Goldcrest House 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 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.

The inspection of Goldcrest House took place on 16 March 2016 and was unannounced. At the last inspection on 25 February 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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, pas

People told us that they were consulted about their care and were able to make their own decisions about life in the home. One person told us “Staff ask me what I want to do and I tell them. They try and facilitate it if they can”.

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.

We found that the service showed signs of being out of date in terms of thinking and practice regarding the consent to care and treatment. Where people did not have capacity to consent, the provider had not acted in accordance with legal requirements.

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.

People who used the service had a range of medical conditions, which meant some were more independent than others. Everyone we spoke with said they liked the service and the staff and said they were well looked after.

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.

We spoke with people who used the service about living in the home and about the care they received. They told us their privacy, dignity and confidentiality were respected. People described the activities they enjoyed which were varied and meaningful. People told us about meetings they attended monthly with their key worker to review their care plan. A person who had recently arrived at the service explained about how the home had helped him with some personal difficulties.

People said they mostly felt safe in the home. People expressed appreciation of the staff that worked with them. One person said, “The staff are all right, they look after us. The staff do everything they should do.”

People told us they attended meetings in the evening with other residents, usually once a month. People also said they completed surveys. People explained to us about how they could make complaints. One person said, “There are complaint forms to fill in, and they help you if you need it.”