Carprea is a ‘care home’ that accommodates up to 31 older people with care and support needs. At the time of our inspection 29 people were living at the service. People in care homes receive accommodation and 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 consists of a detached building which has been extended and accommodation was provided on multiple floors. A passenger lift and a number of stair lifts were provided to enable people with limited mobility to access rooms on other floors.

The service did not have a registered manager at the time of our inspection however, an acting manager who had been previously registered at another location had been appointed. The acting manager intended to apply to become the registered following this inspection. 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.

This inspection began on the evening of the fifth of March and was completed the following day. The inspection was unannounced and began at 20:00 to investigate specific concerns that had been raised in relation to the quality of care provided at night. Concerns reported included that people’s call bells were being deliberately positioned out of reach at night, that medicines were not been supplied as prescribed and that a number significant incidents had not been appropriately investigated.

During this inspection we found no evidence to suggest call bells were being deliberately positioned out of reach. Where people lacked the capacity to use a call bell to summon support at night appropriate other system had been introduced to alert staff when support was required. This included the user on motion sensor technologies which we found staff responded to promptly. One person told us, “I am unable to use a call bell for assistance, I therefore have a pressure mat in place in my bedroom that alerts the carers when I am up and then assistance can be provided.”

Medicines were safely managed by appropriately trained staff. We found no evidence to support the concerns raised prior to the inspection that information about the time at which evening medicines were supplied was being misreported in medicine administration records (MAR). When people chose to go to bed they had been supported to access their bedtime medicines safely and staff had ensured appropriate gaps between consecutive doses of medicine had been maintained.

Medicines were stored securely and there were safe systems in place for the ordering, storage and disposal of medicines. Medicines administration records had been fully completed and regularly audited to ensure their accuracy.

We reviewed the records in relation to managers’ investigations into the specific incidents that had been informed of prior to the inspection. We found appropriate and robust investigation had been completed and where necessary disciplinary action had been taken to address identified staff performance issues.

People were relaxed, comfortable and at home in the service. They told us, “We are very lucky with our staff” who were described as, “Wonderful”, “Caring”, “Lovely and “Exceptional.” People were comfortable requesting support which staff provided promptly and with compassion. One person told us, “I was in hospital for a while. When I came back they brought me in and I thought I am home!” Visiting Professionals were also complementary of the service and it’s management. They told us, “I think it is very good” and “I consider this to be a safe and well-managed service. I would recommend them to friends and family.”

Staff had received safeguarding training and und

Caprera is a care home which provides care and accommodation for up to 33 older people. On the day of the inspection there were 33 people using the service. We carried out this unannounced focused inspection on 18 February 2017.

We carried out an announced comprehensive inspection of this service on 26 January 2016. A breach of legal requirements was found. Arrangements for the management, administration and storage of medicines were not robust. For example, Medicine Administration Records (MAR) were confusing and handwritten entries had not been double signed. Records for medicines requiring stricter controls by law were not accurate. Creams were not dated on opening. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Caprera on our website at www.cqc.org.uk.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. 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.

Systems in place for the management and storage of medicines were robust. MARs were accurate and consistently completed in line with national guidance. Medicines were stored safely at appropriate temperatures.

People told us they were happy with the care they received and believed it was a safe environment. We observed people sitting in small groups chatting and laughing together. People were relaxed and at ease with each other and staff.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

Risks specific to people’s individual health and social needs were identified. Staff described to us how they would support people in particular circumstances. Their descriptions were in line with the guidance in care plans.

This unannounced comprehensive inspection took place on 25 January 2016.

The last inspection took place on 2 May 2014. The service was meeting the legal requirements at that time.

Caprera is a care home which offers nursing care and support for up to 29 predominantly older people. At the time of the inspection there were 29 people living at the service. Some of these people were living with dementia. The service uses a detached house over three floors.

The service had a registered manager in post. 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. The registered manager was not present during this inspection.

We looked at how medicines were managed and administered. We found it was not always possible to establish if people had received their medicine as prescribed. Monthly medicine audits were failing to identify that hand written entries on the Medicine Administration Charts (MAR) had not been witnessed. Medicines were not managed safely.

We walked around the service which was comfortable. There were malodours on the ground floor throughout the day of the inspection. This was due to a burst sewage pipe beneath the cellar of the service. The service were in the process of repairing this issues. People’s bedrooms were personalised to reflect their individual tastes. People were treated with kindness, compassion and respect.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. Staff and visitors told us they felt there were enough staff. People told us staff responded quickly when they called for assistance.

Staff were supported by a system of induction training and quarterly supervision. More specialised training specific to the needs of people using the service was being provided. For example, dementia training and care of people who were suffering from the effects of having had a stroke. Supervision included a performance appraisal. This enabled the service to address any issues promptly.

Staff meetings were held. These allowed staff to air any concerns or suggestions they had regarding the running of the service. Staff told us they felt the management listened to them and responded to their requests. For example, the management were planning to increase staff numbers in the mornings by one extra person. This was as a result of staff reporting that it was difficult to meet people’s needs in the mornings with the current staffing levels.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Activities were provided regularly. People told us they enjoyed some of the activities such as music, quizzes and exercises.

The registered manager was supported by an Area Manager who also supported other services in the group. The service had a stable staff group who told us they felt they worked well together as a team.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the service to take at the end of this report.

We considered our inspection findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by the staff.

People were cared for in an environment that was safe, clean and hygienic.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support. We saw risk assessments had been undertaken and were regularly reviewed.

People were safe because the service had an effective system to manage accidents and incidents and learn from them so they are less likely to happen again.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies in care homes. The service understood the requirements of the Mental Capacity Act 2005 and the related Deprivation of Liberty Safeguards, and put them into practice to protect people. We were told and we saw, an appropriate application had been made for an authorisation of a DOLs care plan. Newly appointed staff received an induction prior to starting work which included a period of shadowing more experienced staff.

Mandatory training was mostly up to date and staff received further training specific to the needs of the people they supported. Some staff required updates.

Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

We observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

We spoke with three people who used the service, their comments included “I am very happy here, the staff are lovely” and “Yes its fine here, no problems, I do as I wish”. Two family members who were visiting a person staying at Caprera for respite told us “it is wonderful here; we wish X could live here all the time” and “the staff are fantastic”.

We saw there was appropriate care planning documentation used in respect of people who lived at the home. We looked at a range of care documentation which evidenced that people’s needs were well understood and staff acted with respect and care in supporting people appropriately. Care plans mostly reflected people’s current individual needs, choices and preferences.

People, or their representatives were not always involved in their assessment and review of care needs.

People told us, and we saw, their views and experiences had been sought. We saw the results of such surveys had been acted upon.

Some people required to be moved using equipment. We saw this equipment was readily available to people. We saw each person who required a hoist to move them, had their own sling in their room. This ensured people’s dignity was protected as slings were not shared.

We saw some people had their end of life wishes clearly stated in their records.

The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Staff had effective support, induction, supervision and appraisal.

Is the service caring?

We spoke with three people who lived at Caprera. People told us they were happy with the care provided. One person told us “I am well looked after here”.

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people.

People told us they were able to do things at their own pace and were not rushed. People’s preferences, interests, aspirations and different needs had been recorded. Care and support was provided in accordance with people’s wishes.

We saw people were given a choice as to where and when they had their meals. We saw some people chose to eat their meals in their rooms; whilst others ate in the communal dining area. People we spoke with told us the food was always good and enjoyable.

Appropriate professionals such as district nurses, GP’s and tissue viability nurses were involved in the planning and management of care and decision making.

Is the service well led?

Caprera had a registered manager. This person was returning from maternity leave on a part time basis, however, there was organised management cover in place for when the registered manager was not going to be at the home.

Caprera had regular support from the district nursing team and GP’s from local practices. This ensured people received appropriate care in a timely way.

Accidents and incidents were recorded and monitored.

Staff meetings were held regularly, and staff felt supported and listened to by management. Staff told us they felt there were enough staff on duty at the home .

Audits were carried out monthly on areas such as accidents, training, medication and care documentation. We saw some care records contained gaps and these gaps had not been identified on the audits we saw.

We saw CQC registration requirements, including the submission of notifications and any other legal obligations were met.

Is the service responsive?

Caprera had an activity co-ordinator who planned and organised activities for people who lived at the service.

People told us they were offered choices at Caprera. We were told people could make choices regarding the times they got up and returned to bed, what they did during the day and what they ate.

People who required assistance with decision making were offered appropriate support.

People’s needs had been assessed before they moved into the home.

People using the service, their relatives and friends completed a quality assurance survey. Where shortfalls or concerns were raised these were addressed.

People’s care needs were regularly reviewed; however, this was not always done with the involvement of the person or their representative.

Caprera had a complaints procedure in place. People who lived at the home felt able to raise any concerns.

Some of the people who lived at Caprera were not able to comment in detail about the service they received due to their healthcare needs. We spoke with three people who lived at Caprera. They told us “I have no problem with anything” and “food is good” and “we go out in the garden when the weather is good, it is lovely”. We spoke with six relatives, four members of staff and a visiting professional. One family member told us “staff are lovely” and “ XX is very happy here”. The visiting professional told us “the nurses know about the patients I am seeing and introduce me to them.”

We saw people’s privacy and dignity was respected and their choices and preferences were acknowledged by the staff by the way staff assisted people with their care needs.

We found people did get the care they needed, and people’s consent was actively sought.

We walked around the home and looked at the communal areas and some people's bedrooms. We saw that the home looked clean, tidy and the decoration homely. We noted a slight unpleasant odour in three areas of the home. The home was warm during our inspection.

We found the systems in place regarding the administration and storage of medication did protect people from the risks associated with medication.

Staff told us they had access to training so their skills were kept up to date.

We spoke to 10 people who used the service at Caprera. They told us they were “pleased” with the care they received. People who used the service and their relatives could not identify any improvements needed to the care that they received or to the environment.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

From reviewing peoples care documentation improvements were needed to ensure that staff were informed, directed and guided as to what assistance the person needed.

People told us they felt “safe” at the home. Improvements are needed in the management of peoples monies which the provider has assured us would be addressed immediately.

Staff told us they had access to training so that their skills were kept up to date. They told us they felt there were sufficient staff on duty at all times. Staff did not have access to one to one meetings with their manager and therefore did not have the opportunity to review their work practises.

Following this inspection the provider reviewed the management structure of the home and has resumed the role of manager of the home to ensure that the quality of the service would be compliant.