We carried out a review of the data available to us about The Conifers on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Conifers, you can give feedback on this service.
We found the following examples of good practice.
The provider had a robust system in place to ensure that all visitors entering the premises had their vaccination status and lateral flow tests (LFT) checked. The provider required visitors to have a negative LFT before entry, and staff were available and trained to support visitors to complete LFT where needed.
The service was very clean, tidy, and well maintained. A cleaning schedule was in place which included additional cleaning of frequently touched areas such as door handles. Windows were open where possible to support good ventilation.
The team manager had a good understanding about the impact of the pandemic on the people they supported. They recognised the particular difficulties they faced and did all they could to make reasonable and safe adjustments to support people and meet their needs.
Where people had been unable to consent to COVID-19 tests or vaccinations, the provider had ensured the Mental Capacity Act 2005 had been followed.
The Conifers is a care home providing personal care to 29 people with a learning disability at the time of the inspection. The service can support up to 30 people. The accommodation is made up of the main home, plus nine separate self-contained flats on the same site.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was registered for the support of up to 30 people, which is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs outside to indicate it was a care home.
People’s experience of using this service and what we found:
People told us they were comfortable and well cared for at The Conifers. People benefitted from a consistent staff and management team who knew them well. Staff were aware of risks to people’s safety and wellbeing and acted to mitigate these. Staff were knowledgeable about how to identify and report any signs of abuse and people received their medicines in line with their prescription.
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. People were offered choice and involved in decisions. People had an annual health check and were supported to access any healthcare services they needed. Staff had been proactive in identifying and supporting people with health issues.
Staff were caring and treated people with respect. People’s independence was promoted, leading to positive outcomes for individuals. Detailed care plans were in place, so staff knew how to support people in line with their needs and preferences. People had opportunity to take part in activities at the service and in the community.
Management systems and records were well maintained and organised. Checks were conducted to monitor the quality and safety of the service. This included audits and feedback questionnaires. The management team promoted a positive, person-centred culture. We received very positive feedback about the management of the service; staff told us they felt well supported and there was good team work.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
At the last inspection the service was rated Good overall (published 5 April 2017).
Why we inspected:
This was a scheduled inspection based on the service’s previous rating.
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.
We undertook this unannounced inspection on the 9 March 2017. The inspection was to check that the registered provider was now meeting legal requirements we had identified at the last inspection. At the time of this inspection there were 28 people using the service.
When we last inspected the service on the 16 June 2015 we found the registered provider was not meeting all of the required standards we checked and they were in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed to ensure the risks were assessed and people were protected. The registered provider sent us an action plan to tell us the improvements they were going to make.
During this inspection we found that the registered provider had made appropriate improvements in line with their action plan. We found these improvements were sufficient to meet the requirements of regulation 12. This meant the service had met the breach of regulation imposed at the previous inspection.
The registered provider is required to and did have a registered manager in post. 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. The registered manager was not present during this inspection and the service assistant manager, deputy manager and head senior supported us throughout the inspection.
People told us that they felt safe whilst they were living at The Conifers. 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 knew they must report concerns or potential abuse to the management team, local authority or to the CQC. This helped to protect people.
We found that the management of medication was safely carried out and staffing levels provided on the day of our inspection were adequate to meet people's needs. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support people living at The Conifers.
Staff understood the risks to people's wellbeing and knew what action they must take to help minimise risks. General maintenance was carried out and service contracts were in place to maintain and service equipment so it remained safe to use.
Staff were provided with training in a variety of subjects, which was updated periodically to help develop and maintain their skills. Regular appraisal and supervision was provided to all staff which helped support them and identify further development needs.
People's nutritional needs were assessed and monitored, with special diets provided, where required. Staff encouraged and assisted people to eat and drink, where necessary and advice was sought from relevant health care professionals to ensure people's nutritional needs were met.
Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Members of staff at the service with whom we spoke, had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The assistant manager and deputy manager explained how staff worked with other professionals and peoples families to ensure decisions were made in a person’s best interests where they lacked capacity to make their own decisions.
People who used the service were supported to make their own choices about aspects of their daily lives. They received compassionate care from kind staff and staff knew about people’s needs and preferences. Staff provided people with information and spoke with them in a patient way. People's privacy and dignity was respected and their confidential information was held securely.
We saw that people were supported according to their comprehensive person-centred care plans, which reflected their needs and which were regularly reviewed. People had the opportunity to engage in hobbies, activities and employment. They had good family connections and support networks.
Members of staff and people who lived at The Conifers told us that the service was well managed. A variety of audits were undertaken to monitor the quality of the service and issues found were addressed. There was a complaints policy and procedure in place. People's views were asked for through formal surveys and informally on a daily basis by the staff. Feedback received was acted upon.
The managers had an open door policy and an on call rota system was operated out of office hours to support people, relatives, visitors and staff. We found there was a homely and welcoming atmosphere within the service.
The inspection of The Conifers took place on 16 June 2015 and was unannounced. At the previous inspection in September 2013 we found the regulations we assessed were being complied with.
The Conifers provides services to 30 people with a learning disability in single and shared accommodation and also in a small number of self-contained flats on the site. People are encouraged to take part in community based activities and pastimes, including education, work and leisure. The service operates in a large Victorian property in a residential area of the town, close to the beach and local facilities. There is limited parking for two cars at the side of the premises or there is on-street parking using permits obtained from the service.
There was a registered manager in post who had been managing the service for the past ten years. This person was also one of the directors of the company. 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.
The premises were safe and well maintained with the exception of there not being window opening restrictors on all windows. While the service had risk assessments in place for most of the issues that could be a risk to people, for example, fire safety and hot water, the service had not recorded when risk assessments on window restrictors had been carried out and so not all windows were fitted with restrictors. This was particularly in respect of decisions that had been made to omit using window restrictors in bedrooms where people had capacity to understand about their personal safety and were not identified as being at risk of having falls from their window. However, this did not mitigate the risk to people that did not have capacity to fully understand the danger that wide opening windows presented to them.
This was a breach of regulation 12 of The Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this inspection report.
We found that people were protected from harm or abuse by systems in place for managing safeguarding issues and a staff team trained in safeguarding people from abuse. Staff were prepared to use the whistle blowing policy when necessary. Important safety information was given to people and risk assessments were in place to protect people from being harmed unnecessarily.
People were kept safe from injury because staff understood their responsibilities around preventing accidents and incidents and reporting them if they occurred so that suitable changes could be made to ensure they could not happen again.
Staffing levels were appropriate to meet people’s needs and staff were safely recruited to ensure people were not exposed to unsuitable staff caring for and supporting them. The management of medicines was safely executed and people were protected from the risk of receiving the wrong medicines. There were safe infection control measures in place.
We found that the service was effective because staff were appropriately trained and skilled to carry out their roles; they followed recognised guidance from organisations connected to learning disability care and training, followed legislation to ensure people’s rights were upheld and encouraged people to lead healthy lifestyles. People’s health care needs were appropriately assessed and planned for.
We found that staff were caring, offered sound guidance for people’s safety and that staff had established supportive relationships with people. Staff were respectful, inclusive and encouraging to enable people to learn and look forward to new experiences. When necessary staff pointed people towards advocacy services and staff worked well with other bodies and organisations to ensure people received the best support available to them.
We found that people’s privacy, dignity and independence were upheld in all respects. Wellbeing of people was paramount.
We found that support plan documents aided staff to provide good care and support. People engaged in activities, occupation and interests of their choosing. We found that complaints were appropriately handled and everyone knew how to represent themselves and complain when necessary.
We found the good culture within the service was based on friendliness, openness and teamwork. The management style was open and inclusive. There was a quality assurance system in place to seek people’s views and assess the effectiveness of support systems in operation. The quality assurance system used meetings, surveys, audits and general day-to-day conversation to find out if the service was meeting people’s needs effectively. We found that recording systems were satisfactory and that they assisted the service in ensuring the quality of the service was maintained.
People received support and some received help with personal care, as they required it and in line with their plan of care. They said, "I am very well looked after here" and "I have no worries at all about being here, I like the staff and I can come and go when I please". We found that plans of care reflected peoples' care and health care needs and were reviewed regularly.
We found there were effective systems in place to reduce the risk and spread of infection and that staff followed good guidelines in their practice.
There were sufficient staff on duty to support people in the home and out in the community, where necessary. People received sufficient support from the staff on duty so their needs were met.
People told us they were listened to and changes were made as necessary to resolve any immediate problems but we saw no audit records or collations to show how overall changes to the service would be or had been made.
We found that people that used the service experienced an open and transparent complaint system, which they were happy to use. It meant they had their complaints listened to and resolved where possible.
People also told us their privacy and dignity was respected and that their personal life issues had always been respected and kept confidential.
People told us they were encouraged to maintain their independence whenever possible. They said their needs were well met and that staff supported them with any decisions or choices.
People said their health care needs had been monitored and that they saw health care professionals when they needed to.
People knew about their care plans and how to make a complaint if they had one.
People we spoke with told us they had good relationships with each other and the staff and felt safe living at The Conifers.
People told us they were satisfied with the arrangements in place to assist them in managing their finances and that they were satisfied with the way their medication was handled.