Archived: The Conifers Residential Care Home

Updated 6 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors visiting the service and 1 Expert by Experience who spoke with relatives via telephone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Conifers Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Conifers Residential Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The deputy manager from another service was serving as interim manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person living in the service and 3 relatives about their experience of care and support provided. Some people were unable to talk with us and used different ways to communicate including signs, pictures, gestures, vocalisations and body language. We observed people and their interaction with staff and each other throughout the inspection visits. We also spoke with 4 members of care staff including the provider, the interim manager, and care assistants.

We viewed a range of records held within the service, this included 3 care plans and multiple medicines records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management and oversight of the service, including staff training records, risk assessments, policies and procedures were reviewed. After the inspection we continued to receive information relating to quality assurance audits, policies and procedures. We sought clarification on staffing, staff training and competencies.

Updated 6 September 2023

About the service

The Conifers Residential Care Home is a residential care home, providing accommodation and personal care for up to 10 people. The service provides support to people with mental health conditions, sensory impairments, physical disabilities and to people living with dementia. It is also registered to provide specialist support for people with a learning disability and autistic people. At the time of our inspection there were 7 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were not supported to have maximum choice and control of their lives, staff did not support them in the least restrictive way possible and in their best interests; policies and systems in the service did not support this practice.

Medicines were not always managed safely

Staff did not always follow the Mental Capacity Act key principles when making best interest decisions.

The provider did not give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Some areas of the home were visibly dirty.

Right Care: The provider did not ensure they always had enough appropriately skilled staff to meet people’s needs and keep them safe

People could not always take part in activities and pursue interests that were tailored to them. The provider did not give people opportunities to try new activities that enhanced and enriched their lives

People who had individual ways of communicating; using Makaton (a form of sign language), pictures and symbols, could not always interact comfortably with staff and others involved in their care and support because staff did not have the necessary skills to understand them.

Staff did not always receive training to enable them to meet the needs of people and keep them safe.

Right Culture: People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs

There was a lack of effective monitoring in place and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection. There was a lack of oversight and leadership within the home.

People were not involved in developing the service. We have recommended the provider seeks advice and guidance to meet people's sensory and emotional well-being needs.

The service was not able to demonstrate they were meeting the underpinning principles of right support, right care, right culture. Staff were not aware of the right support, right care, right culture guidance.

The provider was open and responsive to concerns raised during the inspection.

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 May 2022) and there were 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 we found not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of accidents and incidents in the service. A decision was made for us to inspect to examine those risks and also to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

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

Enforcement and recommendations

We have identified breaches in relation to the storage and management of medicines, fire safety, staffing, protection from the risk of abuse, management oversight of the service and person centred care at this inspection.

We have also made recommendations to ensure the environment is developed to meet people's physical and sensory needs and for the provider to seek further support around sexuality, gender identity and sexual expression.

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