Archived: The Conifers Residential Care Home

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.

The Conifers Residential Care Home is a care home providing personal care to eight people at the time of the inspection. The service can support up to nine people.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

Staff enabled people to access specialist health and social care support, however, guidance given by healthcare professionals was not always followed.

People had a choice about their living environment and were able to personalise their rooms, however, some aspects of the living environment required refurbishment.

The environment was mostly safe for people to live in, however, window restrictors were not always in place on first floor windows.

Staff supported people with their medicines safely and in their preferred way.

The service supported people to have the maximum possible choice and control over their own lives.

People were supported by staff to pursue their interests.

Right Care

The service did not always have enough appropriately skilled staff to meet people’s needs and keep them safe. Staffing levels were not always sufficient, to ensure that people’s healthcare needs were met during the night.

Risk assessments were carried out to assess the risk present in people’s lives, but they were not always followed fully by staff.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

Staff and management did not always follow best practice and guidance given to them by outside professionals.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

People and those important to them, including advocates, were involved in planning their care.

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 Good 6 December 2018.

Why we inspected

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.

We received concerns in relation to staffing levels at night time not being sufficient to meet people’s assessed needs. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

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 improvement. 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.

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 have identified breaches in relation to safe care and treatment and good governance.

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

Follow up

We will request an action plan from 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.

The Conifers is a residential care home that provides accommodation and personal care for up to 10 people. It is one of three care homes owned by the provider, Mrs M Mather Franks in the Rushden area of Northamptonshire. The service is set out over two floors and the lower floor has been adapted to make it accessible for people with mobility needs. On the day of our inspection 10 people were using the service.

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

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were detailed risk management plans in place to protect and promote people’s safety. Staffing numbers were sufficient to keep people safe and the registered provider followed thorough recruitment procedures to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction when they first commenced work at the service and on-going training to ensure they could provide care based on current best practice when supporting people. People received enough to eat and drink and were supported to use and access a variety of other services and social care professionals. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and/or their relative where required. Staff promoted and respected people's cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

Further information is in the detailed findings below

Our inspection took place on 7 July 2016, and was unannounced.

The service had a registered manager. 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.

Staff were aware of the importance of safeguarding people. They had been trained to recognise signs of potential abuse and keep people safe and were aware of the systems in place to report any concerns. Processes were in place to manage identifiable risks both for people and within the service. Risk assessments had been carried out to guide staff to manage and reduce the level of harm to which people may be exposed.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Safe and effective recruitment practices were followed.

Systems were in place to ensure people’s medicines were well managed. There were suitable arrangements for the safe management of medicines.

Staff received support and training to perform their roles and responsibilities. They were provided with on-going training to update their skills and knowledge.

Consent for care was sought by staff on a daily basis and had been recorded in people’s care plans. We found that, where people lacked capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005.

People were provided with a balanced diet and adequate amounts of food and drinks of their choice. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity. We saw that people and where appropriate, their family, were given regular opportunities to express their views on the service they received.

Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes.

We found that the service had good leadership and as a result, staff were positive in their desire to provide good quality care for people. Quality assurance systems were in place and were used to obtain feedback, monitor service performance and manage risks.

At the time of our inspection nine people lived at The Conifers. We spoke with people who used the service who told us that they were happy living at the service. Because of the nature of their disabilities, they were not able to tell us in detail about their experiences. Our summary is based on the views of people who used the service, observations during the inspection, speaking with staff supporting people who used the service, the registered manager and from looking at records. If you want to see the evidence supporting our summary please read the full report.

During the inspection we sought answers the five key questions below:

Is the service safe?

Staff had received training in safeguarding vulnerable adults, understood the different types of abuse and their responsibilities for reporting any concerns about the treatment of people who used the service.

People had been placed at significant risk as a result of two night staff who worked alone not being trained to administer medication. The provider gave us immediate assurances that a trained member of staff would be available on each shift.

Is the service effective?

People's health and care needs were assessed and plans of care developed according to their needs which helped staff to deliver appropriate care. From our observations and discussions with staff, we concluded that staff had a good knowledge of each person's care needs and preferences. This meant that staff were able to support people effectively.

Is the service caring?

We saw that people were treated with dignity and respect by the staff. People who used the service were relaxed in the presence of staff and responded positively to them. People who used the service told us that they got on well with the staff and talked about the staff who would be supporting them on holiday. We heard staff talk about people in a caring and supportive manner.

Is the service responsive?

We saw that staff were available to support people who used the service and that they were responsive to signs that they may need assistance.

Is the service well-led?

We found that the service was well organised. The provider had taken action since our last inspection to make the improvements required in relation to considering people's capacity to consent and safeguarding them from financial abuse.

We were satisfied that the provider responded quickly and appropriately to concerns raised by the inspector that people who used the service were left at night without staff trained to administer their medication. However, the fact that this had been allowed to occur raised concerns about the management and their oversight of the service.

We looked at some care plans and we talked to the people who lived there, their family members and staff who worked at the home. We found that people who lived in the home were happy with how they were treated in the home. We saw some people were relaxing in one of the lounges, watching television.

A family member told us, 'We feel fortunate to have X there.'

Another person told us, 'The staff are polite and helpful. They treat X well and look after him.'

Although we had positive feedback from family members about the care and support provided at The Conifers, we found that care plans did not provide clear evidence about how decision about obtaining consent to care and treatment had been made.

We also found that the Provider had inconsistent arrangements in place for the management of financial arrangements for the people who lived in the home. We have judged that the Provider should take action on these matters.

We also reviewed how the Provider dealt with information and records of the people who lived at the home and of the staff members. We found that the Provider had clear policies and procedures in place. Information was used and stored appropriately.