Conifer Lodge Residential Home

Conifer Lodge is a residential care home providing accommodation and personal care for to up to 20 people in one adapted building. The service provides support to people that may have dementia, physical disabilities and sensory impairment. At the time of our inspection there were 20 people using the service.

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

Improvements to the service we found at our previous inspection had been embedded. This assured us the service was well-led.

People were provided with person centred care that met their preferences and wishes. Care was delivered by kind and compassionate staff. People had their dignity and privacy upheld and were treated respectfully.

The service was welcoming and inviting to visitors. The provider and registered manager were visible and monitored the service effectively. Prompt action was taken when things went wrong.

People and relatives were consulted and involved in how they wished for care and support to be delivered and treated as individuals.

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.

Staffing levels ensured people received timely care. Staff were recruited safely and were competently trained and experienced to carry out their roles to provide safe care.

People’s needs were assessed and risks to their health and wellbeing were managed safely. People were safe and protected from harm and abuse. Medicines were administered as prescribed and people were well nourished.

We were assured that the provider had sufficient infection, prevention and control measures in place.

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 27 March 2021) and there were no breaches of regulation. At this inspection we found improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Conifer Lodge is a residential care home providing accommodation and personal care for up to 20 people aged 65 and over. At the time of the inspection 12 people were using the service.

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

At our last inspection we found multiple failings which put people at risk of harm. This included but was not limited to failings in infection prevention control for the management of COVID-19, safe care and treatment, the providers governance systems and processes and the competency of the two registered managers and nominated individual.

At this inspection we found significant improvements were made and lessons were learnt. These improvements were facilitated in the main by a director of the company who previously only played a small part in running the company.

The director and registered manager were open and transparent and accepted newly implemented systems and processes needed to be embedded and sustained over time.

The provider had implemented robust infection control procedures and followed government guidance to ensure people were now protected as far as possible from the risk of infectious diseases such as COVID-19.

Arrangements were in place to safely manage and monitor risks associated with people’s care. Care plans and risk assessments were reflective of people’s needs, and people's medicines were managed safely.

People were protected from harm and abuse, and relatives felt their family members were safe and well cared for. Staff were trained in safeguarding and knew how to report concerns to the relevant authorities if needed. Improvements to recruitment processes ensured staff employed were safe to care for vulnerable people.

Staffing levels were safe. Staff provided people with safe and compassionate care and gave us many examples of how the service had improved to support them in providing quality care. They felt supported by the provider and the registered manager, and made reference to one of the directors who they felt had orchestrated the improvements.

Previous concerns over the safety of the environment had been addressed. The provider had made several improvements to the décor and presentation of the service which had a positive impact on people’s quality of life. Plans to make further improvement was in place.

People 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 and update

The last rating for this service was Inadequate (supplementary report published 15 December 2020).

This service has been in Special Measures since 15 December 2020. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focussed inspection of this service on 9 September 2020. Breaches of legal requirements were found, and the service was placed in special measures. We imposed conditions on the providers registration. A director completed an action plan after the last inspection to show what they would do and by when to bring about the improvements needed.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at were used to calculate the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this 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 the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Conifer Lodge on our website at www.cqc.org.uk.

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.

Conifer Lodge residential Home is a residential care home providing personal care for up to 20 people aged 65 and over. At the time of the inspection there were 15 people receiving care.

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

People were not provided with safe care.

People were exposed to the risk of acquiring infectious diseases including Covid-19 because infection control procedures were not managed safely. The service has had two previous outbreaks of Covid-19. Despite this, lessons were not learned and, government guidance not followed to minimise the risk of further outbreaks. Personal protective equipment (PPE) was not always disposed of safely and, the service was not cleaned every day. Not all staff had received infection control training.

People were exposed to the continued risks of harm and abuse and, action was not taken to prevent further incidents occurring. Incidents were not investigated or reported to agencies including local authority safeguarding teams and CQC.

Some people’s care needs and risks were not met because they were not assessed when first admitted to the service or when their needs changed. Staff were unable to support and monitor people safely because there were not enough of them on duty all the time.

Environmental risks were not addressed. An electrical wire was hanging loose from a toilet ceiling and, it was unclear whether it was connected to the mains. Hazardous material had also not been secured safely.

Safe recruitment procedures were not always followed which posed risks to people’s welfare. Staff were not supported in their roles and, when they raised concerns they were not always listened to. Supervisions, appraisals and team meetings were not undertaken.

The service was not well-led. Leadership and oversight of the service was poorly coordinated and relationships between managers and the nominated individual were not cordial. Records to support effective quality assurance of the service were not in place.

People were not always supported to have maximum choice and control of their lives. Policies and systems in the service did not support 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 and update

The last rating for this service was inadequate (published 15 January 2020) and there were multiple 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 not enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We planned to undertake a targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 safe care and treatment and Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

However, the registered manger informed us immediately prior to the inspection of serious concerns in the service. These included, but were not limited to, infection control, assessing and monitoring risks of people’s safety, staffing, reporting and recording incidents and, safe management of the service. We therefore carried out a focussed inspection to examine the risks identified inspecting the whole of the safe and well-led key questions. The overall rating for the service has not changed following this inspection and remains Inadequate.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safe care and treatment (Infection control practices, lack of care plans and risk assessments to monitor people safely, safeguarding people from harm and abuse, and staffing staffing), reporting serious incidents and poor management of the service at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Conifer Lodge residential care home providing personal care and accommodation for up to 20 older people. There were 17 people living at the service at the time of our inspection.

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

People could not be assured they would receive safe care. Measures were not in place to protect people from falls from height, scalds and falling furniture. Incidents that occurred within the service were not always reported to the appropriate authorities including the Care Quality Commission.

People’s safety and well-being were at risk. The provider and registered manager failed to make the required environmental improvements identified during our previous inspection. They failed to identify further risks to people from the environment that were found during this inspection.

The provider and registered manager did not have effective systems and process in place to safely monitor the service.

People’s care needs were not always assessed and risks to their health were not always safely monitored.

People were at risk of infection and medicines were not managed safely.

Staff did not receive effective support and guidance from the provider or registered manager.

People and their relatives were provided with little opportunity to share their views of the service. People’s personal information was not securely stored.

Staff were kind and considerate to people and treated them with respect.

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 and update: The last rating for this service was requires improvement (published 22 November 2018) and there were two 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 remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safety, security and suitability of the environment, managing people’s medicines, and assessing and reviewing people’s care needs.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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.

This is the first time the service has been rated Requires Improvement This was the second comprehensive inspection carried out at Conifer Lodge Residential Home, the last inspection in March 2016 was rated Good.

Conifer Lodge Residential Home 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 home accommodates up to 20 people in one adapted building. On the day of our visit, there were 18 people using the service.

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 and associated Regulations about how the service is run.

The provider had not ensured there were sufficient processes in place to assess, monitor and to maintain the health, safety and welfare of service users. The provider had not carried out environmental audits to identify where repairs and maintenance were required. People living with dementia were at potential risk of harm due to access to the stairs, lift and hot radiators.

We made on recommendation relating to creating a dementia friendly environment.

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. Staff had a good understanding of people's needs and preferences.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People could be assured there were enough trained staff to meet their needs and staff received the support they required to carry out their roles. Safe recruitment processes were in place.

People could be confident their complaints would be responded to appropriately.

People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to be involved in their care planning and reviews. Their care and support was delivered in the way that people chose and preferred.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

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 support this practice. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

At this inspection we found that Conifer Lodge Residential Home were in breach of two regulations relating to safe care and treatment and governance of the home.

Further information is in the detailed findings below.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Conifer Lodge Residential Home on our website at www.cqc.org.uk

Conifer Lodge Residential Home is a care home registered to accommodate up to 20 people who are aged over 65. People may also have a physical disability, a sensory impairment, be living with dementia or have a diagnosis of mental ill health. The home is located on two floors, with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 20 people were using the service.

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.’

People told us that they felt safe when staff supported them and that they enjoyed living at Conifer Lodge Residential Home.

Risk assessments were in place which described how to support people in a safe way for most identified risks. We found that there were some risks that had not been fully assessed. Where people displayed behaviour that challenged techniques for staff to support the person to manage this behaviour were not recorded. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

The provider carried out checks before staff started to work at the service, however had not completed these checks fully for all staff. Information about staff's previous work history had not been recorded through obtaining at least two references for each staff member.

People received their medicines at the right time from staff who were trained and assessed as competent to administer medicines. Temperatures were not checked regularly where medicines were stored.

Staff were supported through training and supervision to be able to meet the needs of the people they were supporting. They undertook an induction programme when they started to work at the service.

Staff sought people’s consent before providing personal care. People’s capacity to make day to day decisions had been considered in their care plans however assessments of a person’s capacity to make a specific decision had not always been completed.

People were supported to maintain a balanced diet. People were supported to access healthcare services.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity. Staff understood people’s needs and preferences.

People were involved in decisions about their care. They told us that staff treated them with respect.

People were involved in the assessment of their needs. People and their relatives were involved in the review of their needs.

People were supported to take part in activities that they enjoyed.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

The service was well organised and led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

People were asked for their feedback on the service that they received. The provider carried out some monitoring of the quality of the service.

Relatives told us they were satisfied with the care that had been provided to their family members. One told us, "The care has been excellent. My mother has been very well cared for. She has done well only because of the loving care she has received." Another relative said, "I wouldn't want my mother anywhere else." Both relatives told us that they had been involved in decisions about their respective parent's care. Both told us that they knew how to raise any concerns and were confident that the home would respond to what they said. What people told us reinforced what we saw in responses that people had made to a recent satisfaction survey.

We found that people's needs had been assessed and that staff had received appropriate training and support to be able to meet people's needs. The home was safe and well run.

One person who used the service told us they had been able to spend time how they wanted and were aware of activities that they could join in with if they wanted to. They told us that they were comfortable at the home and liked the room they occupied. They told us, "The staff are polite and friendly, I get the care that I need." Another person told us, "I'm definitely well looked after. The staff are very good, very polite, we have a laugh together." Another person told us, "I'm very well looked after. I'm happy here. The staff are marvellous." A relative told us, "I've been involved in discussions about my mother's care and I'm confident that she is getting all the care she needs. " The relative added that staff were alert to changes in people's health and that, "Staff do a lot to keep my mother stimulated. I know I can raise any concerns and I am confident my mother is safe here." A visiting health professional described the care people were receiving as "excellent."