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Inspection carried out on 17 December 2018

During a routine inspection

About the service: The Conkers is registered to provide accommodation and personal care for up to seven people with learning disabilities and other complex health needs. The home is a one storey, purpose-built building with a separate garden. At the time of inspection 7 people lived in the service.

People’s experience of using this service: People were supported to take their medicines in a safe way however medicines were not always safely managed. We have made a recommendation about the management of medicines.

Formal feedback from people who use the service, their relatives and staff was not routinely sought by the provider to evaluate and improve the service.

Everyone we spoke with told us The Conkers was a friendly and lovely place to visit, that staff were kind and caring and people were treated with respect.

People were involved in their day to day lives through being empowered to make their own choices about where they spent their time, who with and how. People had access to a wide range of activities including access to the local community. Independence was promoted and staff actively ensured people maintained links with families.

Recruitment processes were robust and thorough checks were completed before staff started working in the home. We saw there were sufficient numbers of staff on duty on make sure people’s care needs were met. Staff had received training, supervision and appraisal to ensure people received appropriate care.

The manager and staff knew what to do to keep people safe. Individual risks had been assessment and identified as part of the support and care planning process. We saw nice interactions between staff and people who used the service. We saw staff respected people’s privacy and dignity.

People’s nutritional needs were met and the menus we saw offered variety and choice. Records showed people had regular access to healthcare professionals to make sure their health care needs were met.

A complaints procedure was in place. Relatives told us they would have no hesitation in raising concerns and knew how to do this.

The home had good management. The manager was visible working with the team, monitoring and supporting staff to ensure people received the care and support they needed.

More information is in Detailed Findings below.

Rating at last inspection: Requires improvement (report published 23 December 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements have been made since our last inspection and the provider was no longer in breach of the regulation relating to medicine management. The service has improved and is now rated good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 28 September 2017

During a routine inspection

The inspection of The Conkers took place on 18 September 2017 and on 4 October 2017. We previously inspected the service on 26 March 2015 and was rated Good overall and in all five domains.

The Conkers is registered to provide accommodation and personal care for up to seven people with learning disabilities and other complex health needs. The home is a one storey, purpose-built building with a separate garden. There are private bedrooms with en-suite facilities, a communal lounge, a sensory/small lounge room, a communal kitchen/dining room, a communal bathroom and a separate laundry/domestic room. There were seven people living at the home at the time of this inspection.

The home had a registered manager in place. 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.

During this inspection, we identified that the service was breaching regulations related with safe care and treatment. The medicine room was not secure and there were inaccuracies in the transcribing of how medicines should be taken in the medicine management records. Controlled drugs were not overseen in line with organisational policy.

Staff had been recruited safely and there were sufficient numbers of staff employed to keep people safe.

Risks had been assessed relating to social and leisure activities. Measures had been introduced to reduce risks and to enable people to be as independent as possible.

Regular safety assessments by competent people had been carried out such as those relating to gas, electric, water safety, hoist and sling use.

Staff had received induction and mandatory training. There were outstanding requirements for annual staff update training and the staff training matrix was not up to date.

Staff received regular appraisals and supervision.

Staff demonstrated a thorough understanding of the Mental Capacity Act 2005. Mental capacity assessments had been completed for people who lacked capacity to make decisions and choices.

People were supported with their nutrition and hydration needs. Electronic equipment was used to help support people to choose their meals. It was observed that meal times were a pleasant and enjoyable experience for people.

We saw staff were passionate about providing a supportive environment and were knowledgeable with regards to people’s individual requirements.

Relatives were involved with changes to people’s care and were kept up to date.

Daily record folders containing private and confidential information were kept in the communal area and not secured.

Care plans included a person centred life plan which detailed people’s likes and dislikes, personal routines and mobility capabilities. Staff were very skilled in supporting people to maintain their independence by being knowledgeable about a person’s need.

Regular audits took place within the home although issues with the medicines management had not been picked up by these quality processes.

Staff knew their duties and roles in caring for people and felt supported by their manager.

We found one breach 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 the report.

Inspection carried out on 26 March 2015

During a routine inspection

The inspection of The Conkers took place on 26 March 2015 and was unannounced. This was the first inspection for this service under Section 60 of the Health and Social Care Act 2008.

The Conkers is a purpose built care home. It is part of the Holly Bank Trust which is an organisation specialising in providing education, care and support for young people and adults with profound complex needs.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we spoke with relatives of two people living at the home. Both told us they felt their relative was safe. Staff we spoke with understood the procedure for reporting situations where people were put at risk of harm.

Accidents or incidents were recorded and analysed. One relative we spoke with told us staff responded well to incidents.

We reviewed the recruitment procedure for one member of staff and found it to be thorough. Both relatives and staff that we spoke with told us there were enough staff to meet people’s needs.

We found the system for managing people’s medicines was safe.

Feedback from relatives about the meals served at the home was positive. We observed the lunchtime meal to be visually appealing and people, were supported to make choices about the food they ate.

Staff told us they were supported and that they received regular training and supervision.

The registered manager was aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005.

The home was purpose built, providing homely, practical living for the young people living there and people had easy access to outdoor space from their bedrooms or the communal areas.

During our inspection we found the atmosphere in the home to be happy and friendly. People looked well cared for and staff demonstrated skills and knowledge about the people they were supporting. People were treated with dignity and respect and we saw evidence of staff supporting people to make choices about their everyday lives.

People were supported to engage in a variety of activities both within the home and local community.

Peoples’ support plans were person centred and provided details about their likes, preferences and dislikes. The plans detailed the care and support the person required.

One relative we spoke with told us they had raised a concern and the matter had been resolved to their satisfaction. Relatives and staff spoke positively about the registered manager. The registered manager was visible and accessible to staff, people who lived at the home and their families.

There was a system in place to assess and monitor the safety and quality of the service provided. We saw where an issue had been identified, action was taken to address the matter. Holly Bank Trust had a structure in place to enable parents of the young adults who lived at the home to be involved in the decision making process for Holly Bank Trust.