We found that in some areas care was not being delivered in a way that promoted people's safety and welfare. This included issues with the supply of hot water for personal care.
We also found that the service did not have robust recruitment procedures in place.
We carried out a follow-up inspection on 18 December 2013 and found that the service had not made the necessary improvements.
We also looked at the care plans for four people who used the service. We reviewed the pressure care and dietary arrangements for people who had been assessed as being at risk of developing pressure ulcers or who needed assistance with eating and drinking. We found that staff were aware of who required support with eating and those at risk of developing a pressure ulcer. This information was communicated throughout the service which ensured people had their needs met in accordance with their care plan.
We found that care plans had been regularly reviewed and updated to reflect any changes and showed that people were referred appropriately to specialist professionals. We spoke with staff who showed a good knowledge of the level of support described in people's care plans.
We found that people had not been protected against the risks associated with medicines. This was because the provider did not have appropriate arrangements in place to manage medicines safely.
We found that staff were supported to provide appropriate levels of care.
People's dignity was respected and their privacy and independence was promoted. One person living there said of the staff, 'They are very dignified and respectful, especially when it comes to helping with sanitary arrangements. They make sure doors are closed and you get to keep your privacy.'
We observed activity in the dining room at lunchtime. Staff spoke with people in a kind and friendly way that created a positive atmosphere and conveyed the impression that lunch time was a social activity that everyone participated in. We saw that people who required one-to-one support with their meal were given such support in an unhurried and respectful manner.
We found that action had been taken to rectify a number of environmental faults that we previously identified. We also found that the provider had commissioned other building works that were required to improve the location and this work had been carried out.
The provider had begun a review of care plans to ensure that they reflected people's needs. The provider had also taken account of people's feedback to make improvements. For example, a complaint about faulty call bells resulted in an order being placed to renew call bell units.
At our previous visit of 05 September 2012 we identified some shortfalls in relation to how the service respected and promoted people's dignity. At our visit of 22 January 2013 we found that the specific examples detailed within the report from our previous visit had been addressed but that the culture around respect and dignity within the home had not improved.
The systems in place for monitoring the quality of the care and accommodation were not effective. We saw that shortfalls identified through internal audits and monitoring visits undertaken on behalf of the provider by an external consultant were being repeatedly identified.
At our previous inspection of Conewood Manor we identified shortfalls in record keeping. At this visit we found that there had been some improvement made in this area.
We spoke with six people using the service about their health and personal care needs. They told us they felt they were cared for well. One person said, 'I think they care for both our physical and mental health needs well.' Relatives told us the care staff were, 'Diligent about the care they provide.' Another visitor told us that they were happy to be, 'Kept in the loop' regarding their partner's care.
People told us that the activity provision was starting to improve and that there had been some good times enjoyed by all throughout the Olympic Games. One person said, 'We play different games, do some cooking and sometimes we go out.'
There were mixed views from people using the service about the numbers of staff available to meet their needs. The majority of people told us they believed there were enough staff on duty however one person said, 'Sometimes we have to wait a long time for call bells to be answered. This means I am often waiting in discomfort for a care worker to come and help me to the bathroom.'
People told us they were confident in the staff team that supported them. Comments received included, 'The staff are wonderful, kindness itself. The manager is lovely' and, 'All the staff are so friendly. You would have a hard job to complain about this place.'