Conifers Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment. Risks associated with people’s care were not always documented to reflect safe care and people’s medicines were not always managed safely.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Accidents and incidents had not always been analysed to identify trend and patterns to help mitigate future risks. The management team were not able to show us any examples where learning had been identified following safety events or changes made to improve practice. The registered manager told us on some occasions action plans had been developed to address issues, and discussions held in team meetings to look at ways they could improve. However, no examples were provided.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Staff and leaders liaised with other professionals to ensure people received appropriate care which met their individual needs. One professional said, “The Conifers work collaboratively with the wider teams within the community. Safety is proactively managed; any concerns are escalated and dealt with appropriately. The Conifers prioritise continuity of care and I have always worked alongside the Conifers team to ensure good end of life care is provided in a holistic manner.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Policies and procedures were in place to ensure people were safeguarded from the risk of abuse or harm. Staff were knowledgeable about the safeguarding procedure and knew what to do if they were concerned. Staff told us their managers would take appropriate action to keep people safe.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Staff and leaders worked within the guidelines of the MCA.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Care documentation we reviewed lacked vital information to ensure staff delivered care safely. For example, risk assessments and care plans regarding safe moving and handing and the use of a hoist were poor. Care plans did not always identify the size and type of sling required or loop configuration to use to ensure a safe moving and handling transition. One person’s nutrition and hydration care plan stated they should have 1000mls of fluid per 24 hours, however this was not always recorded or evaluated and some days this target was not reached, putting the person at risk of dehydration. Body maps in place to show skin integrity concerns were not always dated or evaluated to show improvement or escalation if there had been deterioration. The registered manager told us catheter passports were not in place for people with catheters. We raised these issues with the registered manager who told us they would take appropriate actions to address the concerns.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. We carried out a tour of the home and found the care environment was not always safe. We identified large items of furniture were not secured to walls to prevent them falling on to people. We also identified parts of the home where radiators were extremely hot to touch, and no risk assessment had been completed to minimise the risk of burns. We noted bed rails in use did not always have a full-length bumper in place to avoid entrapment. We raised these issues with the registered manager who liaised with the provider to ensure the safety of the environment improved. We found personal emergency evacuation plans were in place to ensure people could evacuate the premises safely in an emergency. Maintenance checks were completed to ensure regular servicing of the building and equipment was carried out.

The provider did not always make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However. Staff worked together well to provide safe care that met people’s individual needs. We reviewed 3 recruitment files and found some gaps in application forms had not been explored during the interview process. We also found where staff had previously worked in health and social care, references had not always been sourced from appropriate employers. We reviewed the staff training record and found there were many occasions where training had not taken place in line with the provider’s policy. However, staff told us they received training and felt they had the skills to carry out their role well. One staff member said, “I feel we would benefit from an extra staff member on the day shift which is 7.30am to 8.30pm especially when our nursing home is full. We always complete our tasks but sometimes it can be very demanding, and we could do with more time especially if a staff member calls in sick. I have never known staffing levels to increase when people’s needs change.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. We carried out a tour of the home and found people were not always protected from the risk and spread of infection. For example, some store rooms were cluttered with items stored on the floor making them difficult to clean, some bare wood to shelving in store rooms, many cloth armchairs which were not easy to clean, lack of pedal bins throughout the home, continence wear was stored in toilets out of packets, mops stored in buckets, and the laundry was disorganised with no dirty to clean flow in place to minimise cross infection. We raised these issues with the registered manager who revised some infection prevention and control practices to improve cleanliness. We received feedback from external professionals who had visited the home following our inspection and had found these issues had been resolved.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Stock balances for some boxed medicines did not tally with the medicines in stock, therefore there was no way to check that people had received their medicines as prescribed. Following our inspection the registered manager carried out a full stock check of medicines and identified further anomalies. The registered manager reviewed and updated the medicines policy. We found prescribed topical creams left in an unlocked container on the upstairs corridor. The registered manager explained that the topical creams remained on the corridor whilst staff were assisting people and then the creams would be safely locked away. The topical creams were paraffin-based and posed a fire risk in an open corridor. There was no risk assessment in place to manage this process. During our inspection the registered manager completed a risk assessment to ensure the safe storage of paraffin-based creams.