Goldcrest House

Goldcrest House is a residential care home providing accommodation and personal care to 16 people aged 18-65 living with a learning disability or autistic spectrum disorder. At the time of our inspection there were 14 people using the service.

People are accommodated in two adapted buildings which are joined to make one service. The service is within a residential area in the town of Goole and is close to local amenities such as shops and a library. Bedrooms are for single occupancy use and have ensuite facilities.

People’s experience of using this service and what we found

People felt safe and well looked after. Sufficient cleaning took place to keep people safe from the risk of infection. Relatives said they were confident that staff provided good care in a safe way.

People had care plans and risk assessments in place for their support needs. These were reviewed regularly and covered people's health conditions. Families were able to contribute their views on their relative’s care and support. The management team carried out regular checks and analysis of falls and incidents to ensure learning from events was undertaken. This meant risks to people's health and safety were reduced.

People received their medicines on time and when they needed them. Staff had positive links with healthcare professionals which promoted people’s wellbeing.

Staffing levels were consistent, and staff were confident they could meet people’s needs. We observed staff being patient, kind and respectful towards people. Care was person-centred and staff had time to chat with people during the day.

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.

There was a registered manager in post. They were making positive changes to the service; people, staff and relatives spoke highly of them. There was evidence of good leadership, oversight and management within the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Although the service is larger (in numbers) than the best practice guidance of six beds or under, the size and design of the premises does not compromise the quality of care, people’s safety or their human rights. People received person-centred care which allowed their dignity and privacy to be maintained.

People could participate in their own local community. They were registered with local health services and had access to the full range of community health services. People could participate in the in-house activities and, when not in a COVID-19 lockdown, people could still take part in the same activities in their chosen community. The care model focused on people’s strengths and promoting what they could do.

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

Rating at last inspection

The last rating for this service was good (published 11 October 2018).

Why we inspected

The inspection was prompted due to concerns received about infection control. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Goldcrest House on our website at www.cqc.org.uk.

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.

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.

Goldcrest House provides accommodation and support to a maximum of 16 younger adults who may have a learning disability or autistic spectrum disorder. At the time of this inspection there were thirteen people using the service full time and one person who used the service for short periods of respite. The home includes outdoor areas and new buildings which housed a games room, gym, activities area, small kitchen and office areas.

At our last inspection in March 2016 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.

There was 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.

Staff had received appropriate training in safeguarding people. Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised.

Support plans provided information about people’s assessed risks for staff and other health professionals to ensure people received safe care and support without undue restrictions in place.

The provider maintained safe staffing levels to meet people’s needs all of the time. Staff recruitment included pre-employment checks that meant only suitable employees were recruited to work in the home.

Systems and processes ensured safe management of medicines and infection control.

People received appropriate care and support to meet their individual needs because staff were supported to have the skills, knowledge and supervision they needed to carry out their roles.

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.

The registered provider was committed to providing people with a positive caring partnership with staff who were clear about the importance of paying attention to people’s well-being, privacy, dignity and independence.

The provider equipped staff with the skills and knowledge to appreciate and respond to the principles of equality and diversity. The provider ensured everybody received care and support that reflected their wishes and preferences and this information was recorded.

Staff supported people to live as they choose and to enjoy a variety of meaningful activities.

Further information is in the detailed findings below.

Goldcrest House is registered to provide accommodation for up to 16 people. The service supports people with learning disabilities, a sensory impairment or an autistic spectrum disorder. It operates from two adjacent and joined properties and en-suite bedrooms are sited on the ground and upper floor. There is a back yard/garden and an extension, which includes a gym/games room, a separate art room and separate offices. There is on-street car parking nearby. At the time of our inspection there were 13 people using the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager that had been registered and in post for the last five and a half years. 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 found that people were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual or group basis to help people avoid injury or harm.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the people that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. The management of medication was safely carried out.

We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and received appraisals of their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing and much of the support they received with this was according to people’s preferred choice. The premises were suitable and well adapted for providing care to adults of all ages that had a learning disability. There was a well-equipped gym/games/sensory room and a rehabilitation kitchen for people to experience a variety of activity and to develop living skills.

We found that people received guidance and support from thoughtful staff who knew about people’s needs and preferences. People were supplied with the information they needed at the right time to enable them to make their own decisions, were involved in all aspects of their support plans and were always asked for their consent before staff undertook any support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain and uphold these wherever possible. This ensured people felt respected, satisfied with their lifestyles and able to take control of their lives.

We saw that people were supported according to person-centred support plans, which reflected their needs well and which were regularly reviewed. People had the opportunity to engage in occupation, pastimes and activities if they wished to in order to improve their general wellbeing, as activities on offer were physical, developmental and mentally stimulating. People had very good family connections and support networks.

We found that there was an effective complaint procedure in place and people were able to have any complaints investigated without bias. People that used the service, relatives and their friends were encouraged to maintain healthy relationships through frequent visits, social media, telephone calls and sharing or each other’s news and events.

The service was well-led and people had the benefit of this because the culture and the management style of the service were open and positive. There was an effective system in place, which used audits, satisfaction surveys, meetings and good communication for checking the quality of the service.

People had opportunities to make their views known through direct discussion with the registered manager or the staff and through more formal complaint and quality monitoring formats. People were assured that recording systems used in the service protected their privacy and confidentiality as records were well maintained and were held securely in the premises.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people's choices and decisions. Two people who spoke with us said they were aware of their care files and had input to them. One person told us 'We have got new care files. I am going to discuss mine tomorrow with my key worker, get it sorted out and then I will sign it.'

We saw that the provider had made a start on improving staffing levels within the service. Recruitment of additional staff had taken place and was ongoing. People who used the service received consistent care from staff who knew their needs and expectations and the service had contingency plans in place to cover for staff sickness or vacancies.

The provider had made a number of changes to working practices within the service since our last visit in November 2013. Improvements to paperwork, staffing levels and quality assurance processes were seen at this inspection.

Records about people who used the service had been reviewed and rewritten to make them person centred. This enabled staff to plan appropriate care, treatment and support. The information needed for this was systematically recorded and kept safe and confidential.

Our observations of the service showed us that the staff were very kind and caring and all the people who spoke with us were very happy with their care. One person said 'The staff are very good, they listen to what we say', another person said 'The staff look after us well'. However, we found that people's wishes, choices and preferences were not always taken into consideration when changes to care were made.

People we spoke with said they felt safe in the service. They understood who to talk to if they had any issues and said the manager and staff were quick to act on any problems. The provider had appropriate policies and procedures in place to protect people from risk of abuse.

We looked at staffing levels as part of our visit and we found there were insufficient numbers of suitably qualified, skilled and experienced staff on duty.

The service had a staff induction and training programme, which meant the staff received professional development and support.

We found that improvements were needed to the quality assurance system to ensure people's health, safety and care was monitored effectively and that appropriate action could be taken where necessary to make changes in the service.

People's personal records were not accurate or fit for purpose. We found that care plans were not up to date. This meant there was a potential risk that people did not receive the appropriate care and treatment.

We observed staff and people interacting during our visit. They were able to communicate to a good level of understanding using verbal and non verbal methods. We observed staff with people who used the service and we saw that staff were genuinely caring towards people and treated them with respect at all times.

People were able to participate in a number of activities both internal and external to the service and were offered choice in what they wanted to do. People were provided with support and choices around eating and drinking. They were offered a selection of meals from a monthly meal plan that they had input to and could eat in the dining room or the activity room.

People told us that they understood how to make a complaint if needed and that they received help and support from their care worker or the manager.