Conifers Nursing Home

Conifers Nursing Home is a residential care home providing personal and nursing care to 43

people with different health and care needs, including those living with a dementia, at the time of the inspection. The service is situated within a residential neighbourhood and can support up to 55 people in one purpose built, two-storey building.

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

People were protected against the risk of abuse. Staff were recruited safely and there were enough of them to meet people’s needs. People were supported to take their medicines safely. The provider had robust infection prevention and control procedures to protect people from cross infection. The provider used accidents and incidents as a learning opportunity to improve the safety of the service.

The registered manager had developed a positive, person-centred culture within the service. The staff team were committed to providing people with high-quality care that met their needs. The registered manager understood their responsibilities under the duty of candour. The provider used feedback and the results of audits to continually improve the service.

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 good (published 12 February 2020).

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 included checking the provider was meeting COVID-19 vaccination requirements.

We received concerns in relation to staff conduct and the management of safeguarding concerns. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The provider had implemented an appropriate policy around visitors during the pandemic. Visits were restricted and management risk assessed each visit. Staff checked all visitors for any signs or symptoms of infection before they were allowed into the home. Visitors were required to follow best practice guidance and wear appropriate personal protective equipment (PPE). The need to restrict visits to the home had been discussed with people and their relatives.

¿ The home had a ‘visiting pod’, which we saw people using during our inspection. This provided a way for people to receive visitors without them entering the home, which reduced the risk of transmission of COVID-19, whilst enabling people to have face-to-face visits with those important to them.

¿ Staff supported people to maintain their relationships with their families and friends. People connected with families and friends through social media, video calls and over the telephone.

¿ The provider had implemented measures to reduce the risks when people returned from hospital. This included people having to isolate in their bedrooms and followed national guidance.

¿ People who lived at the home and staff were supported with regular testing for COVID-19.The provider had plans around cohorting and zoning the premises, which helped to reduce the risk when a positive result was received.

¿ Staff were provided with training around COVID-19 and the correct use of PPE. We observed staff wore PPE appropriately during our inspection.

¿ We observed the home looked clean and hygienic. Staff told us high touch areas such as handles, and switches received additional cleaning several times each day.

¿ The provider had assessed risks related to infection control, COVID-19 and the general environment, in order to reduce the level of risk and keep people safe.

Conifers Nursing Home is a residential care home providing personal and nursing care to older people and people living with dementia. The service was providing support to 50 people at the time of the inspection. The home is situated within a residential neighbourhood of Hambleton and can support up to 55 people in one purpose built, two-storey building.

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

Safe recruitment processes were established and carried out. Pre-employment checks took place to ensure people employed had the correct skills, knowledge and characteristics for working with vulnerable people.

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 (published 12 February 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we received about recruitment processes within the home. We identified no concerns with recruitment processes. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.

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.

Conifers Nursing Home (“The Conifers”) is a residential care home providing personal and nursing care to 48 people with different health and care needs, including those living dementia, at the time of the inspection. The service is situated within a residential neighbourhood and can support up to 55 people in one purpose-built, two-storey building.

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

The registered manager described the ethos and philosophy of the service as one that did not give up on people. Due to their complex needs, including behaviours that challenge, many of the people living at The Conifers had found it difficult to find or maintain appropriate care elsewhere. At the Conifers, positive outcomes had been achieved for people.

Staff enjoyed working at the service and making a difference to people’s lives. Although we received some slightly mixed feedback before and during the inspection, most relatives praised the staff, their dedication and patience. Relatives told us that the local reputation of the service was very good. A person who had lived at the service but passed away had dedicated a hymn at their memorial service to the staff at The Conifers.

Changes to planning and support had started to be introduced, to help develop person-centred, proactive care further. We recognised the potential for developments and innovations at their initial stages, once consistently implemented, to elevate the overall good experience of people using the service.

Personalisation of plans and people’s goals was ongoing to better reflect the person-centred care people received. We considered with the registered manager areas to review to further promote partnership working with people, as well as supporting of individual needs, strengths and abilities. There were enough staff to meet people’s needs, however the service was currently relying on agency staff to provide a substantial number of hours. The registered manager worked with agencies to try and keep to regular staff with the right skills to maintain consistency in support. Recruitment was ongoing, and the provider was exploring innovative ways to attract more staff.

People felt safe living at The Conifers and overall relatives echoed this. A relative told us, “They are so good with [relative] and all of the patients.” People generally appeared relaxed in the presence of staff, engaged with them in interactions that showed they knew each other or were supported effectively by staff during times of distress. One person told us, “What I really like is that they [staff] just are themselves and nothing else. They are a cracking bunch of [staff].” The service endeavoured to engage and stimulate people through a large variety of activities.

A long-standing, well respected registered manager led the family-like, inclusive culture of the service. They involved people, relatives and staff through meetings and regular communications. Service quality checks, with support from provider oversight, had identified effectively ways to continuously improve people’s care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Support was being developed to continuously reduce the need for restrictive interventions, including the use of sedative medicines.

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 (published 12 January 2018). There was also an inspection on 25 March 2019, however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

Conifers Nursing Home is registered to provide accommodation for up to 55 people who require nursing or personal care. The service supports older people with dementia nursing needs. Accommodation is provided over two floors with a passenger lift for access between floors. There are two lounges and dining areas, a smaller quiet lounge and a conservatory to the rear of the property. At the time of our inspection 52 people lived at the home.

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.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with four people who lived at the home. They told us they were happy and supported by staff who cared for them and treated them well.

People visiting the home told us they were made welcome by friendly and caring staff and had unrestricted access to their relatives. They told us they were happy with the care provided and had no concerns about their relatives’ safety.

Staffing levels were sufficient to ensure people received the care and support they required. We observed staff responded quickly when people required assistance and showed genuine concern for their wellbeing.

Staff had received training to safeguard people who may be vulnerable from abuse. The service had systems in place to identify, record and report any accidents or incidents and take action to address these.

Risks assessments were used to identify and minimise the potential risk of harm to people who used the service and staff. These were kept under review to ensure they were up to date and accurate.

Recruitment procedures were robust to ensure only suitable staff were employed. Staff received appropriate training and support in order to ensure they had the skills and knowledge to support people safely and effectively.

The service had systems in place to ensure medicines were managed safely. Staff ensured people received their medicines as prescribed.

People’s independence was promoted as far as possible and people were involved in making decisions about their care. Staff treated each person as an individual and worked to promote dignity and respect.

The building was purpose built, with facilities that were appropriate to the care being delivered. The building was clean, hygienic and maintained. It was a safe place for people to live. Equipment had been serviced and maintained as required.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The Chef had information about people's dietary needs and these were being met.

The service supported people’s involvement in activities within the home as well as organising trips out to local events and attractions. This helped to maintain people’s social health.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and relative meetings to seek their views about the service provided.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

From our observations people appeared relaxed and secure. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw that people were treated with respect and dignity by the staff team and their rights protected. The deputy manager set the staff rotas. The assessed needs of people were taken into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Systems were in place to make sure that any lessons were learned from events such as accidents, incidents, complaints or concerns. This reduced the risks to people and helped the service to improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded as required.

Recruitment practices were in the main safe and thorough. This made sure that only appropriate people that had been properly vetted were appointed.

It the service effective?

There was an advocacy service available if people needed it. This meant that when required, people living at the home or their relatives could access additional support. The people we spoke with and the relatives we spoke with told us that they were pleased with the level of care that was being delivered in the home.

From our observations and through speaking with staff it was clear that there was a good understanding of each person's assessed needs and that personal preferences were accommodated. One person told us, 'It is champion living here, it is very good'. A relative said, 'The staff show a lot of care, patience and dignity. They are always trying to look at each person as an individual rather than looking at everybody together. I have recommended here to a lot of people'.

People's health and care needs had been assessed and the individual or their family were aware of the care being delivered. However not everyone had seen or had been given opportunity to agree to the content of the initial care plan. Although no concerns at all were expressed about the level or type of care being provided, there was never the less potential for care to be delivered in a way that did not meet the expectations of the individual.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. The relatives we spoke with also said that they had good communication with the staff team and were always informed of any changes or concerns.

Is the service responsive?

People living at the home and/or their relatives knew how to make a complaint if they were unhappy about anything. However nobody we spoke with expressed any concerns. One person told us, 'I come here most days at different times of the day. I have never witnessed anything to cause concern. Staff always respond very positively in a calm, relaxed and no pressure way'.

The registered manager and deputy manager worked alongside staff on a daily basis. This meant that the care and support provided by the staff team was continually monitored so that immediate action could be taken if there was any concern.

People enjoyed a range of activities suited to their needs and abilities both in and outside the home. The building and grounds were arranged so that people could move about freely whilst still maintaining a safe environment. One relative told us, 'I like the way I can access the building and take ***** out into the garden. By giving us the key pad code ***** is not aware that there is key pad in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience, humour and gave encouragement when supporting people. A relative said, 'The staff excel, they are very kind and very, very good'. Another relative told us, 'All the staff have been brilliant, they do everything well. **** is very well cared for'.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's preferences. This helped to make sure that people were provided with an individualised service that met their specific requirements.

Relatives and where appropriate people living at the home, had been provided with satisfaction surveys twice a year. We viewed the outcome of the most recent survey. Outcomes were positive. Action would be taken to address any concerns expressed.

Is the service well-led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. All health care related visits had been recorded including the reason for the visit and the outcome. This provided a clear audit trail.

Staff had a good understanding of the ethos of the home and quality assurance systems that were in place. This helped to ensure that the quality of the service was continually improving. Relatives spoken with and one person living at the home told us that they felt listened to and that staff were attentive to their wants and wishes. This helped to ensure that people received a service that met their requirements.

Staff told us that they were clear about their role and responsibility and that they felt well supported by the management team. Staff confirmed that communication within the staff team was positive and that good supervision arrangements were in place. We were also told that staff team worked well together for the benefit of the people living at the home.

A range of routine audits were in place including care plans, risk assessments and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

People living at this home had a range of dementia conditions. This meant communication was limited. However, we used an inspection method available to us called SOFI (Short Observational Framework for Inspection). We decided to use this process as it provided us with information about the needs of people who may be confused or do not use words to communicate directly with us. By using this method we were able to gain a more accurate view of what interaction people were receiving from the staff team.

We were able to speak with a number of visitors during the day of the inspection about their relatives care and support. They told us they were very satisfied with the care their relatives were receiving. Comments included, 'I couldn't thank the staff enough, they are absolutely fabulous. I know when I walk away my relative is getting the best care'. Also, 'Staff are always around and I come at various times. You cannot fault the care anybody receives here'.

In order to gain a general overview of how care was being delivered around the home, we spent time in all the communal and dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

Relatives we spoke with told us they could express their views and were involved in decision making about their relatives care.

Plans of care contained sufficient detail for staff to deliver good practice.

People who used the service told us, "I like it here. I am very happy", "I prefer here to the last home I lived at" and a visitor said, "We are impressed with the home. Mother was a nurse and she likes it here". People told us they liked living at The Conifers.

Many people who used the service told us they enjoyed the meals and could have a choice of where they ate or sat. People who lived at this care home were provided with a nutritious and varied diet.

Two people who lived at the home and two visitors told us they felt able to raise any complaints if they wished.