This inspection took place on 3 and 4 May 2017 and was unannounced. At our last inspection in May 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The Conifers Nursing Home is a home for older people who are in need of nursing care. It provides accommodation to a maximum of thirty people some of whom are living with dementia. At the time of our inspection there were 29 people residing at the home.

There was a registered manager in post. 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 they were well treated and felt safe with the staff that supported them.

Risks to people’s safety had been identified and ways to mitigate these risks had been recorded in their care plans and were understood by staff.

Staff were aware that the people they supported were vulnerable and they understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff turnover was low and staff were positive about working at the home. Staff told us they appreciated the support and encouragement they received from the registered manager.

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.

People told us they enjoyed the food provided and we saw that they were offered choices of what they wanted to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes.

Both people using the service and their relatives told us they were happy to raise any concerns they had with any of the staff and management of the home.

People were included in monitoring the quality of the service and records showed that their suggestions for improvements and preferences about how they wanted to live their lives were respected and acted on.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with three persons who used the service and five family members. We spoke with two nurses, a care worker, office manager and the maintenance supervisor. We also spoke to the manager of a Continuing Care team from the local Clinical Commissioning Group and three social workers. We looked at six care records and seven staff records.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. We were told that there was a member of staff on duty during the day whose sole responsibility it was to ensure that those people who were more frail had sufficient liquids and that they were turned in their beds as scheduled. A person who used the service told us how “staff here make me feel safe. When I lived alone I was always afraid.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People we spoke with told us that they were happy with the care they received and felt their needs were being met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and had a good relationship with them. We saw where a person was able to leave the building that there were clear instructions written outlining measures to be taken to maximise their independence and to ensure their safety. A relative told us how “the staff adapt to my relative’s particular personality traits which helps them to be more a part of the activity.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We saw how when a person was fed by a care worker they had created an atmosphere of calm and intimacy in the person’s room. We noted how nursing staff maintained frequent contact with the relatives of a person who was too unwell to be in the home at that time. One person who used the service told us how “you could not get better care, the staff here are so lovely and kind to us all.” A family member told us that they could visit the service at any time and this made them “feel welcomed and close to my relative.”

Is the service responsive?

Records confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. A care worker told us how, when a person had lost the ability to communicate in English, they had learned some words in what was now their first language from family members in order to communicate more effectively. We saw that care plans were amended in line with the persons changing needs. A social worker we spoke with told us how “staff are very responsive to any of my enquiries, they always return my calls.”

Is the service well-led?

Staff had a good understanding of the ethos of the home and they told us they were clear about their roles and responsibilities. Quality assurance processes were in place and people were encouraged to fill in comment cards. Relatives told us they were frequently asked for their views on the quality of the service provided. A care worker told us how their work was closely supervised by nursing staff and that “the manager is always very available for support.” We spoke with a manager of a Continuing Care team from the local Clinical Commissioning Group. They told us how “the manager will always raise concerns about patients with us. They are very open and transparent.”

We found that people gave their consent verbally, in writing and with the assistance of people significant to them where necessary. One person told us “they ask permission before giving care and it is OK to refuse”.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The staff, manager and provider were praised by relatives. One person we spoke with told us, “staff are so friendly; it’s like a big family.”

Records showed that equipment was regularly maintained and serviced. People told us that the equipment was suitable for their needs and was kept clean.

Staff were supported to enable them to deliver care to people to an appropriate standard. We saw records and were told by the provider and staff that some staff had received training and had regular supervision sessions but had not received annual appraisals.

People who use the service and their representatives were asked for their views about their care and treatment by the service. Records showed that some audits had been made by the provider which led to improvements.

This inspection took place on 12 and 13 May 2015 and was unannounced. At our last inspection in June 2014 the service met all the standards we looked at.

The Conifers Healthcare Limited is a home for older people who are in need of nursing care. It provides accommodation to a maximum of thirty people some of whom have dementia. The service is a family run business and two of the family members work full time at the home.

The majority of people using the service have very complex care needs and are highly dependent on the staff to provide them with appropriate care.

The registered manager had recently left the home after many years working there and we met with the acting manager who was in the process of registering with the Care Quality Commission. 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.

People told us they felt safe at the home and safe with the staff who supported them. They told us that staff were patient, kind and respectful.

People and their relatives said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance when they used the call bell.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought out and recorded how these risks could be minimised.

Most staff understood the principles of the Mental Capacity Act 2005 (MCA) however not all staff had undertaken training in this important aspect of people’s care. Staff told us they would presume a person could make their own decisions about their care and treatment. They told us that if the person could not make certain decisions then they would have to think about what was in that person’s “best interests” which would involve asking people close to the person as well as other professionals.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians. We spoke with a healthcare professional who visited the home on a regular basis. They were positive about the service manager, acting manager and staff at the home.

Food looked and smelt appetising and the cook was aware of and provided any special diets people required either as a result of a clinical need or a cultural preference.

People told us they liked the staff who supported them and staff listened to them and respected their choices and decisions.

People using the service and their relatives were positive about the service manager and acting manager. They confirmed that they were asked about the quality of the service and had made comments about this. People felt the service took their views into account in order to improve service delivery.