About the service:

Coniston Lodge Nursing 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 service provided both nursing and personal care and is registered to care for up to 92 people. At the time of our inspection, 48 people were living at the service. The majority of people were over the age of 65 years and some people were living with the experience of dementia. The service is owned and managed by Bondcare (London) Limited, a private organisation.

People’s experience of using this service:

People living at the service sometimes had to wait for care and support, because there were not enough staff deployed to meet their needs. People had to wait for support with personal care and assistance with meals.

Medicines were not always being managed in a safe way, and some people had not received their medicines as prescribed.

People were not always treated with dignity, respect or kindness. We witnessed interactions which were task based and some which caused people distress and discomfort. The staff supporting these people did not demonstrate an understanding of the person's perspective, nor did they offer comfort or reassurance.

People did not always receive personalised care which met their needs or reflected their preferences. There were not enough social activities or ways for people to spend their time.

The provider's systems for identifying and improving the quality of the service were not always operated effectively. Whilst we found improvements in some areas, these were not sufficient. The provider remains in breach of five Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations relating to person centred care, dignity and respect, safe care and treatment, good governance and staffing. The provider has been in breach of four of these Regulations since we first inspected the service in February 2018.

Notwithstanding the above, people using the service, their visitors and staff spoke positively about their experiences. People told us the staff were kind to them and the staff said they enjoyed working there and caring for people.

There had been improvements at the service, including the introduction of an electronic care planning system which allowed the staff to spend less time on paper work and more time with people using the service.

The provider had shown a commitment to making continuous improvements. Senior managers regularly spent time at the service monitoring this and providing support. There had been increased staff supervision and training, in order to enable them to develop the skills they needed to care for people. The provider's representative contacted us after the inspection visit to let us know about more training they were arranging following the feedback of our findings.

The environment was safely maintained and risks to people's safety and wellbeing had been assessed and planned for. The provider had responded appropriately to safeguarding allegations and worked with other professionals to protect people from the risk of abuse or harm.

People's healthcare needs had been identified and plans described how people should be cared for in respect of these. The staff worked closely with other healthcare professionals and made appropriate referrals when people's needs changed.

There had been improvements with the way in which people's nutrition and hydration needs were monitored and met. The care plans associated with these needs had been improved and the staff recorded people's food and fluid intake. These records could be accessed remotely by senior managers, so they could make sure people were receiving enough to eat and drink. The electronic care planning system alerted the staff if people's weight changed or they did not have enough to eat or drink.

The provider

The inspection took place on 25 and 26 September 2018 and was unannounced.

The last inspection of the service was on 23 January 2018 when we rated the service requires improvement. We identified breaches of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, dignity and respect, safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service to at least ''good.''

At the inspection of 25 and 26 September 2018, we found that the service continued to be rated requires improvement. None of the previous breaches had been met and we identified breaches of a further three Regulations, relating to the needs for consent, meeting nutritional and hydration needs and staffing. We have rated the key question of, 'Is the service well-led?' as inadequate because we have found the service did not have effective systems to make and sustain improvements.

Coniston Lodge Nursing 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 service provided both nursing and personal care and is registered to care for up to 92 people. At the time of our inspection, 52 people were living at the service. The majority of people were over the age of 65 years and some people were living with the experience of dementia.

The service is owned and managed by Bondcare (London) Limited, a private organisation.

The registered manager left their post shortly before the inspection. The provider's representatives told us they had successfully recruited a new manager who was due to take up post in November 2018 and who would apply to be registered with the Care Quality Commission. 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 did not ensure the safe and proper management of medicines. In addition, they had not always mitigated the risk of people acquiring pressure sores because they had not helped people, who were at this risk, to change position as often as they needed.

People's needs were not always being met. People did not always have enough to drink to keep them hydrated. The staff had not responded appropriately when people had lost weight to make sure their care was reviewed, and they had the support they needed. Care plans did not always include guidance about how people's individual care needs should be met.

The provider had not always assessed people's mental capacity and ability to consent to their care and treatment. Information about people's mental capacity was not consistently recorded and the provider had not always sought consent in accordance with legislation.

The staff did not always respect people's privacy or treat them in a respectful way.

The provider's systems for mitigating risks, and monitoring and improving the quality of the service were not always effective. Records were not always accurately maintained and this presented a risk of people receiving care and treatment which was inappropriate and did not meet their needs.

People sometimes had to wait for their care because sufficient numbers of staff were not deployed to meet people's needs.

We identified breaches of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, consent to care and treatment, nutrition and hydration, dignity and respect, person centred care, good governance and staffing.

We are taking action ag

The inspection took place on 23 January 2018 and was unannounced.

This was the first inspection of the service since it was registered with the provider Bondcare (London) Limited in October 2017. Previous to this the service was owned and managed by another provider.

Coniston Lodge Nursing Home is registered to accommodate up to 92 people who require support with personal care and nursing needs. At the time of our inspection there were 41 people living at the service. The majority of people were over the age of 65 years, although there were some younger adults. People had a range of complex health conditions, some people had physical disabilities, some people were living with the experience of dementia and some people were being cared for at the end of their lives.

Bondcare (London) Limited were part of the Bondcare Group, a national provider of care services in the United Kingdom.

There was a manager who had been employed by Bondcare (London) Limited. They were in the process of applying to be registered with the Care Quality Commission. 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.

We have rated the service Requires Improvement overall and in the key questions of Safe, Caring, Responsive and Well-Led. We have rated the key question of Effective as Good.

People liked living at the home and felt their needs were being met. They told us they were cared for by kind staff. People felt they had been involved in planning their care and were given choices. They liked the food they were offered.

The staff felt supported by the manager and told us they had the training and support they needed. Some of the staff did not feel there were enough of them to meet people's needs and keep them safe. The staff told us the manager was approachable and they could discuss their concerns with them. We observed that the staffing levels at the service were sufficient to meet people's basic care and health needs. However, people did not always have access to company and opportunities to spend time with staff other than during practical support tasks. In addition, the staff did not always work efficiently as a team when communicating and meeting people's needs.

We observed some practices where people were being placed at risk. For example, one person who was at risk of choking was not given the support they needed when eating one of their meals. We also found that medicines were not always being safely managed.

The staff did not always care for people in a kind and considerate way. We saw that the staff also tended to focus on the tasks they were performing rather than the feelings of the people they were caring for. However, we also saw examples where individual staff members were kind and thoughtful.

People did not always receive personalised care and support which met their needs. For example, some people had to wait for personal care and they did not always receive the care which had been planned. In addition, whilst some people had opportunities to take part in organised social and leisure activities, others did not have the same level of opportunity for entertainment, leisure and social events. The care plans did not always include clear guidance on meeting people's needs. Although, the provider had recognised this and was taking action to make improvements in this area.

The provider's systems for ensuring people received the support and treatment they needed had not always been operated effectively. The risks of people receiving unsafe care had not always been mitigated.

We found breaches of four Regulations 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