The Conifers is registered to provide accommodation and personal care for up to 30 people with a learning disability. The service operates from a large property in a residential area of Bridlington, in the East Riding of Yorkshire, close to the beach, local amenities and public transport routes. Accommodation is located over two floors and there are 16 bedrooms, one of which is a twin room; and 9 self-contained flats, some of which were shared.

We undertook this unannounced inspection on the 9 March 2017. The inspection was to check that the registered provider was now meeting legal requirements we had identified at the last inspection. At the time of this inspection there were 28 people using the service.

When we last inspected the service on the 16 June 2015 we found the registered provider was not meeting all of the required standards we checked and they were in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed to ensure the risks were assessed and people were protected. The registered provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we found that the registered provider had made appropriate improvements in line with their action plan. We found these improvements were sufficient to meet the requirements of regulation 12. This meant the service had met the breach of regulation imposed at the previous inspection.

The registered provider is required to and did have a registered manager in post. 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 2008 and associated Regulations about how the service is run. The registered manager was not present during this inspection and the service assistant manager, deputy manager and head senior supported us throughout the inspection.

People told us that they felt safe whilst they were living at The Conifers. People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the CQC. This helped to protect people.

We found that the management of medication was safely carried out and staffing levels provided on the day of our inspection were adequate to meet people's needs. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support people living at The Conifers.

Staff understood the risks to people's wellbeing and knew what action they must take to help minimise risks. General maintenance was carried out and service contracts were in place to maintain and service equipment so it remained safe to use.

Staff were provided with training in a variety of subjects, which was updated periodically to help develop and maintain their skills. Regular appraisal and supervision was provided to all staff which helped support them and identify further development needs.

People's nutritional needs were assessed and monitored, with special diets provided, where required. Staff encouraged and assisted people to eat and drink, where necessary and advice was sought from relevant health care professionals to ensure people's nutritional needs were met.

Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Members of staff at the service with whom we spoke, had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions f

The inspection of The Conifers took place on 16 June 2015 and was unannounced. At the previous inspection in September 2013 we found the regulations we assessed were being complied with.

The Conifers provides services to 30 people with a learning disability in single and shared accommodation and also in a small number of self-contained flats on the site. People are encouraged to take part in community based activities and pastimes, including education, work and leisure. The service operates in a large Victorian property in a residential area of the town, close to the beach and local facilities. There is limited parking for two cars at the side of the premises or there is on-street parking using permits obtained from the service.

There was a registered manager in post who had been managing the service for the past ten years. This person was also one of the directors of the company. 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.

The premises were safe and well maintained with the exception of there not being window opening restrictors on all windows. While the service had risk assessments in place for most of the issues that could be a risk to people, for example, fire safety and hot water, the service had not recorded when risk assessments on window restrictors had been carried out and so not all windows were fitted with restrictors. This was particularly in respect of decisions that had been made to omit using window restrictors in bedrooms where people had capacity to understand about their personal safety and were not identified as being at risk of having falls from their window. However, this did not mitigate the risk to people that did not have capacity to fully understand the danger that wide opening windows presented to them.

This was a breach of regulation 12 of The Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this inspection report.

We found that people were protected from harm or abuse by systems in place for managing safeguarding issues and a staff team trained in safeguarding people from abuse. Staff were prepared to use the whistle blowing policy when necessary. Important safety information was given to people and risk assessments were in place to protect people from being harmed unnecessarily.

People were kept safe from injury because staff understood their responsibilities around preventing accidents and incidents and reporting them if they occurred so that suitable changes could be made to ensure they could not happen again.

Staffing levels were appropriate to meet people’s needs and staff were safely recruited to ensure people were not exposed to unsuitable staff caring for and supporting them. The management of medicines was safely executed and people were protected from the risk of receiving the wrong medicines. There were safe infection control measures in place.

We found that the service was effective because staff were appropriately trained and skilled to carry out their roles; they followed recognised guidance from organisations connected to learning disability care and training, followed legislation to ensure people’s rights were upheld and encouraged people to lead healthy lifestyles. People’s health care needs were appropriately assessed and planned for.

We found that staff were caring, offered sound guidance for people’s safety and that staff had established supportive relationships with people. Staff were respectful, inclusive and encouraging to enable people to learn and look forward to new experiences. When necessary staff pointed people towards advocacy services and staff worked well with other bodies and organisations to ensure people received the best support available to them.

We found that people’s privacy, dignity and independence were upheld in all respects. Wellbeing of people was paramount.

We found that support plan documents aided staff to provide good care and support. People engaged in activities, occupation and interests of their choosing. We found that complaints were appropriately handled and everyone knew how to represent themselves and complain when necessary.

We found the good culture within the service was based on friendliness, openness and teamwork. The management style was open and inclusive. There was a quality assurance system in place to seek people’s views and assess the effectiveness of support systems in operation. The quality assurance system used meetings, surveys, audits and general day-to-day conversation to find out if the service was meeting people’s needs effectively. We found that recording systems were satisfactory and that they assisted the service in ensuring the quality of the service was maintained.

We found that people were asked for their consent before support was provided, formally in writing in 'person-centred plans' of care and informally via gestures and verbal agreement on a daily basis. People said, "I helped put my care and support plan together when I first came here" and "Staff ask me if I am okay and if I need any help with anything".

People received support and some received help with personal care, as they required it and in line with their plan of care. They said, "I am very well looked after here" and "I have no worries at all about being here, I like the staff and I can come and go when I please". We found that plans of care reflected peoples' care and health care needs and were reviewed regularly.

We found there were effective systems in place to reduce the risk and spread of infection and that staff followed good guidelines in their practice.

There were sufficient staff on duty to support people in the home and out in the community, where necessary. People received sufficient support from the staff on duty so their needs were met.

People told us they were listened to and changes were made as necessary to resolve any immediate problems but we saw no audit records or collations to show how overall changes to the service would be or had been made.

We found that people that used the service experienced an open and transparent complaint system, which they were happy to use. It meant they had their complaints listened to and resolved where possible.

We spoke with people that used the service about living at The Conifers and they told us they were fully included in their care and support.

People also told us their privacy and dignity was respected and that their personal life issues had always been respected and kept confidential.

People told us they were encouraged to maintain their independence whenever possible. They said their needs were well met and that staff supported them with any decisions or choices.

People said their health care needs had been monitored and that they saw health care professionals when they needed to.

People knew about their care plans and how to make a complaint if they had one.

People we spoke with told us they had good relationships with each other and the staff and felt safe living at The Conifers.

People told us they were satisfied with the arrangements in place to assist them in managing their finances and that they were satisfied with the way their medication was handled.