this visit six people were using the service. The accommodation was over three floors and consisted of six bedrooms. People had access to a communal lounge, kitchen and dining room.

The home is a semi-detached house in a residential area. The service is situated next door to another small care home and they are both managed by the same registered manager, who was present on the day of our visit.

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 people who lived at the home had complex needs which meant they were unable to express their views. Relatives made positive comments about the service. They described the service as safe. Relatives felt involved in decisions about their family members’ care.

Staff had a good understanding of safeguarding and said they would speak up if they had any concerns. Any concerns had been investigated to make sure people were safe.

Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and Deprivation of Liberty Safeguards to make sure any restrictions were in people’s best interests. For example, all of the people who lived there need staff support and supervision when in the community because they had a limited understanding of road safety.

Medicines were managed in a safe way and records were up to date with no gaps or inaccuracies. A signature chart was in place so records could be audited.

There were enough staff to make sure people were supported. Staff training was up to date and staff received regular supervisions and appraisals.

People were supported to enjoy an active lifestyle and eat healthily. People were encouraged to be as independent as possible, and were supported to do household tasks and take part in activities they enjoyed.

Care plans reflected the interests of individuals, and were person-centred and well written.

Relatives felt fully involved in reviews about their family member’s care. Relatives felt staff understood each person and supported them in a way that met their specific needs. People’s choices were respected, and each person had a range of activities they could take part in.

Relatives knew how to make a complaint and felt that complaints would be taken seriously, although no complaints had been made in the past year.

We saw that systems were in place for recording and managing safeguarding concerns, complaints, and accidents and incidents. Detailed records were kept along with any immediate action taken which showed the service took steps to learn from such events, and put measures in place to reduce the risk of them happening again.

Relatives felt the home was well run. One relative told us, “Staff care about the residents and offer help and support to the parents and family members as well.”

We haven’t been able to speak to all of the people using the service because they had complex needs, which meant they were not able to tell us their experiences. However, we gathered some evidence of people’s experiences of the service by observing care practice.

People were treated with dignity and respect and people, staff and families were encouraged to be involved in how the service was run as much as possible. One relative commented, “We visit every week and the staff keep us up to date and we have completed a questionnaire which asked us what we thought of the service” and “The care … gets here is really good”..

We found that people who were using the service were receiving the care and support they needed. For example, the staff we spoke with could describe how they met the assessed needs of the people they were providing with care.

We found that the people who were using the service were protected from abuse as the provider had procedures in place for the staff to follow if they suspected anyone was at risk of abuse.

We found that the provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

The complaints procedures had been made available to the people who used the service and their relatives. This was provided in a format that met their needs.

We found that the premises were comfortable and well maintained. For example the rooms were all different and were furnished appropriately to meet people's needs.

During the inspection, the staff members on duty were observed speaking to people in a kind and respectful way. The methods staff used to communicate with people was personalised and meaningful. We also observed that the people were clean and well groomed.

The people who used the service had speech and language impairments and were not always able to verbally communicate their needs to the staff. However, two people were able to tell us that they were happy at Thorndale by the use of gestures. People answered “Yes” when we asked them if they happy at Thorndale. One person gave a thumbs up gesture when we asked them if they were properly looked after. Another person clapped their hands when we asked them the same question. A staff member explained to us that clapping their hands meant they were happy or agreed to a suggestion.

We met one relative at the time of our inspection visit. They told us, “.. is very happy here , he is well looked after and I am happy with the care he is getting here”. They also told us, “I am told about everything, even if I am abroad; they contact me to let me know if they have any concerns about his care”.

There were various means used, including residents’ meetings, to support people to make choices as much as possible. We saw minutes of the residents meetings for March, April, June and August 2012. These provided details of decisions that individuals had made, including agreement for staff to purchase gifts and flowers for family members. In one case a person who used the service had decided to purchase a season ticket to attend home games for their local football club.

We spoke with service users about feeling safe in the home. Two people told us that they feel safe and the staff supported them well. Another service user said, “I am very happy here. The staff are nice and helpful”.

One service user told us that there was always sufficient staff on duty to help and support them.

Other written comments from parents included:

• “Staff are always approachable. I feel able to approach staff in confidence and Y is always happy and content”.

• “Thorndale is a happy, lovely, clean, welcoming place. I know my son is content”.

• “They treat service users with respect”.

• “Staff have good rapport with my son despite his communication difficulties”.