Conifer Lodge is registered to provide personal care and accommodation for up to 26 people. It specialises in providing support of older people. On the day of the inspection there were 21 people using the service some of whom were living with the early stages of dementia and other health care conditions such as heart disease and diabetes. The service is made up of three combined properties over three floors. Some rooms at higher levels were accessed by a stair lift and some were only accessed by stairs making them unsuitable for some people with mobility difficulties. There was level access throughout the ground floor and to a secure rear garden. This comprehensive inspection took place on the 29 September 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.
At the last comprehensive inspection in 8 July 2015 we identified there was a quality assurance system in place to monitor quality and identify areas for improvement. However this did not include the auditing of care plans. We identified this as an area of practice that needed to improve. At this inspection we identified that a care plan audit had been introduced, but this had not been consistently completed and had not always been effective in identifying shortfalls and bringing about improvements.
At the last inspection we identified that staffing levels were not systematically being reviewed and assessed to determine whether they were sufficient to meet people’s needs and this needed improvement. At this inspection people’s dependency levels were being assessed, however this had not happened as often as the provider required and staffing levels had not been reviewed in line with the providers own protocol. Therefore the provider could not be assured the staffing levels were sufficient to provide responsive care.
At this inspection we identified a range of shortfalls in relation the administration of medicines and the completion of the associated medicine administration records. Audits of medicines and medication records had not been completed on a monthly basis as the provider required and the audits that had been completed had not been effective in identifying shortfalls. Therefore opportunities to identify and rectify shortfalls in the administration of medicines and drive improvement had been missed.
At the last inspection assessed improvements were needed in relation to providing and recording people’s involvement in meaningful activities. At this inspection we identified that improvements had been made.
At the last inspection we identified that the risk of people falling had not been assessed and was an area of practice that needed improvement. At this inspection we identified this had been addressed.
People were supported to live the life they chose and their freedom was not restricted. There was a positive approach to risk taking and people were encouraged to remain independent and we observed people coming and going throughout the day going about their own business. One staff member told us, “We let people live their lives here”. Another staff member said, “If someone wants to do their own thing, like go out, we don’t stop them”.
There was an hour’s daily activity on offer each afternoon such as a quiz, baking or general discussion between people. Entertainers such as musicians and singers also visited the service and occasional trips out were organised. There were regular visits to the service by the local church and people had the opportunity to go on bus trips organised by an external provider.
People were supported to eat and drink sufficient amounts and they told us they enjoyed the food provided. Special diets were catered for and drinks and snacks were freely available throughout the day. People were provided with appropriate levels of support at meal times.
People’s privacy was protected and people were treated with dignity and respect by kind and caring staff. One person told us, “The care staff are very good, I‘m quite content here”. Visitors were welcomed and people had the opportunity to attend meetings at which they could give their views on the running of the service and make suggestions for improvements. People were able to personalise their rooms and bring their own furniture and one person had brought their pet budgies when they moved in.
People’s health care needs were met and professional advice and support was sought from health care professionals such as GP’s and district nurses as and when needed. People were supported by competent staff who received the training and support they needed to undertake their role and effectively meet people’s needs. One person told us they were happy with all the staff and felt a particular member of staff was, “Very efficient”. Another person told us they received the support from staff that they needed and commented, “(Staff members’ name) knows what I like and knows what I need”.
Measures were in place to reduce the risk of harm occurring and protect people from abuse. Accidents were recorded, collated and analysed to identify themes and trends so that the provider could take steps to reduce the risk of reoccurrence. Staff understood the need to gain consent and worked in accordance with the Mental Capacity Act (MCA).
There were processes in place for complaints to be responded to. People told us they would speak with the registered manager or a member of the care staff team if they had any concerns or wanted to make a complaint and one person commented, “They listen to me”.
Recruitment procedures were robust and included identity and security checks were completed before staff were deployed. All new staff completed an induction to the service and were introduced to people before they worked unsupervised.
People and staff felt supported by the management. The registered manager was aware of their legal responsibilities and kept up to date with good practice by attending management meetings with the area manager and other registered managers and providers of other services.
There were two areas where the provider was not meeting the requirements of the law. You can see what action we have asked the provider to take at the back of the full version of this report.