Conifers is a residential care home registered to provide accommodation and personal care for up to six people who have a learning disability. There were six people living at the service on the day of our inspection.

The inspection took place on 9 May 2017 and was unannounced. The last inspection of this service took place in March 2015 and at that time the service was rated as good.

At the time of inspection there was a registered manager in post who was also the registered provider. 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 service was managed by the registered manager, a deputy and a trainee manager who all shared responsibility for running the service on a day to day basis.

At the previous inspection we found that the registered manager had not met the requirements of the Deprivation of Liberty Safeguards (DoLS). At this inspection we found there was still a lack of understanding around DoLS. We made a recommendation that the provider take the necessary steps to increase their knowledge and make the necessary DoLS applications to ensure people were not being deprived of their liberty unlawfully.

People were safe at Conifers. Risks to people were managed safely and positively which ensured people received safe care that met their needs whilst at the same time allowing them to exercise choice and control.

Staff were aware of their whistle-blowing and safeguarding responsibilities. They knew the signs to look for that might indicate that people were being abused and who to report any concerns to.

Medicines were managed safely by staff who were trained and assessed as competent to give medicines safely.

Systems and processes were in place to ensure the safe recruitment of staff with sufficient numbers of staff deployed to meet people’s needs safely.

People were supported to make choices about how they wanted to live their day to day lives including exploring interests and maintaining relationships that were important to them.

Staff felt well supported by the management team who were accessible and listened to them. A regular programme of training was provided with opportunities for specialist training relevant to meeting the needs of the people who used the service.

The service supported people to have enough to eat and drink which reflected their preferences and helped them maintain a healthy balanced diet.

People’s health and wellbeing was maintained. Staff worked with healthcare professionals and were pro-active in referring people for assessment or treatment. The service kept detailed health records and shared this information appropriately with the relevant health and social care professionals. This meant that people’s health was closely monitored to ensure they received any treatment they required in a timely fashion.

Staff had formed positive relationships with people who used the service. People’s privacy and dignity was respected at all times and people were treated with kindness and respect.

People were supported by a longstanding and stable workforce who knew them well and promoted their independence.

The care and support people received was personalised and met their individual needs and preferences. People, or their representatives, were involved in making decisions about how the support was delivered so they felt listened to and included.

The registered manager was held in high regard by people, relatives and staff who all felt included in the running of the home.

There was an open culture and the provider encouraged and supported staff to provide care that was centred on the individual.

There were systems in place to ensure the quality and safety of the service and respond appropriately to c

During our inspection on 08 January 2014, people we spoke with told us they enjoyed living at the home. One person told us: “I like it here.”

We saw evidence from the records we looked at that people received the support they needed to maintain their independence.

Our observations showed us that staff supported people in a patient and sensitive way. We saw that staff had a good understanding and awareness of people’s care needs and preferences, and were enthusiastic about providing a good quality of service to people who lived at the home.

The care records we reviewed included detailed information on how people’s needs were to be met by staff. Staff told us people enjoyed their independence and going out.

People lived in an environment that was secure and maintained. The service co-operated with other agencies, such as community healthcare services and the NHS, to ensure people received continuity of care and support when they needed to access other services.

There were systems in place to recruit staff safely and provide them with the training they needed. This ensured that they had the skills and knowledge to provide safe and effective care. We found that the provider had systems in place to monitor and respond to any complaints received by the home.

Most people using this service were unable to verbally tell us what they thought about the service due to their complex care needs. We met with four people residing at Conifers and two people were able to confirm that they were happy, that staff treated them well and that they felt safe. We sat in the lounge area for 45 minutes and observed that people seemed relaxed and comfortable. We saw that people were able to make choices about where to spend their time and the activities they wanted to be involved in.

We looked at satisfaction surveys completed in December 2012 by three relatives of people who use the service. They had all recorded positive comments about the quality of the care and support provided at Conifers Residential Care Home. Comments included “There is a homely atmosphere" and "Staff are sensitive to my relative's needs". One relative praised the number of activities on offer and another commented on the "Good consistent care."

Most people using this service were unable to verbally tell us about their experience of the care living at Conifers Residential Care Home due to their complex care needs. Some people were able to confirm they liked living at the home, that they liked their room, they liked the staff working at the home and that they could make choices about how they spent their time. We saw that people were able to make choices about where to spend their time and the activities they wanted to be involved in.

The owner's satisfaction surveys completed by relatives of people who use the service in December 2011, recorded positive comments about the quality of the care and support provided at Conifers Residential Care Home. Comments included “They treat everyone as part of a family”, “Conifers not only makes the residents feel at home but also the visitors. We are always given a warm welcome and made to feel at home” and “Our relative is a happy person and we think that no where else could have provided better.”

The inspection took place on 18 and 24 March 2015 and was unannounced. Conifers - Residential Care Home For People with Learning Disabilities provides accommodation and personal care and support for up to five people, some who may have a mental health need. At the time of our inspection there were five people who lived in the service.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People at the service were safe. Risk assessments were carried out and staff had detailed guidance on how best to manage and minimise any risk identified. There were sufficient staff to meet people’s needs. Recruitment processes were robust and staff had received the required training to meet the needs or the people they were caring for.

The manager and staff had some understanding of the Mental Capacity Act (MCA) 2005 and of the Deprivation of Liberty Safeguards (DoLS); however they had not always applied the Act effectively. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals; however DoLS referrals had not always been made, as required.

People were supported to have a balanced diet and to give their views and make choices about the food and drink on offer. People were supported to maintain good health and wellbeing, and to access health and social care support as required. Medications were stored safely and people received their medicines as prescribed.

The service had a calm atmosphere and focused on ensuring people were treated kindly and enjoyed their lives, in privacy and dignity. Staff knew the people they cared for well took their views into consideration.

Care was provided in a personalised way which met individual needs. People engaged in meaningful activities of their choice and were encouraged to keep in contact with family members and other significant people in their lives. People were involved in making decisions about their care and were encouraged to share their views. The service had an effective complaint system.

The manager was visible and promoted a positive culture with a focus on people’s overall wellbeing. There were quality assurance systems in place and audits were used to inform ongoing improvements in the service. The service welcomed feedback and used this to make improvements and develop the service.