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Inspection carried out on 14 December 2017

During a routine inspection

We inspected Conifer Lodge on 14 December 2017. Conifer Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Conifer Lodge is registered to accommodate up to 26 people, some of whom were living with dementia and other chronic conditions. Conifer Lodge comprises of three converted houses, with a lounge and dining areas. There were 19 people living at the service during our inspection.

Following the last inspection on 29 September 2016, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well Led to at least good. We asked the provider to take action to make improvements to the management of medicines and systems of quality monitoring and governance, and this action has been completed

A registered manager was in post. 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 and associated Regulations about how the service is run.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and bowel care training. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, cookie making, quizzes massage and manicures and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Inspection carried out on 29 September 2016

During a routine inspection

Conifer Lodge is registered to provide personal care and accommodation for up to 26 people. It specialises in providing support of older people. On the day of the inspection there were 21 people using the service some of whom were living with the early stages of dementia and other health care conditions such as heart disease and diabetes. The service is made up of three combined properties over three floors. Some rooms at higher levels were accessed by a stair lift and some were only accessed by stairs making them unsuitable for some people with mobility difficulties. There was level access throughout the ground floor and to a secure rear garden.

This comprehensive inspection took place on the 29 September 2016 and was unannounced.

The service had a registered manager. 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 comprehensive inspection in 8 July 2015 we identified there was a quality assurance system in place to monitor quality and identify areas for improvement. However this did not include the auditing of care plans. We identified this as an area of practice that needed to improve. At this inspection we identified that a care plan audit had been introduced, but this had not been consistently completed and had not always been effective in identifying shortfalls and bringing about improvements.

At the last inspection we identified that staffing levels were not systematically being reviewed and assessed to determine whether they were sufficient to meet people’s needs and this needed improvement. At this inspection people’s dependency levels were being assessed, however this had not happened as often as the provider required and staffing levels had not been reviewed in line with the providers own protocol. Therefore the provider could not be assured the staffing levels were sufficient to provide responsive care.

At this inspection we identified a range of shortfalls in relation the administration of medicines and the completion of the associated medicine administration records. Audits of medicines and medication records had not been completed on a monthly basis as the provider required and the audits that had been completed had not been effective in identifying shortfalls. Therefore opportunities to identify and rectify shortfalls in the administration of medicines and drive improvement had been missed.

At the last inspection assessed improvements were needed in relation to providing and recording people’s involvement in meaningful activities. At this inspection we identified that improvements had been made.

At the last inspection we identified that the risk of people falling had not been assessed and was an area of practice that needed improvement. At this inspection we identified this had been addressed.

People were supported to live the life they chose and their freedom was not restricted. There was a positive approach to risk taking and people were encouraged to remain independent and we observed people coming and going throughout the day going about their own business. One staff member told us, “We let people live their lives here”. Another staff member said, “If someone wants to do their own thing, like go out, we don’t stop them”.

There was an hour’s daily activity on offer each afternoon such as a quiz, baking or general discussion between people. Entertainers such as musicians and singers also visited the service and occasional trips out were organised. There were regular visits to the service by the local church and people had the opportunity to go on bus trips organised by an external provider.

People were supported to eat and drink sufficient amounts and they told us they enjoyed the food provided. Special diets were catered for and drinks and snacks were freely available throughout the day. People were provided with appropriate levels of support at meal times.

People’s privacy was protected and people were treated with dignity and respect by kind and caring staff. One person told us, “The care staff are very good, I‘m quite content here”. Visitors were welcomed and people had the opportunity to attend meetings at which they could give their views on the running of the service and make suggestions for improvements. People were able to personalise their rooms and bring their own furniture and one person had brought their pet budgies when they moved in.

People’s health care needs were met and professional advice and support was sought from health care professionals such as GP’s and district nurses as and when needed. People were supported by competent staff who received the training and support they needed to undertake their role and effectively meet people’s needs. One person told us they were happy with all the staff and felt a particular member of staff was, “Very efficient”. Another person told us they received the support from staff that they needed and commented, “(Staff members’ name) knows what I like and knows what I need”.

Measures were in place to reduce the risk of harm occurring and protect people from abuse. Accidents were recorded, collated and analysed to identify themes and trends so that the provider could take steps to reduce the risk of reoccurrence. Staff understood the need to gain consent and worked in accordance with the Mental Capacity Act (MCA).

There were processes in place for complaints to be responded to. People told us they would speak with the registered manager or a member of the care staff team if they had any concerns or wanted to make a complaint and one person commented, “They listen to me”.

Recruitment procedures were robust and included identity and security checks were completed before staff were deployed. All new staff completed an induction to the service and were introduced to people before they worked unsupervised.

People and staff felt supported by the management. The registered manager was aware of their legal responsibilities and kept up to date with good practice by attending management meetings with the area manager and other registered managers and providers of other services.

There were two areas where the provider was not meeting the requirements of the law. You can see what action we have asked the provider to take at the back of the full version of this report.

Inspection carried out on 8 July 2015

During a routine inspection

We inspected Conifer Lodge on the 8 July 2015. Conifer Lodge is a residential care home providing care and support for up to 26 people. On the day of the inspection 21 people were living at the home. The age range of people living at the home varied between 60 – 100 years old. The provider, provided care and support to people living with dementia, diabetes, sensory impairment, risk of falls, mental health needs and long term healthcare needs.

Accommodation was provided over three floors with stairs connecting all floors and a stair lift in situ. Consideration had been given to the environment and making it dementia friendly. The home had received a recent grant to change the carpets throughout the home. The new carpet was plain and pattern free enabling people to freely move around the home and promote their independence.

The home is located centrally in Hove and provides access to the city centre and seafront. There is good access to public transport and throughout the inspection; people were seen coming and going, going out shopping or going to meet friends. People and staff spoke highly of the registered manager. One staff member told us, “She’s very supportive and approachable.”

A registered manager was in post. 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 and associated Regulations about how the service is run.

People had mixed views regarding the opportunities for social engagement and activities. External entertainers came in and people spoke highly of the trips out. However, some people commented they felt lonely and bored. A weekly activities timetable was not in place and therefore people were unaware of what activities were taking place on a daily basis. Documentation failed to reflect what meaningful activities were taking place with people. We have therefore identified this as an area of practice that needs improvement.

People and staff felt staffing levels were currently sufficient. People felt staff at times could be busy and they didn’t wish to be a nuisance. Individual’s levels of care needs were assessed and dependency need calculated, such as high, medium or low. However, these dependency scores were not used to calculate staffing levels. If staffing levels needed increasing, the registered manager was expected to submit a dependency form to the provider requesting additional staff. We have therefore identified this as an area of practice that needs improvement.

Formal systems were not in place to review, monitor and assess the effectiveness of care plans. Care plan were not being audited to ensure all information was correct and up to date. The absence of a care plan audit meant the provider had not identified falls risk assessments were not taking place. We have therefore identified this as an area of practice that needs improvement.

Staff understood the needs of people and we saw care was provided with kindness and compassion. People were dressed in their own style and if they needed support, staff helped people to take a pride in their appearance and dress in their personal style.

People spoke highly of Conifer Lodge. One person told us, “I’m very lucky to be here.” Visiting healthcare professionals praised the service and felt confident staff were following their advice and guidance. Staff received on-going training and support that enabled them to provide effective care

Medicines were stored safely and in line with legal regulations. People told us they received their medicine on time and staff were confident in medicine administration. People spoke highly of the food offered. Risks to people’s nutrition were minimised because staff understood the importance of offering appetising meals that were suitable for people’s individual dietary needs.

People and their relatives told us that they felt the home was safe. Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the registered manager and team leaders who were visible and approachable.

There was a friendly, relaxed atmosphere at the home. People were regularly seen coming and going and people were free to spend the day how they chose.

Inspection carried out on 30 January 2014

During a routine inspection

We visited Conifer Lodge for a day, when we spoke with three members of staff, four people who lived in the home and two visiting relatives, as well as the registered manager. We also shared a lunch table with six people who lived in the home.

Care plans were clearly based on assessments of people’s needs and associated risks. People told us they were involved in how their care was planned and reviewed, and staff understood how to establish and work with people’s consent. Where it became difficult for a person to give consent, appropriate people were involved in establishing how to provide care on a best interest basis.

Care plans included a monthly review of people’s physical and mental health. Staff were observant of changes in wellbeing and kept accurate records, so people received medical attention quickly when necessary. The home had established close working links with specialist health resources in the community.

We saw records of activities offered daily, which were mainly engaging the same half dozen or so people. One member of staff provided weekly arts and crafts sessions and there were special occasion parties arranged through the year. However, activity care plans tended to be generalised and slanted towards the activities provided, rather than supporting individual interests or building on known life history.

All staff undertook annual refresher training about safeguarding vulnerable adults. Training records showed staff were up to date with the training. Staff we talked with felt confident in their understanding of signs of potential abuse and how to respond, including by whistle blowing if necessary. We asked people if they felt safe living in the home and all replied they did. A visitor told us “It’s very safe because it’s so open, the residents look out for each other too and tell staff if they are worried.”

The provider had a trainer and training records showed all staff were up to date with a range of training provided by them, and externally. Staff received regular individual supervision from the manager, which we saw this was effectively planned.

The provider made extensive use of surveys of people in the home, visitors and staff to monitor quality of the service and inform planning for the development of the service. There were quarterly meetings for people who lived in the home, and their supporters, from which ideas and views were taken straight to a staff meeting held on the same day.

The manager and maintenance person monitored health and safety needs in the home. There were regular audits of safety factors such as call bells and medicines practice and the home had arrangements for addressing emergencies.

Inspection carried out on 27 March 2013

During a routine inspection

We observed staff talking with and assisting people throughout the day, this was done with the peoples’ privacy and dignity in mind and showed the staffs’ awareness of peoples individual support needs. Care plans are descriptive and easy to follow.

We spoke with a number of people living in the service and a number of visiting relatives. A visiting relative said “the staff are excellent, (person named) never wants for anything.” We noted a number of positive comments on the forms, one person stated “Friendly personal care”, another indicated (named member of staff, was) “very welcoming and very helpful.” A visiting professional commented “Interaction between staff and residents very good, residents’ files informative and easy to understand.”

A planned refurbishment programme has commenced which will look at a number of areas within the home. There is regular maintenance of the equipment in the home where internal staff and a number of external contractors are used to ensure this is safe for use. Toilets, bathrooms and bedrooms have privacy locks in place. The recruitment process is well documented to ensure people are safe. Staff receive regular training to ensure people are cared for safely.

We spoke with staff and they were able to tell us how people living in the home should be safeguarded and were aware how to follow this up with outside agencies were this necessary.

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