Archived: Goldcrest

Goldcrest is a residential care home providing personal care for up to 26 people. The service provides support to older people living with dementia. At the time of our inspection there were 12 people using the service.

Goldcrest accommodates people in one adapted building in a residential area of Weymouth.

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

We found people were experiencing substantially improved care and support, however further improvements were needed. The oversight of the home had not ensured all issues identified at previous inspections had been addressed.

Goldcrest had recently experienced an unexpected management change. The provider and new acting manager had a plan in place to improve provider oversight and reduce the chance of this happening again. People, their relatives, and stakeholders were being made aware of this change.

Risk management was substantially improved. People were mostly protected from unnecessary risk. Their needs were assessed, their well being was monitored and referrals had been made to health professionals appropriately. However, emerging risk was not always identified and known environmental risks were not being sufficiently managed at the start of our inspection. The provider and the acting manager were responsive and addressed these risks immediately.

The senior team had identified that record keeping was an area for improvement, oversight in place had not been sufficient to ensure enough improvement so that records could be reliably used to support care decisions.

People were supported not to have maximum choice and control of their lives, and staff did not support them in the least restrictive way possible and in their best interests. Whilst people were supported, and encouraged, to make day to day choices and were not restricted within the building, the policies and systems in the service were not supporting people to have maximum choice and control. This was because relatives who held the legal position to speak for their loved ones were not being properly included in decision making.

Recruitment practices had improved, there were, however, some gaps in recruitment records. There were sufficient staff available to meet people’s needs and staff had time to engage with people in meaningful and compassionate ways. Staff training was improved but oversight had not ensured that all staff had kept their training refreshed in line with provider expectations.

People were protected from the risk of abuse as there were systems in place to reduce the risk and staff understood their responsibilities. People described staff as considerate and said they felt safe.

People’s medicines were managed safely. Records confirmed people received their medicines as prescribed.

The environment had been improved and people lived in an environment that they, and their relatives, described as homely. They told us they enjoyed the food.

Staff knew people well, they were positive about their work and felt part of a strong and committed team.

People, and their relatives, were complimentary about staff and of the care provided. People had access to a range of activities and were supported to maintain relationships that were important to them. Staff supported people in ways that reflected their individuality. Staff were kind and respected people’s dignity and privacy.

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

Rating at last inspection and update

The last rating for this service was inadequate (July 2022). We took enforcement action and the provider completed an action plan after the last inspection to show what they would do and by when to improve. In October 2022 we inspected to follow up on part of this enforcement action. We did not rate the service at this time.

At this inspection we found some improvements had been made and the provider was no longer in breach of some regulations. They also remained in breach of some regulations.

At our last inspection we recommended that the provider review good practice related to adaptive communication. Some improvements in communication had been made.

This service has been in Special Measures since September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at our last two inspections.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to risk management, staffing, the implementation of the MCA and governance at this inspection. As a result of these continued breaches, we have not removed the conditions placed on the provider’s registration following the July 2022 inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Goldcrest is a residential care home providing personal care for up to 26 people. The service provides support to older people living with dementia. At the time of our inspection there were 12 people using the service. Goldcrest provides accommodation in one adapted building in a residential area of Weymouth.

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

People did not always receive their medicines as prescribed. The senior team addressed the issues identified immediately.

People lived in a home where most environmental risks had been identified and were being addressed. Additional risks identified by inspectors were addressed following our visit.

People were at reduced risk from harm. Risk management and medicines management had improved. Further work was required to ensure improved practice was embedded and consistent.

People were supported with their medicines by staff who had received training and been assessed as competent. This was an ongoing process with tailored support provided to staff when needed.

People were protected from the risks associated with cross infection.

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 Inadequate (published September 2022)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make further improvements. Please see the safe section of this full report.

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 COVID-19 and other infection outbreaks effectively.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to risk management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Goldcrest is a residential care home providing personal care for up to 26 people. The service provides support to older people living with dementia. At the time of our inspection there were 13 people using the service.

Goldcrest accommodates people in one adapted building in a residential area of Weymouth.

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

On the first day of our inspection serious concerns were identified about people’s safety. Medicines were not safely managed, people were not helped to move when they needed help, the home was not clean, and staff were not wearing PPE appropriately. CQC liaised with the local authority and the provider to ensure immediate actions were taken to ensure people’s safety. An independent care consultant was appointed by the provider to help address immediate concerns and support the newly appointed manager (hereafter referred to as the manager).

There were insufficient trained staff to meet people’s needs. We saw people were unsupervised, did not receive their medicines safely, and did not have support to use their time meaningfully. Staff had not undertaken training necessary for them to carry out their roles effectively. Actions were taken following the inspection to ensure staffing reflected the needs of people in the home.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice. Actions were taken by the provider to reduce immediate restrictions. There were plans to introduce more choice.

People were not protected from harm of known risks. Risk management systems were not operated effectively, and care plans were not always followed to ensure people were protected from harm. The environment people lived in was not safe or well maintained.

People were not always treated with respect. Whilst staff cared about the people they supported, they spoke about them in relation to care tasks needed and did not always encourage independence.

People’s needs had not been reviewed and assessed sufficiently and changes in their needs had not always been followed up with referrals to appropriate professionals. Actions were taken by the manager to address this during our inspection.

Staff knew how to report safeguarding incidents. One allegation of abuse had been reported but not addressed appropriately by the provider.

Quality assurance measures were not effective and had not identified the concerns identified during the inspection.

During the inspection immediate actions were taken and an action plan was put in place. Staff and the manager told us they were committed to providing good, kind and safe care. The provider committed to employing the care consultancy whilst the required improvements were addressed and to develop their oversight of the safety and quality of care people received.

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 (19 June 2018). We inspected, but did not rate, the service in March 2021.

Why we inspected

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 COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about medicines management, staffing, risk management and governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. During the inspection we identified further concerns about people’s experience of care. As a result we widened the scope of the inspection to include the key questions of caring and responsive.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, person centred care, dignity and respect, staffing, the environment, the implementation of the MCA and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

The information about CQC’s regulatory response to the more serious concerns found during the inspection have been added to the report. We served a warning notice and imposed additional conditions of registration to ensure compliance with the regulations.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

Risks to people were being minimised because staff were following good infection prevention and control practices and wearing appropriate personal protective equipment.

The registered manager was keeping up to date with guidance relating to COVID-19 and was carrying out regular audits. This helped to make sure people received support in accordance with up to date guidance.

People were being supported to keep in touch with friends and family by visits, phone and video calls and letters. This had included facilitating safe visits for a number of people on Mother’s Day.

People and staff were participating in regular testing for COVID-19 which included rapid on-site tests and weekly laboratory tests.

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.

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 meal time and kitchen staff had received guidance on how to meet people’s specific nutritional needs.

The service was generally well maintained, carpets on the ground floor had been recently replaced and corridors, communal lounges and people’s bedrooms where pleasantly decorated with paintings and numerous ornaments. However, some areas were dated and in need of redecoration. During a recent survey of people who used the service and their relatives comments had been made about the exterior appearance of the building. In response, directors were in the process of commissioning significant works to address these concerns.

Activities were generally provided on a one to one basis at Goldcrest and we observed staff spending time sitting and chatting with people throughout our inspection. Staff told us they regularly supported people to engage with craft activities and during the afternoon of our inspection a game of armchair tennis was played in one of the service lounges. Relative’s told us, “they regularly hold functions and tea parties and they have outside entertainment with a man who plays the piano. I am always invited”, while a director commented, “We are always looking for any excuse for a tea party.” Photos of people enjoying events were displayed throughout the home and in people’s care plans.

The service was well led. Both directors regularly visited the service and staff told us they were well supported. The registered manager had been working reduced hours for an extended period. In order to provide staff with appropriate level of managerial support during this period an additional deputy manager had been appointed.

People’s feedback was valued and acted upon. Resident’s meetings were held regularly and an annual quality assurance survey of people, their relatives and professionals who visited regularly had been completed in January 2016. The results of this survey had been highly complementary. In addition the service regularly received compliments and thank-you cards from people and their relatives.

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.

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.

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.