Conifers Care Home

Conifers Care Home is a residential care home that provides accommodation and personal care for up to 20 people. People had a range of care and support needs including impaired mobility, frailty of age, diabetes and some people were living with dementia. At the time of our inspection there were 14 people using the service. Accommodation was in one adapted building over two floors which were accessed by a lift.

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

Systems were in place to protect people from the risk of abuse and improper treatment. Staff knew how to identify potential harm and report concerns. Risk to people were identified and managed. People told us they received safe care. Relatives had no concerns about their loved one’s personal safety.

People and relatives told us the care people received was very good and the staff were kind, caring and compassionate. Feedback included “Instantly we walked through the door our first impressions were good and we haven’t been disappointed”. And “The staff are lovely and so caring”.

People received support from a skilled and consistent team of staff. There were enough numbers of staff to ensure people’s needs were met in a timely way. People told us they never felt rushed and staff had time to sit and talk with them.

Care was personalised to meet people’s care, social and well-being needs. Care plans provided detailed information and guidance for staff. Staff knew people well and provided support in line with people’s preferences. People’s diverse needs were catered for and they were treated with dignity and respect.

The culture of the service was positive, and people and staff were complementary of the registered manager and provider. Systems and process were in place to monitor the quality of the service being delivered. Staff told us it was a good place to work.

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.

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 requires improvement (published 4 September 2020) and there were breaches of regulations. A warning notice was served, and conditions were placed on the providers registration. The provider completed an action plan to show what they would do and by when to improve.

We undertook a targeted inspection (published 6 January 2021) to check whether the Warning Notice we previously served had been met. The targeted inspection found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service did not change following this targeted inspection and remained requires improvement.

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 inspection was carried out to follow up on action we told the provider to take at the previous inspections.

We undertook an unannounced focused inspection of the service on 30 July 2020. Breaches of legal requirements were found in relation to safe care and treatment and good governance. A Warning Notice was served in relation to Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Conditions were placed on the providers registration in relation to Regulation 17(good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook an unannounced targeted inspection of the service on 11 December 2020 to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, and it had. We use targeted inspections to follow up on Warning Notices or to check 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.

The provider completed an action plan after the inspection on the 30 July 2020 to show how they would improve and by when. The provider has continued to send CQC a monthly report of actions to demonstrate how they are meeting the conditions placed on their registration in respect of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Conifers Care 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.

Conifers Care Home is a residential care home that provides accommodation and personal care support for up to 20 people. People have a range of care and support needs including diabetes and some people were living with dementia.

Conifers Care Home is a detached house located in a residential area of Selsey. The service had been adapted and was over three floors. At the time of our inspection 18 people were living at the service.

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

There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete. People's care risk assessments lacked important detail to guide staff on how to make people safe. People did not always receive person centred care that met their needs and preferences.

Aspects of leadership and governance of the service were not effective in identifying some service shortfalls, such as failing to assess, monitor and mitigate risks relating to the health and safety and welfare of people.

Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns.

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.

Positive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful.

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 requires improvement (published 8 May 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 7 and 22 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, protecting people from harm and good governance.

Following the inspection, the provider was issued with a Warning Notice for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Conifers Care Home is a residential service that provides accommodation and personal care support for up to 20 people. People have a range of care and support needs including diabetes and some people are living with dementia and the frailties of old age. At the time of our inspection 13 people were living at the service.

Conifers care home is a detached house located in a residential area of Selsey. The service has been adapted over three floors.

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

Significant improvements had been made since the last inspection. The changes are still recent and need time to embed fully.

People spoke confidently about the registered manager and were positive in their feedback. Staff had an enthusiastic and caring approach to their work, which was observed at inspection.

Care plans and risk assessments had been overhauled and were now written with respect to reflect each person’s individual needs. Giving levels of detail on health needs and clear guidance for staff to follow.

People commented on the improvements to the environment and told us of choice they had been offered to decide on décor. The gardens were now place’s people said they liked to use. Staff reflected that the service was now organised and support was able to be delivered effectively.

The administration of medicines had been changed to comply with guidelines and the staff room had been moved to a different part of the building. Staff had received training and only trained staff were administering medicines.

Systems had been put in place to assess risks around falls and people’s health needs, staff understood their role in raising concerns and reporting issues. The registered manager demonstrated detailed knowledge of people’s needs and how to look for trends and indicators that someone’s needs were changing.

People's risks were identified, assessed and managed safely. If accidents or incidents occurred, these were reviewed and analysed; lessons were learned to prevent a reoccurrence. People received their medicines as prescribed. Infection prevention and control procedures were effective and applied rigorously. Staffing levels were sufficient to meet people's needs.

Auditing systems continued to be implemented well and were effective in monitoring and measuring the care delivered and the home overall. The registered manager adopted a pro-active approach and was involving staff in the management of the home.

The registered manager told us they are seeking more information from reputable sources to improve the service’s dementia environment and support practice and are seeking more information from reputable sources to facilitate this.

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.

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 requires improvement (published 4 September 2020) A warning notice was served and conditions placed on the providers registration that the provider must undertake audits of the care plans, risk assessments, medicines and staff training and that the provider must send a report to CQC every calendar month to include results and analysis of the audits. The report should also include a summary of actions taken in response to shortfalls, timescales for improvements and who is responsible for them. The audits have been undertaken and CQC has received the first monthly report. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to follow up on action we told the provider to take since the last inspection in respect of breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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.

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 coronavirus and other infection outbreaks effectively.

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 Care Home is a residential care home that provides accommodation and personal care support for up to 20 people. People have a range of care and support needs including diabetes and some people were living with dementia.

Conifers Care Home is a detached house located in a residential area of Selsey. The service had been adapted and was over two floors. At the time of our inspection 18 people were living at the service.

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

People were not always protected from avoidable harm because the provider did not have effective procedures in place to make sure people were safe. Incidents were not always reported to the appropriate authority. Environmental risks were not well managed.

Risks to people’s health and wellbeing were not consistently managed. Processes were not in place to ensure support plans and risk assessments contain detailed and person-centred information to accurately reflect the needs of people and mitigate identified risk.

There were not adequate processes in place for assessing and monitoring the quality of the services provided and that records were accurate and complete. People's care risk assessments lacked important detail to guide staff on how to make people safe.

Some refurbishments had taken place since the last inspection. In some areas further work was required to repair and update the environment. There was no hot water or heating to parts of the building. Portable heaters were being used to maintain care. Some furniture and fittings were worn and required replacement to further improve peoples’ living experiences. This was an area that required improvement.

People’s privacy and dignity was not always respected. Confidentiality of personal information was not always protected. This was an area that required improvement.

People were cared for by staff who had the right skills and knowledge to meet their needs effectively. Checks were carried out prior to staff starting work to ensure their suitability to work with people. People received support from a consistent staff team who knew them well. There were sufficient numbers of staff to ensure people did not feel rushed and people received their support on time.

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.

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 requires improvement (published 18 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, protecting people from harm and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service: Conifers care home is a residential care home that accommodates a maximum of 20 people. At the time of this inspection 18 people lived at the home. Older people who lived with disabilities including dementia, Parkinson's disease and diabetes, were supported with personal care and accommodation. People who displayed behaviours that may challenge were also supported at the service. The home provided a homely atmosphere and environment that met people's individual needs.

People’s experience of using this service:

Since our last inspection in April 2018, the provider had invested resources to improve the service. A new kitchen had been fitted and the environment had been improved. This was work in progress and ongoing works were scheduled to improve the environment further.

The management team had implemented new quality and safety checking systems to monitor maintenance and the environment. It was evident that these checks were being used. However, these systems required more time to be used consistently and to be fully embedded in daily practice at the home. This was an area that required improvement.

People received their medicines safely. Improvements had been made since our last inspection and controlled drugs were managed safely. However, for one person, one of their regular medicines had not been given as prescribed. Management at the home had followed this up with the doctor surgery but this had been delayed. Systems were not always robust to check that all medication had been prescribed for one person. All other medication had been given as prescribed. This was an area that required improvement.

The registered manager told us after this inspection that the response from the surgery had now improved regarding medicines.

People and their relatives spoke positively about the staff and the care received at Conifers care home. There was enough food and drink. People received lunch time meals from an external catering company. People who had dietary needs such as allergies or who required specialist diets were catered for. One person told us, “They [staff] look after you and feed you well."

People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. One person said, "They’re [staff] just all good. They treat you nice.” One person's relative told us, “They [staff] give first class care.”

Behaviours that may challenge were understood by staff. Professional advice and guidance was sought from healthcare professionals which we were told by a community psychiatric nurse [CPN] staff acted upon appropriately. The CPN said, "They’re [staff] very thorough and willing to try advice given.”

Regular activities were provided for people. Some entertainers who visited the home were specialists in providing activities for people who lived with dementia.

The management team worked proactively and professionally with external health and social care professionals. Local management forums were attended by the home which ensured they maintained positive working relationships with other local homes and professionals.

Rating at last inspection: Requires improvement. (Last inspection report published 14 July 2018).

The service was rated as Requires improvement at this inspection. This was the second consecutive time the service had been rated Requires Improvement.

Why we inspected: This was a planned comprehensive inspection based upon the previous rating.

We inspect all services with one or more key questions rated as 'Inadequate' within six months to ensure that we regularly monitor and review the quality and safety of the service people receive. As a result of the last inspection rating we asked the provider to complete an action plan to demonstrate how they would meet the shortfalls at the home. We inspected to review this action plan and any improvements made. We saw that improvements had been made to the service people received since our last inspection. However, we found that some systems for monitoring the quality and safety of the service required improvement.

Follow up: We will review the service again within 12 months of the inspection report published date to monitor the improvements made and ensure these are embedded in practice.

Conifers Care Home 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. The home provides accommodation, for up to 20 older people, who are living with dementia and who require support with their personal care needs. On the day of our inspection there were 16 people living at the home. The home is a large property situated in Selsey, West Sussex. The home has 20 single bedrooms 11 of which have an en suite toilet. There was a communal lounge and dining room as well as a garden which people used. There is a passenger lift so people can access the first floor.

We found the premises were poorly maintained in a number of areas, including bedrooms, the kitchen, toilets and bathrooms. There were identified risks to people from the poor quality of the environment including exposed hot pipes in a bedroom posing a risk of burns to people and infection control risks due to a lack of wash basins in two toilets. These were in the older part of the building; the newer part of the building was well maintained.

Medicines were not always safely managed. Significant errors in the recording, handling and administration of some medicine were found. We made a safeguarding alert to the local authority about this.

The process of audits and checks on the quality and safety of the service had not identified and acted where we found attention was needed regarding the quality and safety of the premises as well as the safe management of medicines.

The provider did not always follow the correct guidance of the Mental Capacity Act 2005 and the associated Code of Practice. We have made a recommendation about this.

People and their relatives were satisfied with the standard and safety of the care provided. Staff had a good awareness of the principles and procedures for safeguarding people in their care.

Sufficient numbers of care staff were employed to ensure people were looked after well.

There were systems to review people’s care and when incidents or accidents had occurred.

People’s health and social care needs were assessed. There was a culture of supporting staff to attend training in current care procedures such as in palliative care and in supporting people who had needs regarding problems when swallowing food. Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

Health care professionals reported staff to be caring, skilled and as having good communication with community nursing teams

People were provided with varied and nutritious meals. There was a choice of food.

People were observed to receive care from kind and caring staff. People said they received care from kind and caring staff. For example, one person said, “They couldn’t be kinder. They’re absolutely lovely.”

People’s rights to privacy and choice was promoted. The registered manager had sought guidance for staff regarding the rights of older people to have personal and sexual relationships. People were consulted about their care and how they liked to be supported.

People received personalised care that was responsive to their needs. This was also reflected in the feedback we received from people and their relatives; for example, one person told us, “Oh yes. Anything you want, you only have to ask and you’ll get it.”

Care plans reflected people’s needs and preferences. A range of activities were provider for people to take part in.

The provider had a complaints procedure and records were made of any complaint or concern raised. These records showed complaints were looked into and a response made to the complainant.

Whilst there were no people in receipt of palliative care staff were trained in this and there were plans to extend this to more staff.

There were opportunities for people and their relatives to express their views which the provider responded to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We gathered information from a variety of sources. These included talking with six people who lived at the home and three relatives. We also spoke with the manager and four members of staff. As some people were unable to tell us about their care and support we completed a 30 minute observation using our Short Observational Framework Inspection (SOFI) tool. This tool is designed to help us understand the quality of care that people receive. We also left comment cards for people to complete if they wished to inform us of their views on the home. Four people returned completed comment cards.

Everyone told us that they were happy with the care and support they received. One said, 'It's peaceful here and the food is pretty good. The carers are very helpful and I feel secure'. Another told us, 'I think they're wonderful, I couldn't tell you anything wrong, nothing at all'. Relatives were complimentary about the home. One said, 'There is a calm atmosphere and the staff are well trained and very caring'. Another told us, 'Nothing is too much trouble; they go out of their way to help'. One person used a comments card to share, 'All the staff went the extra mile to cater for my relative's needs and I would highly recommend the home to anyone else who has a relative with dementia'.

Staff were enthusiastic about working in the home. One told us, 'It's a lovely small home'. Another said, 'If you know dementia it is easy to work with them, you need to look at the person not the dementia, you treat each person differently'.

People told us that they were happy with the support they received from the home to access healthcare professionals.

The provider had an effective system to regularly assess and monitor the quality of dementia care that people received. This included seeking the views of people who used the service and acting upon their wishes.

We spoke with four relatives. They told us that they were very satisfied with the care provided. One said, 'I bless the day I found the place' and, 'The staff are so good, they do understand and they see what you need as well'. Another said, 'The staff I find excellent'.

We spoke with the manager and three members of staff. They were all enthusiastic about their work and the people that they cared for. The manager said, 'I love my job and I like to get things right. I run it so that everyone is welcome to come in'. Staff told us that they had a good team. One said, 'I go home and feel I've done well today', another, 'I think I've struck lucky'.

We saw that parts of the home were being renovated and that there were plans for further improvements. Relatives and staff that we spoke with welcomed this work and said that there had already been a big improvement in the physical environment.