This inspection visit took place on 4 April 2017 and was unannounced. We spoke with relatives via telephone on 19 April 2017.

Thornfield Grange is a home for up to 10 people who have a learning disability and who may be on the autistic spectrum. On the day of our visit there were eight people using the service. It is situated in Bishop Auckland close to all facilities and transport links.

The service had a registered manager in place. 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 the service on 19 February 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Staffing was provided at safe levels and any staff absences were mainly covered by the registered provider’s own permanent and bank staff. The service were using agency staff as they were recruiting to permanent posts and were saw these staff were checked, supported and used consistently where possible. Staff told us they felt levels were generally safe but felt that night time should be kept under review.

Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff we spoke with were aware of procedures to follow if they observed any concerns in relation to safeguarding and we saw that staff were encouraged to raise concerns through supervisions and staff meetings that took place.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.

We saw that people were supported to access a wide range of activities in the community and this included staff supporting people with educational and employment opportunities. Staff did feedback to us that another vehicle would reduce the pressure on planning community outings as presently this limited the access for people due to only having one vehicle.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are 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 protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. We experienced the lunchtime meal and saw people were given choices and support to eat a healthy and nutritious diet. Care records contained evidence of visits to and from external healthcare specialists.

Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service at their own pace. We found that transition care plans could be more prominent and specific as the service did have people moving in and moving on from the service and there was not much written evidence of their support needs at that time.

Staff and relatives fed back that consistency of staff approach was the main challenge to the service and this could be improved.

Staff supported people who used the service with their social needs. We observed that all staff were caring in their interactions with people at the servi

During our inspection we spent time talking with people who were living at Thornfield Grange care home and watched how staff gave them support and care. We found peoples’ care and welfare needs were met in a way which ensured their safety.

When we visited we found the majority of people were unable to tell us directly about their experiences and views of their care. Therefore, we watched staff practices as they supported people. We found people were treated with dignity and respect. We also saw staff supported people to develop independent living skills.

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse.

We found staff were recruited appropriately. This helped to make sure only people with the right skills and knowledge were employed to work for the care home.

We saw the provider had a system to regularly assess and monitor the quality of the service people received. People who used the service and their representatives were also asked for their views about the service.

We inspected this service on 19 and 21 January 2015. The inspection was unannounced. This meant the staff and provider did not know we would be visiting.

Thornfield Grange provides care and accommodation for up to ten people. The home specialises in the care of people who have autism. On the day of our inspection there were four people using the service.

The home had 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.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a very friendly and respectful manner.

We spoke with four members of staff who told us they felt supported and that the registered manager was very approachable. Throughout the day we saw that people and staff appeared very comfortable and relaxed with the registered manager and staff on duty.

People had their physical and mental health needs monitored. There were regular reviews of people’s health and the home responded to people’s changing needs. People were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

We saw people’s care plans were very person centred and written in a way to describe their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for service users to understand by using of lots of pictures and symbols. We saw lots of evidence to demonstrate that people were involved in all aspects of their care plans.

The staff we spoke with said they received appropriate training, good support and regular supervision. We saw records to support this.

The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. We also viewed records that showed us there were safe recruitment processes in place.

The registered manager understood her responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made appropriately.

Throughout the day we saw staff interacting with people in a very caring and professional way. There were a range of individual activities that people took part in both in the home and in the local community.

The catering staff told us there was always plenty of food held in stock so people could choose what they wanted to eat each day. One person told us, “I like the food. I like the Pizza.”

We saw the provider had policies and procedures for dealing with medicines and these were followed by staff.

There was a range of information available to people in a picture format, for example, how to make a complaint, safeguarding adults and advocacy. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were closely monitored. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns. One service user told us, “Yes I made a complaint.”

We discussed the quality assurance systems in place with the registered manager. We saw there were a range of audits carried out both by staff, the registered manager and senior staff within the organisation. We saw where issues had been identified, action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.