We inspected this service on 12 November 2018. The inspection was announced.

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 unders

The Conifers provides accommodation and support for up to twelve people with learning disabilities and complex needs. It is situated in a residential part of Rushden, close to local amenities. On the day of our visit, there were eight people living in the service.

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.

During our inspection in April 2014, we found that people were not protected from the risks of infection, as there were ineffective cleaning processes in place. Communal areas within the service, and people’s bedrooms had not been cleaned effectively. We found that cleaning within the service was not satisfactory or robust. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by 22 June 2015.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Conifers on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 25 June 2015.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that appropriate standards of cleanliness and hygiene had been maintained. New cleaning schedules had been implemented to ensure that cleaning regimes were effective. Staff had reviewed their practice in respect of cleaning, and had worked hard to ensure this was now more thorough.

We also reviewed the audit systems in place, which in the past inspection had failed to identify the issues we found in respect of poor hygiene. We found that these had been strengthened and had more managerial oversight which meant that any issues could be identified and addressed in a timely manner.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

The Conifers Residential Care Home is provides personal care and accommodation for up to 12 people who have learning disabilities. The home is located in a residential area of Rushden.

The inspection took place on 15 April 2015.

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.

At our previous inspection on 26 September 2014, we found that there were not always suitable arrangements in place to ensure that staff received appropriate training to enable them to deliver care safely. This was a breach of Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also found that people who used the service were not protected from the risks of unsafe care because the registered manager did not identify, assess or manage risks. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action to make improvements to staff training and quality assurance systems and to inform us when this was complete.

During this inspection we looked at these areas to see whether or not improvements had been made and we found that the provider was now meeting these regulations. However we also found that the home’s infection control procedure was not appropriately followed. Appropriate standards of cleanliness and hygiene of the environment were not maintained within the home.

We also found that records were not consistently well maintained in order to prevent people from the risks of unsafe care.

People told us that they felt safe and were protected by staff providing their care.

Staff were knowledgeable about the risks of abuse and there were suitable systems in place for recording, reporting and investigating incidents.

Risks to people’s safety had been assessed and provided staff with guidance to protect and promote people’s independence.

Staff numbers were based upon the amount of care that people required, in conjunction with their assessed dependency levels.

Robust recruitment policies and procedures were followed to ensure that staff were suitable to work with people.

Safe systems and processes in place for the administration, storage and recording of medicines.

People were supported by staff that had been provided with appropriate knowledge and skills to carry out their roles and responsibilities.

Staff knew how to protect people who were unable to make decisions for themselves. There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

People’s nutritional needs had been assessed and they were supported to make choices about their food and drink.

People’s health was monitored, so that appropriate referrals to health professionals could be made.

Staff were caring and ensured that people’s privacy and dignity was respected at all times. They enabled people to make choices about their care and daily lives.

People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon.

The service had an effective complaints procedure in place. Staff were responsive to people’s concerns and when issues were raised these were acted upon promptly.

The provider had internal systems in place to monitor the quality and safety of the service but these were not always used as effectively as they could have been.

You can see what action we told the provider to take at the back of the full version of the report.

Our inspection focused on how the people who lived at the home were involved in the planning and delivery of their care, their consent to treatment, safeguarding and how the Provider managed information.

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.

At the time of our visit eight people were living at The Conifers. We spoke with two people who told us they were happy with their support. One person told us that the staff were “good” and “helpful”.

There were 10 residents living at the service when we visited on 17 January 2012. We spoke with two residents and three members of staff to ask for their comments.

We observed residents relaxing in the lounge. We saw staff talking with people and saw that people looked content.

Because most of the people who live at The Conifers were are not able to tell us about their experiences we spent time watching people's state of well being and how they interacted with staff members and others.

Our inspection was carried out by one adult social care inspector who visited the service unannounced on 23 September 2014. This was a routine inspection; however we also wanted to check that the provider had made improvements to the arrangements for obtaining consent to care and treatment and safeguarding people from abuse. We had asked them to make the improvements following our inspection on 10 December 2013.

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.