About the service:

Capwell Grange Care Home is a ‘care home’. It provides personal and nursing care for up to 146 people living with a variety of health conditions, physical disability and dementia. The service also provides short-term care and treatment to adults who require a period of rehabilitation following a stay in hospital due to ill-health, surgery or an injury. The service comprises of five self-contained bungalows which they call ‘houses’. At the time of the inspection, 115 people were being supported by the service.

People’s experience of using this service:

People were not always protected from harm because potential risks to people’s health and wellbeing were not consistently managed well. Some care records were not up to date, legible or accurate which meant staff could not always provide safe care. There were not always enough and consistent staff to ensure people’s needs were met safely. People found the higher use of agency staff in recent months did not ensure they received consistent care. Incidents were not always reviewed in a timely way to enable learning from them and to reduce the risk of recurrence.

People’s rights were not always protected. Restrictions on people’s liberty had not always been authorised because most of the Deprivation of Liberty Safeguards (DoLS) authorisations had not been renewed. Applications had also not been made for people new to the service who may lack mental capacity to make decisions about their care. Formal support for staff by way of supervisions had not been regularly carried out.

The provider’s quality monitoring processes had not been used effectively to drive continuous improvements. Inconsistent management and leadership of the service had resulted in declining in standards of care and safety. Audits had not been carried out regularly to ensure people received good quality care. There had not been opportunities for people to provide feedback about the service because meetings were no longer planned regularly. The above issues resulted in breaches of three regulations.

However, people, relatives and professionals told us staff provided care in a caring and responsive manner. Feedback from everyone was positive about how staff supported people in a kind and person-centred way. There was evidence that people mainly received good care because staff worked hard to support people the best way they could.

Staff supported people well. However, they found e-learning was not always effective at helping them to learn. The provider was going to look at further ways of supporting staff to develop their skills. People were supported well to have enough to eat and drink. Staff supported people to access healthcare services when required. People’s medicines were managed well. This helped people to maintain their health and well-being.

People said they were involved in making decisions about their care and support. Staff respected and promoted people’s privacy, dignity and independence.

There was a system to ensure people’s suggestions and complaints were recorded, investigated, and acted upon to reduce the risk of recurrence. However, more needed to be done to ensure there was a way of recording concerns raised by people or relatives in each of the ‘houses’.

Rating at last inspection:

The service was rated 'good' when we last inspected it. That report was published in July 2018.

Why we inspected:

This inspection was prompted by information of concern that was shared with CQC. This showed people were at risk of potential harm because of poor care records, poor infection control measures and inadequate governance.

Enforcement: There were four breaches of regulations. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

Follow up:

We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme

This unannounced comprehensive inspection was carried out on 2 and 3 May 2018, and was concluded on 8 May 2018. This was the first inspection since the service was taken over by HC-One Oval Limited. We found they were meeting the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Capwell Grange Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 146 people with a range of care needs including those living with dementia and physical disabilities. People are accommodated in five separate bungalows. At the time of the inspection, 116 people were being supported by the service.

There was no registered manager in post as she had deregistered in April 2018. The deputy manager was the interim manager while a newly appointed manager was undergoing induction training. 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.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Staff had regular supervision and they had been trained to meet people’s individual needs effectively. The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided to people with their input to ensure that this continued to meet their individual needs in a person-centred way. The provider had an effective system to handle complaints and concerns. A variety of activities that people enjoyed were provided, and people were supported to pursue their hobbies and interests. People were supported to remain comfortable, dignified and pain-free at the end of their lives.

The service was well managed and the provider's quality monitoring processes had been used effectively to drive continuous improvements. The manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, relatives and external professionals resulted in positive care outcomes for people using the service. Feedback was positive about the quality of the service.

Further information is in the detailed findings below.