The inspection took place on 17 and 21 January 2019 and was unannounced.

Capri 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.

Capri is registered to provide accommodation for up to nine people and supports older people, some of whom are living with dementia, a physical disability or a mental health need. At the time of our inspection, there were seven people living in the service.

There was a registered manager at the home. 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 our last inspection, in January 2018, the service was rated as Requires Improvement overall with breaches of Regulation 12, 17 and 18 of the Health and Social Care Act 2008 and Regular 18 of the Care Quality Commission (Registration) Regulations 2009. We identified concerns relating to the failure to safely manage environmental risks within the home, the failure to ensure staff were suitably qualified and had the skills required to carry out their roles and a lack of effective systems to monitor the quality of the service. We also identified that the provider had failed to notify the CQC of significant events, in line with their registration. At this inspection, we found action had been taken to address these issues, and there were no longer any breaches of regulation.

Individual and environmental risks were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

People felt safe living at Capri. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Thorough staff recruitment checks were carried out when a new staff member started working for the service. There were enough staff available to keep people safe at all times.

There were robust systems in place to ensure the safe management of medicines. People were supported to receive their medicines by staff who had been trained appropriately and medicine administration records were completed accurately.

Staff received a variety of training and demonstrated knowledge, skill and competence to support people effectively. Staff were supported appropriately by the registered manager.

People had access to health and social care professionals where required and staff worked together co-operatively and efficiently.

People were supported by staff with their nutritional and hydration needs. People were offered choice at mealtimes and menus contained a variety of nutrition and healthy foods.

People were cared for with kindness and compassion. Staff had developed positive relationships with people and knew what mattered most to them.

Staff took action to protect people’s dignity and privacy at all times and encouraged people to be independent with all aspects of their daily routines where possible.

People had a clear, detailed and person-centred care plan in place, which guided staff on the most appropriate way to support them.

The service had a clear process in place to deal with complaints to ensure they were dealt with in a timely and effective manner.

There were appropriate auditing systems in place, which ensured that issues were acted upon and ideas for improvement were responded too.

People, their relatives, visitors and staff members commented positively on the leadership of the service and felt that the service was well-led. The provider was engaged with the running of the service and was approachable to people and staff.

Capri is a privately run ‘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 home is registered to provide accommodation for nine people. There were eight people living at the home at the time of the inspection.

The home was based over two floors, connected by a set of stairs with a chair lift. Each bedroom had a vanity unit; there were toilets available on each floor and a bathroom on the first floor. There was a communal lounge and a separate dining area where people were able to socialise.

The inspection was conducted on 27 November 2017 and 13 December 2017 and was unannounced. 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.

The provider and the registered manager did not have an effective system in place to monitor the quality and safety of the home. they had not identified the areas of concern we found during this inspection.

Risks associated with the environment, such as water temperature, were not always assessed and safely managed.

The registered manager did not always notify CQC of all significant events.

Staff did not always receive the training they needed to ensure they had the appropriate knowledge and skills to meet the needs of the people they were supporting.

Staff sought consent from people before providing care. However, they did not always follow legislation designed to protect people’s legal rights. We have recommended that the provider seek advice and guidance on compliance with MCA, capacity assessment, best interest decisions and DoLS.

There were no structured activities to provide mental stimulation to a person living with dementia. Other people were supported to engage in activities they enjoyed. We have recommended that the provider seek advice and guidance on providing appropriate activities and mental and physical stimulation to those people living with dementia.

Care plans were not always personalised and did not provide sufficient information to enable new staff to understand how to support them. Staff were responsive to people’s changing needs.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

Medicines were administered by staff who had received appropriate training and assessments. People received their medicines at the right time and in a way that met their needs.

Staff were aware of the risks related to people’s care and support and the action they should take to reduce those risks.

There were enough staff to meet people’s needs in a timely way. People were supported by staff who had received an induction into the home. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

People were supported to have enough to eat and drink. Staff who prepared people’s food were aware of their likes, dislikes and dietary needs. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

Adaptations had been made to the environment to make it supportive of people who lived at Capri.

Staff developed caring and positive relationships with people. They were sensitive to their individual communication sty

Capri is a privately run residential care home providing care for a maximum of nine people. The home provides support to older people including those with a cognitive impairment. At the time of the inspection the home accommodated eight people.

There was 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 inspection was unannounced and was carried out on 27 August 2015.

The people living at the home told us they felt safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided enough information to allow staff to protect people whilst promoting their independence.

Care plans were personalised and reflected people’s individual needs. Staff used the information contained in people’s care plans to ensure they were aware of their needs and how to support them.

People were supported by staff who had received the appropriate training, professional development and supervision to enable them to meet their individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner. The registered manager had established a safe and effective recruitment process, and there were systems in place to manage short term absences of staff.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training. Healthcare professionals such as GPs, chiropodists, opticians and dentists were involved in people’s care where necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions made were the least restrictive and were in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain their family relationships and their bedrooms were individualised to reflect their personal preferences.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

There was an opportunity for people, their families, health professionals and staff to become involved in developing the service. They were encouraged to provide feedback on the service provided. They were also supported to raise complaints or concerns should they wish to.

People told us they felt the service was well-led and were positive about the registered manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the service.

There were systems in place to monitor quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We spoke with three of the eight people who used the service. They all confirmed staff sought their consent before they delivered any care. They told us they were very happy with the level of care provided and staff understood their needs. One person said “staff look after me very well, they know what I like”. We looked at four care plans and saw they were individual and included the necessary information to inform staff as to the specific care people required. We observed care in the communal areas of the home and saw staff interacting with people in a positive way.

We saw the home had an infection control policy and the manager told us they were the infection control lead for the home. We spoke with two members of staff and the manager, all of whom told us they had received infection control training. All of the people we spoke with told us the home was always clean. One person said “Everywhere is clean, they are always cleaning”. The home was maintained to an appropriate standard. However, the decorations in some of the rooms was old fashioned and in need of updating. We saw the garden was well maintained and regularly used by people

We saw there was a duty roster system, which detailed planned cover and arrangements in place to manage short term absence. The people we spoke with told us there was sufficient staff to meet their needs. One person said “staff always have time for you”.

We found the provider had an effective quality assurance system in place and sought the views of the families of people who use the service through regular surveys.

People were able and happy to talk with us. They told us they liked living at Capri. People told us they liked all the staff, and that all the staff had worked in the home for a long time. We were told the staff and manager were approachable and if people had any concerns they would tell the manger or a member of staff. People told us they were able to spend their time how they wished. Some people explained how they accessed the local community on a regular basis and enjoyed having meals out. People told us they enjoyed the meals at Capri and could ask for what they wanted on a daily basis.

Some people using the service were able to tell us about their experiences and we also spoke with other professionals. We spent some time in the home’s communal lounge speaking with people and observing people and staff. Interactions we observed were warm and friendly with staff clearly having a good knowledge of the people they were caring for.

People were very positive about the home. They viewed it as their home and said that they were able to make lots of choices and decisions. We saw that people’s opinions were sought by staff and that people felt able to request things and express opinions. People said their health and personal care needs were met and that they would recommend the home to friends or family. People had no complaints but said that if they did they would say something to the manager.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met. They were positive about the home and felt people’s needs were met in an individual supportive way.