This inspection took place on 8 January 2018 and was announced. The provider was given 48 hours’ notice because the location was a small care home for younger adults who are often out during the day; we needed to be sure that someone would be in

Thornhill is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service could accommodate up to seven people. At the time of the inspection six people were using the service.

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.

The care service has been developed and designed in line with the values that underpin the 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.

We inspected the service in November 2015 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

Relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, accident and incident policies. Staff had received training in safeguarding and knew how to report concerns.

Staff recruitment procedures were robust and included Disclosure and Barring Service checks and references. Staffing levels were appropriate to the needs of the people using the service.

Risk assessments were detailed, person-centred, and gave staff clear guidance about how to help keep people safe. People had personal emergency evacuation plans in place in case of an emergency.

Staff were trained in a range of subjects such as infection control, health and safety and fire safety. Staff had also received training to support them to meet the needs of people who used the service, such as autism.

Staff received regular supervisions and an annual appraisal which covered their personal development. Staff felt they were well supported by the registered manager and assistant manager.

People had access to a range of healthcare, such as GPs, opticians and dentistry. Nutritional needs were acknowledged and people enjoyed a healthy varied diet.

The premises were well suited to people’s needs, with ample individual living space. Communal areas were available for people to spend time together. Bathrooms were designed to meet the needs of the people living at the home.

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 encouraged to make choices in everyday decisions wherever possible. Staff provided support and care in a dignified manner, ensuring privacy when necessary.

Person-centred care plans were in place and contained good levels of detailed information. Care plans contained people’s likes, dislikes and preferences. Regular reviews took place to ensure staff had up to date information.

People enjoyed a range of activities both inside and outside the home. The service had positive links with the community with people accessing local community centres, discos and shops.

The provider had a complaints process in place which was accessible to people in a pictorial format.

The provider had a quality assurance process to monitor the quality of the service. Staff were extremely positive about the registered manager and assistant manager. We found people who used the service, family members and staff attended

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.

We also undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between them and the staff. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

During the SOFI, we observed people being supported to express their preferences; for example, one of the people who used the service was observed using pictorial cards to communicate with the care staff. Staff were seen to be attentive and gave people the information about their activity options in a way that was appropriate to their needs. One person had been supported to make their own drink and was sitting beside the care staff drinking it. We observed another person being supported by care staff in their own living room getting ready to go out for a meal.

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 was 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 some records, which the provider is required to keep, to protect the peoples' safety and wellbeing, were being stored securely and could be located promptly when needed. For example, the care records were kept in secure cabinets.

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

This announced inspection took place on 13 and 19 November 2015.The last inspection of this home was carried out on 9 July 2013.The service met all the regulations we inspected against at that time.

Thornhill provides care and support for up to seven people who have learning disabilities or autistic spectrum disorders. At the time of the visit five people were using the service.

The home had a registered manager who had worked with the organisation for several years. 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 tell us in detail about the service. Relatives made positive comments about the service and said people enjoyed being at the home. They described the service as being safe for their family member. Relatives felt involved in decisions made about their family members care. One relative told us “[family member] is always happy to go back to Thornhill after their visit home. That makes us feel that they are being looked after”.

People had individual apartment type accommodation which allowed privacy; these were comfortably furnished in accordance with people’s choices and preferences.

Staff had a good understanding of safeguarding and whistleblowing. They were confident that any concerns would be listened to and investigated to make sure people were protected. A record was maintained of all safeguarding alerts which showed that appropriate action was taken.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people are not restricted unnecessarily.

Medicines were managed in a safe way. Records were up to date with no gaps or inaccuracies found. A staff signing sheet was available so records could be audited.

There were enough staff employed to make sure people were supported. Relatives told us their family members had the correct levels of staff supporting them in the home and in the community. One relative told us, “[family member] has a team that all work together, they understand [family members] so and know exactly how to look after him, what he likes and what he doesn’t like.”

Recruitment practices at the service were thorough, appropriate and safe so only suitable people were employed. Staff training was up to date and staff received regular supervision and appraisals.

People’s choices were acknowledged. Each person had a range of activities they could take part in. People were supported to be as involved as possible in choosing menus. People’s dietary needs were respected and were used to develop a four weekly menu that met the preferences, choices and needs of each person.

Relatives felt involved in their family member’s care and were kept fully informed of any changes. Relatives made many positive comments about the service. For example one relative commented that “They have given [family member] his life back.” Another told us, “They are fantastic with [family member] very caring, any little thing they phone us to keep us informed.”

People’s care records and risk assessments showed us that people were encouraged to be as independent as possible, with life skills being promoted. People’s healthcare needs were monitored and assessed, contact was made with other health care professionals when necessary.

Staff used alternative forms of communication such as pictures and gestures to communicate with people.

We saw that systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. Relatives we spoke to knew how to make a complaint. Information was available in picture form on how to make a complaint. Records were kept along with any immediate actions taken which showed the service responded to behaviours and lessons were learnt from such events to reduce risk.

Relatives and staff told us the organisation was well run and the home was well managed. There were no concerns raised by other health and social care organisations. Staff told us they felt the service was open, approachable and had a positive culture. The service had an auditing system in place, these were carried out at regular intervals to check the performance of the service and to make continuous improvements.