About the service: Conifers nursing home is a nursing home registered to provide accommodation for up to 55 people who require nursing or personal care. At the time of the inspection there were 54 people living there many of whom were living with varying stages of dementia and behaviours which may challenge.

People’s experience of using this service:

The service met the characteristics of good in all five key questions. Therefore, our overall rating for this service is good.

People and their relatives told us they felt safe and were happy living in the home. The provider had effective safeguarding procedures. Staff had a good understanding of abuse and felt confident raising concerns.

We found both environmental and individual risk assessments were comprehensive and provided guidance for staff to keep people safe.

Staffing levels were appropriate and staff were competent. The provider followed safe recruitment systems

Medicines were managed safely and the registered manager made sure staff were competent to administer medicines.

Staff received training in infection control and followed procedures to reduce risks for people.

People’s plans of care were comprehensive and centred around them. Staff regularly reviewed people’s planned care and involved external professionals when necessary. People's health and wellbeing was well documented.

Staff told us they had an appropriate induction and had received appropriate training to confidently carry out their role. People told us they had a choice of meals and we saw that people were regularly offered drinks to prevent dehydration.

Staff had appropriate knowledge of the Mental Capacity Act (2005) and appropriate Deprivation of Liberty Safeguards applications had been made. We observed staff gained consent from individuals.

Staff were caring. We saw positive interactions between staff and service users. People were treated with dignity and respect.

People had access to meaningful activities.

Families knew who to speak to if they had a complaint and felt able to express concerns to staff.

The registered manager carried out audits and managed accidents and incidents appropriately. The registered manager was keen to develop her practice further and promoted an open culture within the service.

Rating at last inspection: Good (12 January 2018)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 6 and 14 November 2017 and was unannounced on the first day.

Conifers Nursing Home is registered to provide accommodation for up to 55 people who require nursing or personal care. The service supports older people with dementia nursing needs. Accommodation is provided over two floors with a passenger lift for access between floors. There are two lounges and dining areas, a smaller quiet lounge and a conservatory to the rear of the property. At the time of our inspection 52 people lived at the home.

There was 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 the last inspection the service was rated Good. At this inspection we found the service remained Good.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with four people who lived at the home. They told us they were happy and supported by staff who cared for them and treated them well.

People visiting the home told us they were made welcome by friendly and caring staff and had unrestricted access to their relatives. They told us they were happy with the care provided and had no concerns about their relatives’ safety.

Staffing levels were sufficient to ensure people received the care and support they required. We observed staff responded quickly when people required assistance and showed genuine concern for their wellbeing.

Staff had received training to safeguard people who may be vulnerable from abuse. The service had systems in place to identify, record and report any accidents or incidents and take action to address these.

Risks assessments were used to identify and minimise the potential risk of harm to people who used the service and staff. These were kept under review to ensure they were up to date and accurate.

Recruitment procedures were robust to ensure only suitable staff were employed. Staff received appropriate training and support in order to ensure they had the skills and knowledge to support people safely and effectively.

The service had systems in place to ensure medicines were managed safely. Staff ensured people received their medicines as prescribed.

People’s independence was promoted as far as possible and people were involved in making decisions about their care. Staff treated each person as an individual and worked to promote dignity and respect.

The building was purpose built, with facilities that were appropriate to the care being delivered. The building was clean, hygienic and maintained. It was a safe place for people to live. Equipment had been serviced and maintained as required.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The Chef had information about people's dietary needs and these were being met.

The service supported people’s involvement in activities within the home as well as organising trips out to local events and attractions. This helped to maintain people’s social health.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and relative meetings to seek their views about the service provided.

The inspection visit took place on 29 September 2015 and was unannounced.

The Conifers is a purpose-built care home situated in the rural village of Hambleton. The home is located in a quiet cul-de-sac within its own grounds. The home provides nursing and dementia care for 55 people. The accommodation comprises of 47 single and four double rooms, many which have en suite facilities. There are communal lounges and dining areas. A passenger lift is available. There is a large parking area to the front of the home, and rear safe garden area. At the time of the inspection 52 people were living at the home.

There was 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 the last inspection on 06 May 2014 the service was meeting the requirements of the regulations that were inspected at that time.

Some people had complex needs and were not able to tell us about their experiences. However comments from people we spoke with told us they felt safe because there were sufficient staff on duty to meet their needs. We found people’s care and support needs had been assessed before they moved into the home with risk assessments in place to ensure peoples safety. Care records we looked at contained details of people’s choices, personal likes and dislikes.

Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. One staff member said, “We have had safeguarding training recently which is regularly updated.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action when required.

We observed medication being administered in a safe manner. We looked at how medicines and controlled drugs were managed. We found appropriate arrangements for their recording and safe administration.

People were happy with the variety and choice of meals available to them. During the day we observed drinks being served as and when people who lived at the home requested them. The cook had information about people’s dietary needs and these were being met. One person who lived at the home said about the quality of food, “Great food and always plenty of choice.”

We found examples where the service had responded to changes in people’s care needs. We found evidence in records where referrals had been made to external professionals. Records were up to date and reviewed providing information for staff to deliver quality care.

People who lived at the home were encouraged and supported to maintain relationships with their friends and family members.

The area manager and registered manager used a variety of methods to assess and monitor the quality of the service. These included annual satisfaction surveys and regular auditing of the service to monitor the quality of care being provided. We found people were satisfied with the service they were receiving.

During our inspection we looked at the way people were cared for, the safeguarding arrangements in place, staff recruitment, the way staff were supported, the number of staff on duty and quality monitoring systems. We spoke individually with three people living at the home, five relatives, three members of the care staff team, the registered manager, and deputy manager. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

From our observations people appeared relaxed and secure. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw that people were treated with respect and dignity by the staff team and their rights protected. The deputy manager set the staff rotas. The assessed needs of people were taken into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Systems were in place to make sure that any lessons were learned from events such as accidents, incidents, complaints or concerns. This reduced the risks to people and helped the service to improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded as required.

Recruitment practices were in the main safe and thorough. This made sure that only appropriate people that had been properly vetted were appointed.

It the service effective?

There was an advocacy service available if people needed it. This meant that when required, people living at the home or their relatives could access additional support. The people we spoke with and the relatives we spoke with told us that they were pleased with the level of care that was being delivered in the home.

From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. One person told us, “It is champion living here, it is very good”. A relative said, “The staff show a lot of care, patience and dignity. They are always trying to look at each person as an individual rather than looking at everybody together. I have recommended here to a lot of people”.

People’s health and care needs had been assessed and the individual or their family were aware of the care being delivered. However not everyone had seen or had been given opportunity to agree to the content of the initial care plan. Although no concerns at all were expressed about the level or type of care being provided, there was never the less potential for care to be delivered in a way that did not meet the expectations of the individual.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. The relatives we spoke with also said that they had good communication with the staff team and were always informed of any changes or concerns.

Is the service responsive?

People living at the home and/or their relatives knew how to make a complaint if they were unhappy about anything. However nobody we spoke with expressed any concerns. One person told us, “I come here most days at different times of the day. I have never witnessed anything to cause concern. Staff always respond very positively in a calm, relaxed and no pressure way”.

The registered manager and deputy manager worked alongside staff on a daily basis. This meant that the care and support provided by the staff team was continually monitored so that immediate action could be taken if there was any concern.

People enjoyed a range of activities suited to their needs and abilities both in and outside the home. The building and grounds were arranged so that people could move about freely whilst still maintaining a safe environment. One relative told us, “I like the way I can access the building and take ***** out into the garden. By giving us the key pad code ***** is not aware that there is key pad in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience, humour and gave encouragement when supporting people. A relative said, “The staff excel, they are very kind and very, very good”. Another relative told us, “All the staff have been brilliant, they do everything well. **** is very well cared for”.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s preferences. This helped to make sure that people were provided with an individualised service that met their specific requirements.

Relatives and where appropriate people living at the home, had been provided with satisfaction surveys twice a year. We viewed the outcome of the most recent survey. Outcomes were positive. Action would be taken to address any concerns expressed.

Is the service well-led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. All health care related visits had been recorded including the reason for the visit and the outcome. This provided a clear audit trail.

Staff had a good understanding of the ethos of the home and quality assurance systems that were in place. This helped to ensure that the quality of the service was continually improving. Relatives spoken with and one person living at the home told us that they felt listened to and that staff were attentive to their wants and wishes. This helped to ensure that people received a service that met their requirements.

Staff told us that they were clear about their role and responsibility and that they felt well supported by the management team. Staff confirmed that communication within the staff team was positive and that good supervision arrangements were in place. We were also told that staff team worked well together for the benefit of the people living at the home.

A range of routine audits were in place including care plans, risk assessments and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

We spoke with a range of people about the home. They included the registered manager and deputy manager, staff members some people who lived at the home and a number of visitors. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at The Conifers Nursing Home.

People living at this home had a range of dementia conditions. This meant communication was limited. However, we used an inspection method available to us called SOFI (Short Observational Framework for Inspection). We decided to use this process as it provided us with information about the needs of people who may be confused or do not use words to communicate directly with us. By using this method we were able to gain a more accurate view of what interaction people were receiving from the staff team.

We were able to speak with a number of visitors during the day of the inspection about their relatives care and support. They told us they were very satisfied with the care their relatives were receiving. Comments included, “I couldn’t thank the staff enough, they are absolutely fabulous. I know when I walk away my relative is getting the best care”. Also, “Staff are always around and I come at various times. You cannot fault the care anybody receives here”.

In order to gain a general overview of how care was being delivered around the home, we spent time in all the communal and dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

Relatives we spoke with told us they could express their views and were involved in decision making about their relatives care.

During this unannounced inspection we talked to two people who used the service, two family members and two staff. People who used the service told us they had been consulted with and agreed to their care and treatment. Two people who used the service told us, "They talk to me about my care and you can be sure if I don’t like it I tell them" and "I chose here myself. I had been in hospital and knew of the home and some of the staff so I wanted to come here. They are here to look after me. I give my consent to what they do". A visitor told us, "They keep us informed of what is going on. They talk to us about mothers care". People were consulted and agreed to their care to ensure their wishes were taken into account.

Plans of care contained sufficient detail for staff to deliver good practice.

People who used the service told us, "I like it here. I am very happy", "I prefer here to the last home I lived at" and a visitor said, "We are impressed with the home. Mother was a nurse and she likes it here". People told us they liked living at The Conifers.

Many people who used the service told us they enjoyed the meals and could have a choice of where they ate or sat. People who lived at this care home were provided with a nutritious and varied diet.

Two people who lived at the home and two visitors told us they felt able to raise any complaints if they wished.

We visited this home unannounced on Wednesday 25th January 2012. During the course of the site inspection we spoke individually with the registered manager, two deputy managers, five people living at the home, seven visitors, two qualified members of staff and a number of care assistants, as well as ancillary staff. Short informal chats also took place with some other residents and members of staff throughout the course of the day. We found people we spoke to were very welcoming.

A large number of people living at this home are affected by a range of dementia conditions. This affects how they can communicate. For this reason we spent a lot of our time at the home in various communal areas, so we could observe how the home is operating and how staff communicate and help people.

People we spoke to told us they like living there, comments included, "Oh yes everybody is very helpful,” and, “It’s always busy, there’s always something going on.”

In addition to gaining the views and comments of people experiencing the service, we asked other external agencies including social services contracts team. They told us there has been some involvement with the service and the manager worked closely with social services to address some concerns raised. The infection control practitioner told us the home is compliant with their standards.

We spoke to a range of staff working in the home and they all demonstrated an awareness of individual nursing needs of people living there. They also spoke of the importance of treating people with respect and dignity. A relative told us, "They are very good in general, always around if you need them.”

All the staff we spoke to told us this is a good care home to work for and staff felt supported in carrying out their roles. Members of staff we spoke to said, "I feel really supported by all the managers.” Also, "Its all about working as a team.”