Thorne House

Thorne House is a care home providing care and support for up to 18 people living with learning disabilities and autistic spectrum disorder.

The service is a large home, bigger than most domestic style properties. It is registered for the support of up to 18 people and 17 people were living there at the time of our inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the service working hard to make sure outcomes for people reflected the principles and values of Registering the Right Support. There was a very strong focus on promoting people’s choice and control, independence and inclusion. People's support very clearly focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We found the outcomes for people using this service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People’s experience of using this service:

The service continued to be outstandingly responsive and to celebrate people’s achievements in a way that helped people to grow in confidence, maturity and skills. Staff successfully promoted people’s independence and as a result, some people had become much more independent and had much richer lives.

The provider had continued to ensure people received care and support that was exceptionally personalised, very well planned and particularly responsive to their needs. People’s individual support plans were very person centred and well designed to meet people’s communication needs. Staff sought opportunities for people to have different experiences and to do things in the community. People had their own interests and hobbies and took part in many activities. We saw instances where employment opportunities had given people a sense of self-worth and confidence. People were supported to maintain their family relationships and friendships and make new friends.

People were safe, protected from avoidable harm and risks were well managed. There were enough staff on duty to ensure people’s needs were met and they had been recruited in a way that helped to keep people safe. Staff had a clear understanding of safeguarding people and of the action they should take if they suspected any abuse. People's medicines were managed well,

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 maintain a balanced diet and received on going healthcare support. Staff received appropriate training, support and supervision. Although homely, in some places the environment needed attention and refurbishment. This was being actively addressed by the management team.

People were treated with understanding, dignity and respect and supported to make day to day choices and decisions. There was an effective system to manage complaints.

People’s views were regularly sought about the quality of the service. There was a focus on treating people with equality and on involving and empowering those with communication difficulties, to ensure their voices were heard and valued. Staff and relatives we spoke with felt the service was well led and the registered manager was approachable and listened to them. There was an open and transparent management of the service, with very comprehensive checks and audits to maintain quality and safety.

Leadership was of good quality and people who used the service, their relatives and representatives were involved in how the service was run and operated. staff felt supported and spoke positively about the provider and the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The service was rated good at the last inspection in February 2017 (published March 2017).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was unannounced and was undertaken over two days. The first visit was on 3 February 2017. We returned to complete the inspection on 6 February 2017. We last inspected the service in June 2015 and rated it as Good.

Thorne House is a care home providing support for up to 18 people living with learning disabilities. The home is set in its own grounds and has accessible garden spaces. The home is divided in to 5 apartments. At the time of our visit there were 17 people using the service.

The service had a registered manager in post. 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 service was outstandingly responsive and celebrated people’s achievements in a way that helped people to grow in confidence, maturity and skills. Staff had successfully promoted people’s independence, so that some people had become much more independent, and had much richer lives.

People’s needs were assessed and care and support was well planned, and delivered in line with their individual support plan. The support plans were person centred and some included photographs and pictures to assist the person to understand their plan.

Relationships and the communication within the home were positive, enabling and therapeutic. People had their own interests and hobbies and took part in many activities and events of their choosing.

People’s care and support was planned and delivered in a way that made sure they were safe. The support plans we looked at included risk assessments, which identified any risk associated with people’s care. We saw risk assessments helped minimise and monitor the risk.

Staff had a clear understanding of safeguarding adults and what action they would take if they suspected abuse.

There were enough staff with the right skills, knowledge and experience to meet people’s needs.

We found the service to be meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good knowledge of this topic and said they would speak to the registered manager for further advice.

People were supported to eat and drink sufficient to maintain a balanced diet. Meals were appropriately spaced throughout the day with snacks in-between. Meals were flexible to meet the needs of the people who used the service.

People were supported to maintain good health, have access to healthcare services and received on going healthcare support. We looked at people’s records and found they had received support from healthcare professionals when required.

People who used the service were supported to maintain their family relationships and friendships.

The service had a complaints procedure and people knew how to raise concerns. We noted that there had been more compliments than complaints.

Staff and relatives we spoke with felt the service was well led and the registered manager was approachable and listened to them. There was an open and transparent management of the service, with very comprehensive checks and audits to maintain the quality. The service maintained good and clear records. We noted that there was good partnership working.

Although the apartments were homely, in some places the environment and décor was in need of attention and refurbishment and this was acknowledged by the management team.