The Goodwins

¿ The home has shown continuous improvement following our previous inspection in March 2016 and has met the characteristics of a good service in safe and effective and an outstanding service in all other areas and overall. For a home which supports people with multiple and complex needs and with behaviours that challenge, there have been remarkably positive and consistent outcomes for people. The registered manager told us, “I have always run a home around whether I would be happy with my brother or sister living there, I would here.”

¿ People have shown less behaviour that challenges as a result of the consistent positive support approach taken and therefore have needed less ‘as required’ medication and no use of restrictive interventions. Not only is this for people which have lived at The Goodwins for several years but people who have only lived there for a few months.

¿ The provider promoted a good quality of life for people. People were happy living at the home, were able to express themselves and engage with staff, participate in activities they enjoyed within the home and in their community and develop their skills and independence.

¿ People were supported to regain and maintain relationships with those important to them and to develop new relationships. The home used ‘intensive interaction’ to engage with people in a way which was meaningful to the individual.

¿ The registered manager had inspired and supported the staff team to improve people’s lives, had achieved good outcomes for people, ensured people were kept safe and received high quality, person centred care and support in line with all their individual needs.

More information is in Detailed Findings below.

Rating at last inspection:

Good overall and in all domains except caring, which was rated as outstanding (report published 20 April 2016).

About the service:

The Goodwins is a residential care home that was providing personal care for eight people living with severe learning disabilities, autism spectrum disorder and behaviour that challenges. The home 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. These values were seen in practice at the home. For example, the building was like any other on the road with no signs to show it was a care home. Staff did not wear uniforms and people lived their lives in the ways they wanted.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of Good in safe and effective and Outstanding in all other areas. The overall rating is Outstanding.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Outstanding.

The Goodwins is a privately owned service providing care and support for up to 12 people with different levels of learning disabilities. There were five people living at the service at the time of the inspection. The house is a detached property set in its own grounds. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had its own vehicle to access facilities in the local area and to access a variety of activities.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40’s and the oldest in their 70’s. Some people had behaviours that challenge and communication needs.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager supported throughout the inspection.

Staff assumed people had capacity and respected the simple decisions they made on a day to day basis. When people needed help or could not make a particular decision on their own, staff supported them. Decisions were made in people's best interests. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. We received information from the service informing us that people had applications granted to deprive them of their liberty to make sure they were kept as safe as possible.

People received care that was personal to them. Staff understood their specific needs well and had good relationships with them. People were settled, happy and contented. People chose to spend time with staff. They sat close to staff for comfort and reassurance. Staff treated people as individuals with dignity and respect. Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. When people could not communicate verbally, staff anticipated or interpreted what they wanted and responded quickly. Staff respected decisions that people made when they did not want to do something and supported them to do the things they wanted to. People had choices about how they wanted to live their lives. Throughout the inspection people were treated with kindness and respect.

Before people decided to move into the service their support needs were assessed by the registered manager and another senior member of the organisation to make sure the service would be able to offer them the care that they needed. People were satisfied and happy with the care and support they received. People's care and support was planned and reviewed to keep people safe and support them to be as independent as possible.

People were supported to participate in a variety of activities that they enjoyed. Activities took place regularly. Potential risks to people were identified. There was guidance in place for staff on how to care for people effectively and safely and keep risks to a minimum without restricting their activities or their lifestyles. People received the interventions and support they needed to keep them as safe as possible.

People were offered a balanced diet that met their individual needs. People enjoyed their meals. People received their medicines safely and when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns and they would be listened to. The registered manager was clear about the disciplinary procedures they would follow if they identified unsafe practice. Plans were in place to keep people safe in an emergency. Systems were in place to manage any complaints.

The registered manager monitored incidents and accidents to make sure the care provided was safe. They assessed these to identify any pattern and took action to reduce risks to people. Incidents were discussed with staff so that lessons could be learned to prevent further occurrences.

The registered manager led the staff team and had oversight of the service. Staff were motivated and felt supported by the registered manager who was approachable. The registered manager and staff shared a clear vision of the aims of the service. Staff had received regular one to one meetings with a senior member of staff. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

There were enough staff, who knew people well, to meet their needs at all times. The needs of the people had been considered when deciding how many staff were required on each shift and to support people in different activities. Staff were clear about their roles and responsibilities and worked as a team to meet people's needs. People received care and support from a dedicated, stable team of staff that put people first and were able to spend time with people in a meaningful way.

Staff completed induction training when they first started to work at the service. Staff were monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. Staff completed essential training provided by the company. There was also training for staff in areas that were specific to the needs of people. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so.

The provider had systems in place to monitor the quality of the service. Audits and health and safety checks were regularly carried out. The registered manager had sought formal feedback from people, relatives, staff and visiting professionals.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service. Staff told us that there was an open culture and they openly talk to the registered manager. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

People indicated that they received the care and support they needed to remain well and healthy. We observed that they were happy at the service. People were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way. There were enough activities and that they enjoyed going out in the local area and doing different things.

People's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing.

People told us and records confirmed that medicines were given to people when they needed them in a safe way.

There was enough staff on duty to meet support and meet people's needs. The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

The views of the people who use the service were listened to and acted on. There was complaints procedure in place and any complaints received by the service were addressed and dealt with appropriately.