About the service: Conifers care home is a residential care home that accommodates a maximum of 20 people. At the time of this inspection 18 people lived at the home. Older people who lived with disabilities including dementia, Parkinson's disease and diabetes, were supported with personal care and accommodation. People who displayed behaviours that may challenge were also supported at the service. The home provided a homely atmosphere and environment that met people's individual needs.

People’s experience of using this service:

Since our last inspection in April 2018, the provider had invested resources to improve the service. A new kitchen had been fitted and the environment had been improved. This was work in progress and ongoing works were scheduled to improve the environment further.

The management team had implemented new quality and safety checking systems to monitor maintenance and the environment. It was evident that these checks were being used. However, these systems required more time to be used consistently and to be fully embedded in daily practice at the home. This was an area that required improvement.

People received their medicines safely. Improvements had been made since our last inspection and controlled drugs were managed safely. However, for one person, one of their regular medicines had not been given as prescribed. Management at the home had followed this up with the doctor surgery but this had been delayed. Systems were not always robust to check that all medication had been prescribed for one person. All other medication had been given as prescribed. This was an area that required improvement.

The registered manager told us after this inspection that the response from the surgery had now improved regarding medicines.

People and their relatives spoke positively about the staff and the care received at Conifers care home. There was enough food and drink. People received lunch time meals from an external catering company. People who had dietary needs such as allergies or who required specialist diets were catered for. One person told us, “They [staff] look after you and feed you well."

People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. One person said, "They’re [staff] just all good. They treat you nice.” One person's relative told us, “They [staff] give first class care.”

Behaviours that may challenge were understood by staff. Professional advice and guidance was sought from healthcare professionals which we were told by a community psychiatric nurse [CPN] staff acted upon appropriately. The CPN said, "They’re [staff] very thorough and willing to try advice given.”

Regular activities were provided for people. Some entertainers who visited the home were specialists in providing activities for people who lived with dementia.

The management team worked proactively and professionally with external health and social care professionals. Local management forums were attended by the home which ensured they maintained positive working relationships with other local homes and professionals.

Rating at last inspection: Requires improvement. (Last inspection report published 14 July 2018).

The service was rated as Requires improvement at this inspection. This was the second consecutive time the service had been rated Requires Improvement.

Why we inspected: This was a planned comprehensive inspection based upon the previous rating.

We inspect all services with one or more key questions rated as 'Inadequate' within six months to ensure that we regularly monitor and review the quality and safety of the service people receive. As a result of the last inspection rating we asked the provider to complete an action plan to demonstrate how they would meet the shortfalls at the home. We inspected to review this action plan and any improvements made. We saw that improvements had been made to

The inspection took place on 19 April 2018 and was unannounced. The previous inspection took place on 15 October 2015 when it was rated as ‘Good.’

Conifers Care 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 home provides accommodation, for up to 20 older people, who are living with dementia and who require support with their personal care needs. On the day of our inspection there were 16 people living at the home. The home is a large property situated in Selsey, West Sussex. The home has 20 single bedrooms 11 of which have an en suite toilet. There was a communal lounge and dining room as well as a garden which people used. There is a passenger lift so people can access the first floor.

We found the premises were poorly maintained in a number of areas, including bedrooms, the kitchen, toilets and bathrooms. There were identified risks to people from the poor quality of the environment including exposed hot pipes in a bedroom posing a risk of burns to people and infection control risks due to a lack of wash basins in two toilets. These were in the older part of the building; the newer part of the building was well maintained.

Medicines were not always safely managed. Significant errors in the recording, handling and administration of some medicine were found. We made a safeguarding alert to the local authority about this.

The process of audits and checks on the quality and safety of the service had not identified and acted where we found attention was needed regarding the quality and safety of the premises as well as the safe management of medicines.

The provider did not always follow the correct guidance of the Mental Capacity Act 2005 and the associated Code of Practice. We have made a recommendation about this.

People and their relatives were satisfied with the standard and safety of the care provided. Staff had a good awareness of the principles and procedures for safeguarding people in their care.

Sufficient numbers of care staff were employed to ensure people were looked after well.

There were systems to review people’s care and when incidents or accidents had occurred.

People’s health and social care needs were assessed. There was a culture of supporting staff to attend training in current care procedures such as in palliative care and in supporting people who had needs regarding problems when swallowing food. Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

Health care professionals reported staff to be caring, skilled and as having good communication with community nursing teams

People were provided with varied and nutritious meals. There was a choice of food.

People were observed to receive care from kind and caring staff. People said they received care from kind and caring staff. For example, one person said, “They couldn’t be kinder. They’re absolutely lovely.”

People’s rights to privacy and choice was promoted. The registered manager had sought guidance for staff regarding the rights of older people to have personal and sexual relationships. People were consulted about their care and how they liked to be supported.

People received personalised care that was responsive to their needs. This was also reflected in the feedback we received from people and their relatives; for example, one person told us, “Oh yes. Anything you want, you only have to ask and you’ll get it.”

Care plans reflected people’s needs and preferences. A range of activities were provider for people to take part in.

The provider had a complaints procedure and records were made of any complaint or concern raised. These records showed complaints were looked into and

Conifers Care Home is a residential care home which is registered to provide accommodation for up to 20 older people, the majority of whom are living with dementia. The home provides accommodation over two floors and there is a lift available to access the first floor. There was a total of 16 care staff, two domestic staff, 2 cooks a catering assistant and an administrator. The registered manager was in addition to these staff and she provided additional support for people as and when required. On the day of our visit 14 people lived at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People felt safe with the home’s staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm. Risks to people’s safety had been assessed and care records contained risk assessments to manage identified risks.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely. The provider’s medicines policy was up to date. There were appropriate arrangements for obtaining, storing and disposing of medicines.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely. People and relatives told us there were enough staff on duty and staff also confirmed this.

People told us the food at the home was good. There was a four week rolling menu displayed in the kitchen and staff went round each morning to check people’s choices for lunch and supper. Information regarding meals and meal times were displayed in the dining room.

Staff were aware of people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handovers at the beginning of each shift. The home was well supported by a range of health professionals. A visiting health professional told us that the registered manager and staff were very pro-active in asking for advice and support. They said the registered manager worked well with them to meet people’s needs.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one. We found that the provider had suitable arrangements in place to establish, and act in accordance with the Mental Capacity Act 2005 (MCA). Staff had a basic understanding of the Mental Capacity Act (MCA) 2005

Each person had a care plan which provided the information staff needed to provide effective support to people. Staff received training to help them meet people’s needs. Staff received an induction and there was regular supervision including monitoring of staff performance. Staff was supported to develop their skills by means of additional training such as the National Vocational Qualification (NVQ) or care diplomas. These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard. All staff completed an induction before working unsupervised. People said they were well supported and relatives said staff were knowledgeable about their family member’s care needs.

People’s privacy and dignity was respected. Staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

The registered manager operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable.

There was a clear complaints policy and people knew how to make a complaint if necessary.

The provider had a policy and procedure for quality assurance. The registered manager worked alongside staff and this enabled her to monitor staff performance. A group manager employed by the provider visited the home regularly to carry out quality audits.

Weekly and monthly checks were carried out to monitor the quality of the service provided. There were regular staff meetings and feedback was sought on the quality of the service provided. People and staff were able to influence the running of the service and make comments and suggestions about any changes. Regular one to one meetings with staff and people took place. These meetings enabled the registered manager and provider to monitor if people’s needs were being met.

At the time of our visit there were 15 people living at Conifers Care Home. The home specialises in caring for people with dementia.

We gathered information from a variety of sources. These included talking with six people who lived at the home and three relatives. We also spoke with the manager and four members of staff. As some people were unable to tell us about their care and support we completed a 30 minute observation using our Short Observational Framework Inspection (SOFI) tool. This tool is designed to help us understand the quality of care that people receive. We also left comment cards for people to complete if they wished to inform us of their views on the home. Four people returned completed comment cards.

Everyone told us that they were happy with the care and support they received. One said, “It’s peaceful here and the food is pretty good. The carers are very helpful and I feel secure”. Another told us, “I think they’re wonderful, I couldn’t tell you anything wrong, nothing at all”. Relatives were complimentary about the home. One said, “There is a calm atmosphere and the staff are well trained and very caring”. Another told us, “Nothing is too much trouble; they go out of their way to help”. One person used a comments card to share, ‘All the staff went the extra mile to cater for my relative’s needs and I would highly recommend the home to anyone else who has a relative with dementia”.

Staff were enthusiastic about working in the home. One told us, “It’s a lovely small home”. Another said, “If you know dementia it is easy to work with them, you need to look at the person not the dementia, you treat each person differently”.

People told us that they were happy with the support they received from the home to access healthcare professionals.

The provider had an effective system to regularly assess and monitor the quality of dementia care that people received. This included seeking the views of people who used the service and acting upon their wishes.

We spoke with three people who lived at Conifers Care Home. They told us that they were happy living there and that they felt safe. We observed that staff had a good relationship with people and knew them well.

We spoke with four relatives. They told us that they were very satisfied with the care provided. One said, “I bless the day I found the place” and, “The staff are so good, they do understand and they see what you need as well”. Another said, “The staff I find excellent”.

We spoke with the manager and three members of staff. They were all enthusiastic about their work and the people that they cared for. The manager said, “I love my job and I like to get things right. I run it so that everyone is welcome to come in”. Staff told us that they had a good team. One said, “I go home and feel I’ve done well today”, another, “I think I’ve struck lucky”.

We saw that parts of the home were being renovated and that there were plans for further improvements. Relatives and staff that we spoke with welcomed this work and said that there had already been a big improvement in the physical environment.

People told us they were quite happy living at Conifers. Many of the people were not able to engage in meaningful conversation as they were very confused but those that could were able to say that they were treated kindly and that the staff looked after them well.

We spoke with visitors to the home who also told us that they thought the care was good and that the staff were exceptionally kind and patient.