Golcrest is a residential care home providing personal care for up to 26 older people, some of whom are living with dementia. Nursing care is not provided at the home. This is provided by the community nursing service. At the time of our inspection there were 15 people living in Goldcrest.

At the last inspection in April 2016 the service was rated Good overall. 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.

Why the service is rated Good.

The people who lived in Goldcrest were provided with high quality; caring support which was person centred and met their individual needs. Comments from people who lived in Goldcrest included; “They are very helpful and take good care of us” and “It’s all so good, I couldn’t ask for better.”

People spoke highly of the staff who worked at Goldcrest, with comments including; “They are kind and very caring. If you happen to mention you want a cup of tea or something, there it is!” and “Oh yes they are very kind and caring to me. They are great!” Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people spoke highly of the food at the home.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice.

People who lived in Goldcrest had a variety of needs and were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs knowledge relating to the administration of medicines was regularly checked. Staff told us they felt comfortable raising concerns.

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Further information is in the detailed findings below.

Two adult social care inspectors carried out this unannounced inspection of Goldcrest on 19 February 2016. The service was previously inspected on the 17 March 2015 when it was fully compliant with the regulations.

The service is registered to provide care and accommodation for up to 26 people. On the day of our inspection ten people some of whom had a diagnosis of dementia were living at the service. There was a registered manager in post; however, the registered manager had been working significantly reduced hours for an extended period. 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.

People told us they were safe and well cared for at Goldcrest. We saw people were relaxed and comfortable in the service. People readily approached staff when they wished to be supported and staff respected people’s privacy and dignity. People told us, “I feel this is my home”, “I don’t think I could be better anywhere”, and, “I have been very fortunate to be here.”

While relatives commented, “[My friend] really is so happy here it is a joy. I do not have to worry.”

There were sufficient staff available to meet people’s care needs. Although there was one current staff vacancy at Goldcrest agency staff had been used where necessary to ensure people’s needs were met. The service’s deputy manager told us, “we would never leave a shift un-covered that’s not in the remit at all.” The service operated safe and robust recruitment procedures to ensure all new staff were suitable for work in the care sector.

Assessments of risks had been completed and people’s care plans included guidance for staff on the action they must take to protect people from identified risks. Where accidents or incidents had occurred these had been documented and fully investigated.

Staff records demonstrated all staff had received regular training updates and appropriate supervision to ensure they were sufficiently skilled to meet people care needs. Staff told us, “I have had lots of training” and, “I had supervision on Monday.” People told us their staff were kind and caring and commented; “I don’t think anybody could do better than the staff do here” and, “I cannot speak highly enough of the staff, they are excellent.”

People’s care plans had been regularly updated and accurately reflected the person’s individual care needs. These documents provided staff with clear direction and guidance and included information about the person’s background, life history and interests.

Staff knew people well and provided calm and compassionate support throughout our inspection. Staff spoke warmly of the people the cared for and we saw that people requested support from staff freely and without hesitation.

People received regular support from external health care professionals and guidance professionals provided, had been incorporated into people’s individual care plans.

Staff, the deputy manager and the directors of the service understood the requirements of the Mental Capacity Act 2005 (MCA). People’s capacity to make decision had been assessed and where people lacked capacity decision appropriate best interest decisions had been made. Where managers had identified that people’s care plans were potentially restrictive appropriate application for authorisation had been made to the local authority.

People told us their care staff respected their choices and one person commented, “Oh yes they do what I want them to do, they always say it’s your decision.” Staff told us they always offered people choices and respected their decision.

The service’s kitchen had a five star food hygiene rating and people told us, “The food is gorgeous it really is.” People were offered choices at m

This inspection was carried out by a single inspector. This was a follow-up inspection; to make sure improvements had been made in relation to consent to care and treatment. We considered our inspection findings to in relation to questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? As it was an inspection to check specific areas of a previous breach of regulation, we did not gather evidence to answer all five questions but focused on whether the service had suitable arrangements in place to meet the standard for consent to care and treatment.

At the last inspection on 9 April 2014 we found the provider had not ensured there were suitable arrangements in place for assessing and recording people's mental capacity or ensuring best interest decision making. At this inspection we found that improvements had been made.

The provider had introduced procedures to assess and record people’s mental capacity. Information about people’s ability to make decisions was stored in their care plans. Some processes for making sure that care and treatment was being given in people's best interests were not recorded clearly. This meant that we could not be sure that all decisions had been made with the involvement of appropriate people.

Staff had received refresher training in the Mental Capacity Act (2005) but were not sure of the detail of what they had learned. Staff were able to tell us how they made sure that they cared for people in ways that respected their wishes.

The improvements that had been made were sufficient to meet the standard.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. There were suitable arrangements in place for the safe handling, storage and administration of medicines.

Is the service effective?

People told us that they were satisfied with the care they received. From our observations and from speaking with staff we saw that they understood people’s care and support needs and that they knew them well. One person told us, "I can't find any fault here, it's lovely." People's needs were assessed before the service started and changes were noticed and acted upon. The service worked closely with other agencies to ensure specialist support was requested in a timely manner to meet people’s changing needs.

Care Quality Commission monitors the application of the Mental Capacity Act 2005. We found that although there was a policy in place there was not a procedure which ensured that if someone lacked capacity this was recorded. There was no process for recording best interest decisions and this meant that valid consent to care and treatment could not be demonstrated.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. A relative told us," they are brilliant with my mum they treat her as an individual; they know what is going on with her”. There was a welcoming atmosphere for visitors and family and people were supported to maintain these relationships.

Is the service responsive?

People’s needs had been assessed before they moved into the home and the care plans confirmed people’s preferences, interests and care needs. The support people needed was described clearly with relevant guidance to staff about particular conditions.

Is the service well-led?

At the time of inspection the deputy manager and provider were covering whilst the registered manager was away.From our observation of the care given, the care planning and the checks made by the deputy manager we saw that there was effective monitoring of quality and safety. People influenced some changes in the service such as decor. Staff competency was observed by the deputy manager and extra support given where required. We spoke with the registered manager who was able to tell us about other regular monitoring which helped to provide a safe quality service.

During our inspection people and their relatives spoke positively about the home. We found that risk assessments were not always present or current, and staff had not followed guidance to ensure that people's risks were being managed. The home had not always acted in a timely manner to meet people’s identified needs.

People were cared for in a clean and hygienic environment.

Medicines administration records were not always accurate, and the recording of some administered medicines was not specific regarding the dose administered. The opening dates on liquid medicines had not always been recorded and the home had not followed its own policy for staff competency and the return of unused medicines.

The provider did not have an effective system that ensured all appropriate pre-employment checks were completed.

The service had some systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. However, care plan and medication audits were not robust and had not identified that people’s recorded care needs had not been completed and staff had made medication recording errors.

In this report the name of Alan Mann appears as a registered manager. They were not in post and not managing the regulatory activities at this location at the time of the inspection. The location was being managed by Alison Chandler. Alan Mann’s name appears because they were still a registered manager on our register at the time.

Some of the people who lived at Goldcrest had dementia and were not able to tell us about their experiences. To help us to understand people’s experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they receive and whether they had positive experiences. Some people who used the service were able to tell us about their experiences. We also spoke with visitors and other health professionals.

People we spoke with told us they were happy at the home and felt “well looked after.” Another person said “I have no complaints and never could have whilst I am living here.”

People told us that staff were “wonderful”, “like family,” and “kindness itself.” One person said “They are lovely girls, it’s like a family. I never have to want for anything.”

People told us they did not have to wait for attention when they requested it. During our observation we saw staff were very receptive to people’s needs. Examples included offering to open windows, provide more drinks or assist people to the bathroom. We saw that people who had chosen to stay in their rooms were checked during the morning. One person positively said “It’s always like that. They pop their head around the door just to check I am OK.”

Relatives told us they thought the staff were competent and knew how to care for people with dementia. Relatives also appreciated that staff were welcoming and friendly and thought this was because the manager led by example.

We saw staff interacted well with people living at the home and saw no negative interactions. We saw staff treated people with respect. People appeared calm, relaxed and happy. Staff were attentive and noticed for example if they looked uncomfortable or wanted something to eat or drink.

Staff ensured that people's dignity was maintained when personal care was provided. Staff were sensitive and discreet when additional support was required.

People who lived at the home or their relatives understood the care and treatment choices available to them. One person said “I’m not interested in reading my notes, I leave that to the girls and my relative.” Another person’s relative said “It’s great that the staff show us what they write. It shows they know what he needs.”

We saw examples to show people had choice whilst living at the home. One person said they could get up and go to bed when they wanted to and could opt out of the activities if they wanted.

The people we spoke with said they felt safe living at the home. People also said they felt able to speak to any of the staff if they felt scared, unwell or unsafe. One person said “I could speak to any of them and they’d sort it out.”

We found that the manager responded to requests and feedback well but there was no formal or regular way of assessing whether the service was appropriate and continued to meet the needs of people. People we spoke with said they felt able to ask staff for anything they needed. Relatives said they felt “able to ask questions, request changes or feed back any issues.” Healthcare professionals said communication was “excellent” and the staff were “responsive to suggestions.” However, the people, relatives and healthcare professionals we spoke with said they had not formally or regularly been asked what they thought of the service.