This inspection took place on 10 February 2015 and was unannounced.
The last inspection of Coniston House took place on 19 March 2014. At that time we found inconsistencies in care planning and suitable arrangements were not in place to safeguard people against the risk of abuse. We deemed this to have a minor impact on people. We asked the provider to take action to make improvements in care planning and safeguarding procedures. We received an action plan, in which the provider said they would meet the relevant legal requirements by May 2014 . This action has been completed.
Coniston House is arranged over two floors, with each floor having bedrooms, bathrooms and a communal lounge and dining room. All bedrooms have en-suite facilities consisting of toilet and washbasin, with some also having a shower. There are gardens and a patio area with seating. The home is registered to accommodate 43 people. At the time of our inspection 39 people lived at the home.
The home is required to have a registered manager in place. 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 last inspection on19 March 2014 no registered manager was in place. In July 2014 a new manager was employed. This person’s application was accepted and a certificate issued on 24 December 2014.
People we spoke with all told us that they received their medication when they should. Staff administered medicines in a safe, kind and patient way. We saw that medicines were stored safely in medicine trolleys within a locked medicine storage room. However we had concerns over the access to this room. Some medication had gone missing. We also found gaps in some medicine administration records and the instructions for when people received ‘as required medicines’.
People we spoke with and their relatives told us that they felt safe and in a protected environment. Staff had received training in the protection of adults and policies and procedures in line with local guidelines were in place.
Robust systems were in place in terms of recruitment. A full range of background checks including references and Disclosure and Barring Service (DBS) checks had been completed. The DBS checks to see if there is any criminal or other reason why a person should not be employed to work with vulnerable people.
People who lived at the home and relatives we spoke with all told us they thought there were enough staff to meet people’s needs and keep them safe from harm. Staff rotas and our own observations confirmed this.
People we spoke with who lived at Coniston House told us they felt that staff knew them well and were able to access health and medical support as they needed it. Staff we spoke with were knowledgeable about the people they supported.
Staff had been supported to undertake a range of induction and basic training such as moving and handling, food hygiene and infection control. However staff we spoke with had not received training on the Mental Capacity Act 2005 (MCA) and the deprivation of Liberty Safeguards (DoLS). Whilst staff were witnessed to put the principles of the MCA into practice, their knowledge of what they were doing and why was limited.
Care plans we looked at showed people had been involved in planning their care and had given valid consent. Where people were unable to do so, we saw that their relatives had been involved in these discussions. We saw that all aspects of the recording and filing of DoLS applications and subsequent authorisations was good.
Staff we spoke with gave us mixed messages about staff supervision. We were unable to see any records that staff had received regular one to one supervision and appraisal during our time at the home. However we were provided with records which showed many people had received such support.
People who lived at Coniston House told us that they enjoyed the food in the home and that there was sufficient choice of nutritious food. We found the atmosphere in the dining room was calm and relaxed. Where people needed assistance this was done in a kind and unhurried manner.
People who lived at Coniston House and their relatives spoke well of the staff at Coniston House. Interaction between people who lived at the home and members of staff were seen by us to be respectful, kind and caring. People were treated with dignity and respect.
We found pre-admission assessments for people were of a good quality and consistent. Care plans we looked at contained details of personal information including people’s history and background. We found them to be personalised to each individual. Each care plan contained a range of risk assessments which explained the risk how staff should monitor and deal with each risk.
There was no restriction on visiting and contact with friends and relatives. We saw no organised activities during our inspection and the activities coordinator had recently left. However the home was actively recruiting someone to fill this post. We observed that staff had little knowledge on how to engage or interact with people who lived there to entertain them.
The home had policies and procedures in place to handle and deal with any complaints. There was information available to people on how to complain if necessary and people we spoke with knew how to make a complaint.
People who lived at Coniston House and their relatives were aware that there had been a number of changes in staff, both at management level and staff on the floor. They told us the new manager was approachable and supported the changes which had been made.
Staff we spoke with told us they felt happier and that there was now a better atmosphere. Staff told us they attended handover meetings at the start of every shift and regular staff meetings were held.
Regular audits and checks were carried out by the registered manager and other members of the management team for the home. We saw a system in place for the registered manager to monitor the response times when people used their call bells and a new medication audit tool had just been introduced.
We saw records of fire equipment, emergency lighting, water temperatures and the electrical system being checked. The home was also subject to internal inspections and audits by the family members of Rochcare (the parent organisation for the home), for instance the regional manager visited the home on a frequent basis.
We found that [the registered person had not protected people against the risk of people receiving their medication in a safe manner. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 (1)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of the report.