Conifers Nursing Home

We found the following examples of good practice.

Clear guidance, an explanation and apology about restrictions were displayed at the entrance to the home. All visitors have lateral flow test undertaken. Temperatures are checked, hand sanitiser is available and PPE stocks.

In line with government guidance, the home had recently commenced in-home visits. There was a clear pre-booking system with 10 appointments available throughout the day. Scheduled deep cleaning was undertaken between each visit. The home had dedicated one room, close to an alternative entrance to be used just for these visits. Stocks of PPE were situated next to this.

The home also supported visiting through a purpose-built pod and window visits. To support people to communicate during these visits baby monitors were used to aid listening. There was a gazebo to shelter relatives during window visits. Relatives were well-supported to visit people at the end of their life.

Additional cleaning had been put in place. The registered manager had good oversight of cleaning and regular checks about infection prevention and control (IPC) processes were undertaken.

The Conifers Nursing Home is a nursing and residential home that provides accommodation and personal care for adults with a range of care and support needs, including adults who are living with dementia. The home can accommodate up to 33 people in one adapted building over two floors. At the time of this inspection there were 21 people using the service.

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

People received a good standard of care and we saw examples where people had achieved better health outcomes after moving to the home, made possible due to the dedication and skill of the staff team. People received care from a knowledgeable staff team who had access to a wide variety of training and support.

The service was safe. Risks to people’s health and safety were assessed and mitigated. Medicines were managed in a safe and proper way. Incidents and accidents were logged and investigated and learnt from where appropriate. The service was safely staffed, although interactions with people tended to be task-led.

The management team was supportive, responsive and promoted a culture of person-centred care at the service. The registered manager recognised that further work was needed to the environment to ensure the home remained a nice place to live and was suitably adapted to meet the needs of people living there. The service used a number of methods to ensure people and relevant persons involved in their care had a voice, which was valued and listened to most of the time. We felt the provider and registered manager had not adequately listened to people’s feedback about the provision of activities available at the home and saw long periods at the home which lacked stimulation.

Throughout the inspection we saw very caring interactions between staff and people who used the service. Everyone involved in the service provided positive feedback about the overall quality of the service. There was a person-centred culture with the management and staff team and all were highly involved in peoples’ care and support.

Staff encouraged people to make their own decisions and they obtained consent from people before care was delivered. 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 28 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection took place on 29 January 2019 and was unannounced, this means no-one connected to the home knew we were visiting the home that day. The home was previously inspected in September 2016 when we judged the overall rating of the service to be 'Good’. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Conifers’ on our website at www.cqc.org.uk’.

At this inspection we rated the service ‘Requires Improvement’ as we found improvements were needed to meet the expected standards.

At the time of the inspection there was no registered manager in post as they had retired at the end of December 2018, however an acting manager had been appointed. 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.

People told us they were very happy living at The Conifers. They spoke positively about the care provided and the staff who supported them.

People were protected from the risks of abuse because staff had a clear understanding of safeguarding people, and care and support was planned and delivered in a way that ensured people were safe. Risks associated with people’s care had been identified and appropriately managed.

Most of the time a safe staff recruitment system had been followed to ensure staff employed were suitable to carry out their roles and responsibilities in a safe manner. However, we found in one case where some essential checks had not been carried out in a timely manner.

Staff were trained and supported to develop their skills and provide people with the standard of care they required.

Staffing numbers were adequate to meet the care needs of the people living at the home at the time of our inspection. However, there was no formal allocation of staff to enable people to take part in regular social activities to meet their individual needs.

Medication was mainly managed safely and administered by staff who had completed appropriate training. However, we found information on ‘as and when required’ medicines needed improving.

People were supported to receive a healthy diet, which they said they enjoyed.

Staff supported people in an inclusive, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. The people we spoke with made very positive comments about how staff delivered care and said they were happy with the way the home was run.

People’s needs had been assessed and care plans drawn up to highlight where they needed support, providing guidance to staff on how best to do this.

Various checks and audits had taken place to highlight areas for improvement, but these did not always have an action plan showing the timescale for the work to be completed and who was responsible. Neither did they evidence the shortfalls found had been addressed. Where new audits had been devised to improve the ones previously used, these needed to be embedded into practice to ensure on-going improvement.

Further information is in the detailed findings below.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at The Conifers took place on 17 July 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 23 August and was unannounced. This meant the people who lived at The Conifers and the staff who worked there did not know we were coming. On the day of our inspection there were 24 people living at The Conifers.

People spoken with were very positive about their experience of living at The Conifers. They told us they felt safe and they liked the staff.

Relatives spoke highly of the staff and the care provided to their family member. They had no concerns or complaints about the home.

Healthcare professionals spoken with told us they had no concerns about The Conifers and felt people were well cared for.

We found systems were in place to make sure people received their medicines safely.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. They told us they liked their jobs, worked well as a team and were well supported by the registered manager.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided to people which took into account dietary needs and preferences so their health was promoted and choices could be respected.

Some activities were provided by care staff and a range of entertainers visited the home to provide leisure opportunities.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via questionnaires. The results of these had been audited to identify any areas for improvement.

We spoke with 4 relatives to obtain their views of The Conifers.

We spoke with registered manager, the qualified nurse on duty, 3 care staff, the cook and assistant cook about their roles and responsibilities.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service told us they felt safe.

We observed, and people told us they felt their rights and dignity were respected.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them and their representatives, and they were involved in writing their plans of care. People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

People were provided with a choice of food and drink in line with their preferences. People's weight and food/ fluid intake was monitored to maintain their health.

Staff were provided with training to ensure they had the skills to meet people's needs. Some staff needed refresher training to make sure their skills were up to date. Staff were provided with formal individual supervision to ensure they were adequately supported and their performance was appraised.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

We asked people using the service for their opinions about the support provided. Feedback from people using the service was positive, for example, 'It's champion here. The staff are lovely and we're well looked after' and 'It's good here. I can't fault it. Nothing is too much trouble'. Comments from relatives were also positive. They included, 'I have no worries at all. The staff are great' and 'I am very happy. (My relative) is well looked after and the staff really care'.

Observations showed people's needs were met by staff in a patient and kind manner.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People's needs were identified and reviewed so any changes were responded to. People had some opportunities for leisure activities.

People spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

People living at the home told us that they were happy and that they were satisfied with the care they received. They told us, "I think it is excellent here. I have made friends and the staff are very kind" and "the staff are lovely, nothing is too much trouble for them."

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff appeared positive. Staff spoken with knew the people living at the home well. We found that care and support was offered appropriately to people.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

We found that sufficient numbers of staff were provided to meet people's needs. Staff were provided with relevant training to maintain and update their skills and knowledge.

The home had an effective complaints system available. A system was in place to respond appropriately to any complaints received.