Conifers Care Home

Conifers Care Home is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 15 people in one adapted building.

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

Medicines were stored, managed and administered as prescribed. People were safe and protected from abuse and avoidable harm. The registered manager identified risks, and this was documented to support staff and ensure people’s safety. Staff followed robust infection prevention and control procedures related to COVID-19 and other infections. Visitors were welcomed into the home and asked to follow infection prevention measures to keep people and staff safe. Staff were recruited safely, and staffing levels were flexible to support people’s needs. The registered manager had systems to learn from incidents to further improve the safety of the service.

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.

The management team had auditing systems to maintain ongoing oversight of the service and make improvements where necessary. Quality assurance processes ensured people and their relatives were able to give their views of the service and improvements made when they were identified.

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 05 May 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 changed from requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We carried out an unannounced inspection of this service on 17 January and 24 February 2021. 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 safe care and treatment and 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.

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 providing personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 15 people in one adapted building.

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

Medicines record keeping did not always support and evidence that medicines were given as prescribed. The management team had a system for auditing and monitoring the service to check on the quality and to make sure staff were providing good care. Auditing was generally good and identified issues that had been attended to. However medication audits had shortfalls that may not identify issues and put people at risk and we made a recommendation regarding this. Following the inspection visits the management team had introduced new medication systems to ensure any discrepancies would be found and improvements made.

People and their relatives told us they felt they were cared for safely by the staff team. People were protected from the risk of abuse and kept safe by staff who were trained to protect them. A staff member said, “We have all the training we need the owner is really hot about training its very good.” The management team recorded and audited any incidents and accidents and learnt from them. People felt safe living at the service and one person told us, “I never had brothers and sisters, I do now."

Staff continued to be recruited safely and sufficient numbers of staff supported people to live as independent a life as possible. The provider ensured safety checks of the home environment were completed regularly. Recent repairs and renewals to fixtures and fittings highlighted by the first inspection visit were promptly attended to by the provider. There were good stocks of PPE and infection control stations throughout the home. Staff used equipment correctly, such as disposable gloves, masks and aprons and had received enhanced training throughout the COVID-19 crisis.

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 22 May 2018).

Why we inspected

We initially undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about medicines, the environment, the provision of meals, and care provided. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the safe management of medicines so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We discussed our concerns with the provider who took action to ensure improvements were made and risks minimised.

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.

Enforcement

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 enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulations in relation to the safe care and treatment linked to the management of medicines.

Please see the action we have told the provider to take at the end of this report.

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 ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection in February 2016, the service was rated ‘Good’. At this inspection we found the service remained Good and met the all relevant fundamental standards.

We found the registered provider continued to provide a good standard of care to people who lived at the home.

We have made a recommendation that the registered provider introduce processes to ensure key information about the service required by CQC is submitted within an agreed timescale.

The service had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the commission when required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives. One relative wrote and told us, ‘Without going into every detail, the correct balance of safe, professional and humanitarian attitude, is consistently met by the management and all staff at the Conifers.’

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not commence in post until the registered manager completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and found it had been refurbished, maintained, was clean and a safe place for people to live. We found equipment had been serviced and maintained as required.

Medication care plans and risk assessments provided staff with a good understanding about specific requirements of each person who lived at Conifers Care Home.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

We only received positive comments about the quality of meals provided. One person commented, “The meals are good.” A relative commented, “The meals always smell delicious.” We observed lunch time and noted people had their meal in the dining room where they sat or in their bedroom. People told us it was their choice.

We observed only positive interactions between staff and people who lived at Conifers Care Home. There was a culture of promoting dignity and respect towards people. We saw staff had time to sit and chat with people. People who lived at the home told us staff treated them as individuals and delivered personalised care that was centred on them as an individual. Care plans seen confirmed this.

People told us activities happened regularly. One person told us, “We don’t sit around doing nothing all day.” People also said if they did not wish to take part in activities, their wishes were respected.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided.

Further information is in the detailed findings below.

The Conifers Care Home is registered to provide personal care and accommodation for up to 15 older people. Care is provided on a 24 hour basis, including waking watch support throughout the night. All accommodation and facilities at the home are provided at ground floor level. There are 13 single rooms and two rooms which are available for people to share.

The communal rooms within the home consist of a large lounge and dining area and a conservatory. There is a garden area, with a lawn at the front of the home.

The home is managed by a registered provider. A registered provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were happy living at Conifers Care Home and the care met their individual needs. People described staff as ‘kind’ and told us they were supported in a prompt way.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document the measures required to reduce risk. Staff were knowledgeable of the measures in place and we observed these were followed these to ensure peoples’ safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner and there were systems in place to ensure medicines were stored securely.

We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet peoples’ needs.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We saw people were offered a variety of foods and people told us they liked the meals at Conifers Care Home.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. We spoke with one visiting health professional who voiced no concerns with the care provided at the home.

We saw staff treated people with respect and kindness and people told us they were involved in their care planning.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we saw people were supported to carry out activities which were meaningful to them.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home.

We saw systems were in place to identify if improvements were required. The registered provider monitored the quality of service by carrying out quality assurance checks.

People who lived at the home were offered the opportunity to participate in an annual survey. People also told us they found the registered provider and care manager approachable if they wished to discuss any matters with them.

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?

We saw that people were treated with respect and dignity by the staff team. People told us that they felt safe and secure living at the home. People were cared for in an environment that was safe, clean and hygienic. Equipment in the home had been well maintained and serviced.

The senior management team had identified a gap in their staff training requirements and were taking action to address this shortfall. Policies and procedures were to be developed in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) and staff training was planned. By developing this policy and ensuring that staff received this important training, would strengthen the processes in place to protect people living at the home.

Recruitment practices were safe and thorough. Policies and procedures were in place to make sure that unsafe practices were identified and that people were protected.

In the main medication practices were sound. Only senior staff that had received appropriate medication training had responsibility of the administration of medication. A monthly medication audit was in place. This helped to ensure that medication practices remained safe, by ensuring any shortfall was quickly identified and addressed.

Is the service effective?

People told us that they were pleased with the level of care that was being delivered to them and that their needs were being well met. 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, 'I was reluctant to leave my own home but I am very glad I came here. It's all very nice and I am looked after very well. There are lots of laughs with staff'.

People's health and care needs had been assessed with them and people had been involved, as far as they wished, in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans as required. The premises had been arranged to ensure that people could move around freely and safely.

The visitors we spoke with confirmed that that were able to see people in private and at a time of their choice. 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 caring?

We saw that people were supported by kind and sensitive staff. Staff were attentive to people's needs and showed patience and encouragement when supporting them. We observed that people were encouraged to do things at their own pace and were not rushed. One person commented, 'It's like being in a luxury hotel here, it's all very nice and there are lots of laughs with the staff'. A relative said, 'They (The staff team) look after residents well and always make people feel comfortable'.

Although we saw that satisfaction surveys were freely available in a communal area of the home, we were told that nobody ever completed or returned one. People living at the home and their family and friends preferred to speak with staff on an ad hoc basis in order to express their views or opinions. This was confirmed by people we spoke with.

In the main people's preferences, interests and individual needs had been recorded along with the actions required to ensure these were met. This helped to make sure that people were provided with an individualised service that met their specific requirements. However there was some inconsistency. This meant that staff may not have been fully informed of the preferences of each person.

Is the service responsive?

People spoken with said they were satisfied with the range of activities provided. We saw that a number of people were very much enjoying an afternoon concert on the television. A relative told us, 'Mum is safe and has settled in brilliantly, she is much improved. She is talking and mixing with other people, more importantly she is a lot happier'.

The people we spoke with were not really sure whether they had seen a copy of the home's complaint procedure but were completely unconcerned about this. However people spoken with did know who they would complain to if they were unhappy. One person said, 'If I needed to say anything I would. I am always being asked if everything is alright and I always say yes because it is'.

We were told that no complaints had been received for a considerable period of time. We looked at the home's complaint procedure that was displayed in a communal area. Most relevant information was included, including the named person to address a complaint to and the timescale for a response. We did notice that there was some out of date information included, but we were told that the document would be immediately reviewed and amended. This would ensure that all current and up to date information was incorporated in the procedure.

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. A visiting health professional confirmed that staff followed any advice given, that staff were always respectful and that the care home was, 'Very homely and caring'.

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. People 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 consistent service at all times.

Staff told us that they were clear about their role and responsibility and that they felt very well supported by the management team. Staff confirmed that good supervision arrangements were in place, that they had their say that helped influence change. 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 medication and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

We observed staff interacting with people in a very supportive and respectful manner. This matched their related care plans. Care records were person-centred and reviewed regularly. One relative told us, 'It's like home from home here for my grandfather. I think it has probably prolonged his life'.

The Conifers met people's nutritional needs adequately. We additionally observed that the home worked with external providers adequately. A visiting community nurse told us, 'The staff have a good rapport with patients. I would recommend the Conifers and would have no doubts about placing my mum here'.

Staff were appropriately trained and supervised in order to enable them to provide care to people they were supporting. However, the home did not fully protect people from unsafe premises. We found issues with the maintenance of safe premises and the home's systems to monitor maintenance and quality assurance.

We asked people about their (or their loved one's) experiences of living at the home.

We received some very positive feedback about the service. People told us that they felt their needs were well met and that their care was provided in a dignified manner.

People spoke highly of the manager and staff. One resident said 'Everyone of them is wonderful.'

Other comments we received included;

'We could not wish for a better home, the staff are absolutely brilliant.'

'The staff understand (name removed) sense of humour and they have good fun with him. He really loves that.'

'All the staff are lovely. They all seem to have been here for a long time.'

'Nothing ever seems to be too much trouble.'

'The atmosphere is not like a care home, it's great and so welcoming.'

The vast majority of comments we received were very positive. However, the provider may wish to note that one resident we spoke with commented that she felt residents would benefit from having the opportunity to take part in more activities within the home.