This inspection took place on 2 October 2018 and was unannounced.

This is the first time the service has been rated Requires Improvement This was the second comprehensive inspection carried out at Conifer Lodge Residential Home, the last inspection in March 2016 was rated Good.

Conifer Lodge Residential Home 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 home accommodates up to 20 people in one adapted building. On the day of our visit, there were 18 people using the service.

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 and associated Regulations about how the service is run.

The provider had not ensured there were sufficient processes in place to assess, monitor and to maintain the health, safety and welfare of service users. The provider had not carried out environmental audits to identify where repairs and maintenance were required. People living with dementia were at potential risk of harm due to access to the stairs, lift and hot radiators.

We made on recommendation relating to creating a dementia friendly environment.

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. Staff had a good understanding of people's needs and preferences.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People could be assured there were enough trained staff to meet their needs and staff received the support they required to carry out their roles. Safe recruitment processes were in place.

People could be confident their complaints would be responded to appropriately.

People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to be involved in their care planning and reviews. Their care and support was delivered in the way that people chose and preferred.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

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 support this practice. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

At this inspection we found that Conifer Lodge Residential Home were in breach of two regulations relating to safe care and treatment and governance of the home.

Further information is in the detailed findings below.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Conifer Lodge Residential Home on our website at www.cqc.org.uk

This was an unannounced comprehensive inspection that took place on 29 March 2016.

Conifer Lodge Residential Home is a care home registered to accommodate up to 20 people who are aged over 65. People may also have a physical disability, a sensory impairment, be living with dementia or have a diagnosis of mental ill health. The home is located on two floors, with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 20 people were using the service.

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.’

People told us that they felt safe when staff supported them and that they enjoyed living at Conifer Lodge Residential Home.

Risk assessments were in place which described how to support people in a safe way for most identified risks. We found that there were some risks that had not been fully assessed. Where people displayed behaviour that challenged techniques for staff to support the person to manage this behaviour were not recorded. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

The provider carried out checks before staff started to work at the service, however had not completed these checks fully for all staff. Information about staff's previous work history had not been recorded through obtaining at least two references for each staff member.

People received their medicines at the right time from staff who were trained and assessed as competent to administer medicines. Temperatures were not checked regularly where medicines were stored.

Staff were supported through training and supervision to be able to meet the needs of the people they were supporting. They undertook an induction programme when they started to work at the service.

Staff sought people’s consent before providing personal care. People’s capacity to make day to day decisions had been considered in their care plans however assessments of a person’s capacity to make a specific decision had not always been completed.

People were supported to maintain a balanced diet. People were supported to access healthcare services.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity. Staff understood people’s needs and preferences.

People were involved in decisions about their care. They told us that staff treated them with respect.

People were involved in the assessment of their needs. People and their relatives were involved in the review of their needs.

People were supported to take part in activities that they enjoyed.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

The service was well organised and led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

People were asked for their feedback on the service that they received. The provider carried out some monitoring of the quality of the service.

We spoke with two people who used the service and relatives of three other people who used the service. All of the people we spoke with made positive comments about the service. One person who used the service told us, "I like it here because there is no hard and fast regulation." Another told us, "I like it because you can have a laugh and a talk." A relative told us, "It's a homely service, relaxed and not regimented." Another relative said, "There is no sense of institutionalisation here." Our own observations were that the home had an informal and friendly atmosphere added to by staff who were cheerful and friendly.

Relatives told us they were satisfied with the care that had been provided to their family members. One told us, "The care has been excellent. My mother has been very well cared for. She has done well only because of the loving care she has received." Another relative said, "I wouldn't want my mother anywhere else." Both relatives told us that they had been involved in decisions about their respective parent's care. Both told us that they knew how to raise any concerns and were confident that the home would respond to what they said. What people told us reinforced what we saw in responses that people had made to a recent satisfaction survey.

We found that people's needs had been assessed and that staff had received appropriate training and support to be able to meet people's needs. The home was safe and well run.

We spoke with three people who used the service and a relative of another person who used the service. We also spoke with a health professional who visited the home on the day of our inspection. Everyone we spoke with was complimentary about the home. People told us that they had been well cared for, that staff were friendly, that they had enough to do to keep occupied and that they felt safe at the home.

One person who used the service told us they had been able to spend time how they wanted and were aware of activities that they could join in with if they wanted to. They told us that they were comfortable at the home and liked the room they occupied. They told us, "The staff are polite and friendly, I get the care that I need." Another person told us, "I'm definitely well looked after. The staff are very good, very polite, we have a laugh together." Another person told us, "I'm very well looked after. I'm happy here. The staff are marvellous." A relative told us, "I've been involved in discussions about my mother's care and I'm confident that she is getting all the care she needs. " The relative added that staff were alert to changes in people's health and that, "Staff do a lot to keep my mother stimulated. I know I can raise any concerns and I am confident my mother is safe here." A visiting health professional described the care people were receiving as "excellent."

During our previous review of Conifer Lodge in November 2011 we spoke to some of the people who used this service. They told us that they were satisfied with the service they received. They felt that staff responded to their needs promptly and they appreciated the friendly and welcoming atmosphere.

People told us that they were satisfied with the service provided at Conifer Lodge. They felt that staff responded to their needs promptly and the appreciated the friendly and welcoming atmosphere.