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Inspection carried out on 7 March 2019

During a routine inspection

About the service:

¿ The Conifers is a residential care home that provides personal care for to up to six people living with learning disabilities or autism spectrum disorder.

¿ The size and design of the building fit in with local residences and there were deliberately no identifying signs, in line with current best practice guidelines. People had easy access to local amenities and could live a life as any other citizen.

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

People’s experience of using this service:

¿ The provider delivered an outstanding service to people which achieved positive outcomes.

¿ The staff team worked well with other providers and services to ensure people had access to healthcare services they needed and were given personalised support when accessing these services.

¿ The service had a highly skilled behavioural support team and staff team who worked closely together to provide high quality support to people with a high level of need.

¿ Best practice standards and professional research was used to implement high quality, effective care.

¿ Staff used a wide variety of communication methods fluently with people and created highly individualised communication support plans to involve them as much as possible in their care and support and to give them choice and control in their lives.

¿ Staff did not allow any physical or learning disability become a barrier to participating in activities or being part of the local community.

¿ People’s families spoke highly of the quality of care and of the approach of the provider and staff in supporting their loved ones, and held up the service as an example to others.

¿ The registered manager and senior managers fostered a culture of openness and professional challenge. This ensured all staff understood and were able to meet the high standards of quality expected of them.

¿ Quality assurance measures were extremely robust and well embedded into every-day practice. Staff reviewed the quality and safety of care delivered in an in-depth way on a regular basis and their performance was closely monitored in a supportive way.

¿ The outcomes for people using the service reflected the principles and values of Registering the Right Support. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Rating at last inspection:

¿ At the last inspection the service was rated Outstanding (16 April 2016).

Why we inspected:

¿ This was a planned inspection to review whether the service remained outstanding.

Follow up:

¿ We did not identify any concerns at this inspection. We will therefore aim to re-inspect this service within the published timeframe for services rated outstanding. We will continue to monitor the service through the information we receive.

Inspection carried out on 18 and 20 January 2016

During a routine inspection

This inspection was unannounced and took place on the 18 and 20 January 2016.

The Conifers is a care home which provides residential care for up to six adults with mild to moderate learning disabilities. People receiving the service also live with health conditions such as schizophrenia and epilepsy. The care home comprises of two floors with its own secure garden and is situated on the outskirts of Basingstoke town centre. At the time of the inspection six people were using the service.

The Conifers has 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 provider and registered manager were highly committed and passionate about support worker training and development. The registered manager used creative, proactive and innovative ways of developing support workers that enabled them to apply their learning in their practice. Clinical quizzes were created on peoples support needs and used to consistently check support workers knowledge to ensure they delivered outstanding personalised, quality care.

There was strong emphasis that people were supported to eat and drink safely whilst maintaining their dignity and independence. Innovative methods were used to ensure that people remained safe. People at risk of choking received personalised health care professional assessments. Recommendations made were followed by support workers to ensure their needs were being met. Where required unique visual templates were created and use to support people with their eating to minimise their risk of choking. We saw that people were able to choose their meals and they enjoyed what was provided. Records showed people’s food and drink preferences were documented in their support plans and were understood by support workers. People were supported to eat and drink enough to maintain a balanced diet.

The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. The provider and support workers were motivated to ensure that people were provided with the opportunity to experience holidays and participate in activities which they had not previously experienced.

Support workers were highly motivated to develop close relationships with the people they were assisting. Support workers understood people’s communication needs and were committed to enabling people to express their views. Innovative non-verbal communication methods such as social stories and communication cards were used to exceptional affect to interact with people. These methods of communication were well known and practically demonstrated by the registered manager and support workers. Support workers also used verbal reassurance and touch when people had limited understanding of the care support workers were providing for them in order to enable the person to feel safe and cared for.

Support workers actively promoted people’s independence and sought activity placements to ensure people’s continued personal development. This had resulted in positive changes in behaviour being noted for people who could demonstrate behaviours which challenged. Support workers interactions demonstrated that they knew, understood and valued the needs of the people they were supporting. Support workers had received training to enable them to work with and support people who displayed behaviours which challenged.

People received personalised, dignified and respectful care from support workers who had an exceptional understanding of their specific care needs. People had care and support which was delivered from individualised care plans delivered by skilled and tested support workers. Support plans contained detailed information to assist support workers to provide outstanding care in a manner that respected each person’s individual requirements and promoted treating people with dignity. People were encouraged and supported by support workers to make choices about their care including how they spent their day within the home or in the community.

Relatives of people using the service told us they felt their family members were kept safe. Support workers understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage appropriately. People were assisted by support workers who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable support workers. New support workers induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely. There were sufficient support workers employed to ensure that people’s individual needs were met.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale support worker sickness and fire or floods. Fire drills were documented, understood by support workers and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Support workers responsible for administering medicines had received training to ensure people’s medicines were administered, stored and disposed of correctly. Support workers skills in medicines management were regularly reviewed by the registered manager to ensure they remained competent to administer people’s medicines safely.

People, where possible, were supported by support workers to make their own decisions. Support workers were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of Independent Mental Capacity Advocates (IMCA’s) where people were unable to make key decisions in their life. This is a legal right for people over 16 who lack mental capacity and who do not have an appropriate family member of friend to represent their views.

Support workers sought people’s consent before delivering their care and support. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and support workers showed a comprehensive understanding of what constituted a deprivation of a person’s liberty. Appropriate applications were in the process of being submitted to the relevant supervisory body to ensure people were not being unlawfully restricted.

Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way although none had been received in the previous year. Relatives and support workers were encouraged to provide feedback on the quality of the service during regular meetings with support workers and the registered manager. Information was made available in alternative formats to allow people receiving the service to provide their feedback or complaints enabling them to feel valued.

The registered manager and support workers promoted a culture which focused on providing individuals with the opportunities to live their lives as independent members of the community. People were assisted by support workers who encouraged them to raise concerns with them and the registered manager. The provider routinely and regularly monitored the quality of the service being provided.

The provider’s value of care was communicated to people and understood by support workers. We saw these standards were evidenced in the way that care was delivered to people.

The registered manager provided strong positive leadership and fulfilled the legal requirements associated with their role. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. Quality assurance processes were in place to ensure that people, support workers and relatives could provide feedback on the quality of the service provided.

Relatives told us and we saw that the home had a confident registered manager and support workers told us they felt supported by the registered manager.

The last inspection of this home was completed on the 10 July 2013 where no concerns were raised.

Inspection carried out on 10 July 2013

During a routine inspection

We were welcomed into the home. Two people gave us a guided tour of their rooms. They told us how they had chosen the colour scheme and how it was decorated. We spoke with two people who told us they attended GP or dentist visits regularly. They told us that staff talked to them before the appointment and went with them the “make sure everything was OK.”

We saw that people had a full activities programme which they selected from each day. We saw that there were appropriate risk assessments in people's support plans which meant they could partake in a range of activities safely. We looked at three care and support plans. They were all detailed and, where appropriate, in easy read format. We spoke with three people who told us they chose to do a variety of activities. They said they enjoyed living in the Conifers and that the staff were “great”.

The building was clean and tidy. Consideration had been given to the needs of the individuals when furnishing areas of the property. There was a large, well maintained, safe rear garden. One person told us how they enjoyed the garden and had planted vegetables for everyone to eat.

Appropriate checks were made before recruiting staff. The provider had taken steps to ensure they had an effective recruitment and selection process.

There was an effective system to monitor and assess the quality of the service that people received.

Inspection carried out on 29 August 2012

During a routine inspection

The people using the service had complex needs which meant that they were not able to tell us about their experiences. We saw that the people living in The Conifers appeared happy and relaxed. We observed good interaction between the staff and the people living in the home.

Inspection carried out on 20 September 2011

During an inspection in response to concerns

The people we spoke to who were able to express a view told us that they were happy at the home.

Relatives told us that they liked the home and that their relative was happy living there.

They said the staff were good and knew what they were doing, and, if anything happened involving their relative, staff kept them informed.

They told us they had no complaints about the home.

Another relative told us that their relative was a totally different person since moving into the home. They told us that their relative had stopped taking a number of their medicines as they no longer needed them.

Residents and relatives told us that they believed they were safe living at the Confiers.

Reports under our old system of regulation (including those from before CQC was created)