We carried out a review of the data available to us about Caprera on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caprera, you can give feedback on this service.
Caprera is a residential care home. It is registered to provide accommodation and personal care for up to 31 predominantly older people. The service does not provide nursing care. Nursing services are provided by the community nursing team. At the time of the inspection there were 27 people living at the service.
People’s experience of using this service and what we found
People told us they were happy with the care they received and people said they felt safe living there. Comments from people included, "I am very happy here," "Yes its all ok," "I am well cared for and have a lovely view from my room,"and "Staff come to me regularly." One relative told us, "No concerns whatsoever, they speak with me all the time, they are very communicative" and "I think it is lovely here I have no complaints."
People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were supported by staff who completed an induction, training and were supervised. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and staff assisted people with activities in the afternoons. Staff knew how to keep people safe from harm.
Staff received appropriate training and support to enable them to carry out their role safely, including dementia care training.
The environment was safe, with an improvement programme ongoing. The outside of the building was being painted at the time of this inspection. People had access to equipment where needed.
People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.
Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm.
People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.
People were supported by a service that was well managed. Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.
Staff told us the manager and the provider of the service were available and assisted them as required. They went on to say how they were approachable and listened when any concerns or ideas were raised. One staff member said, “The owner just wants what is best for the people living here” and “They have been very supportive to me.”
Rating at last inspection
The last rating for this service was good (Published15 May 2018) At this inspection the rating has remained good.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
We found the following examples of good practice.
All areas of the service were clean and free of malodours. Effective cleaning routines had been put in place to ensure infection control risks were minimised and people were kept safe. High contact areas were cleaned regularly throughout each shift and cleaning procedures had been reviewed and updated.
All staff had completed online infection prevention and control and covid-19 training. In addition, the infection control lead carried out individual training with staff to check they understood the online training and were using PPE correctly. The service had maintained good stocks of PPE and managers routinely worked alongside care staff to help ensure best infection control practices were followed.
The entrance to the building had been changed to enable visiting professionals and staff to enter into an area designated for hand wash, hand sanitising and putting on PPE. Appropriate waste bins were in place for the deposing of used PPE. Staff put on and took off their uniforms in the designated area. This helped to reduce the risk of infection because visitors and staff did not enter areas of the home, where people lived, until appropriate infection control measures were in place.
Staff kept in touch with families by regular telephone and video calls. The service was currently closed to visitors following government guidance. Some families were still visiting in the garden to see people through the window and the provider had plans to erect an external building as a temporary visiting room in the garden.
People and staff were being regularly tested in accordance with current guidelines. Appropriate admission procedures had been developed and everyone who moved into or returned to the service from hospital had a negative test result on the day they returned to the service
The service had reviewed their infection control policy in response to the pandemic. Specific covid-19 policies had also been developed to provide guidance for staff about how to respond to the pandemic. These policies were kept under continuous review as changes to government guidance was published.
The registered manager communicated regularly with people, staff and relatives to make sure everyone understood the precautions being taken, and how to keep people safe.
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 understood their responsibilities in relation to protecting people from abuse, harm sand all forms of discrimination. Staff told us they would report any concerns to their managers who they were confident would take any action necessary to ensure people’s safety.
Staff had the skills necessary to meet people’s needs and their training had been regularly updated and refreshed. Staff told us, “The training is really good actually.” Newly appointed staff completed a formal induction and shadowed more experienced staff before providing support independently. In addition, staff new to the care sector completed the care certificate. This nationally recognised training programme is designed to give new staff an understanding of good working practices.
The staff team were well motivated and worked effectively together. Staff told us their managers were supportive and addressed any issues reported. Their comments included, “Management are approachable and will deal with any concerns we raise”, “The mangers are very supportive” and “The managers are really good, really approachable.” Staff team meetings were held regularly and involved all staff. This enabled any issues between departments to be raised, discussed and resolved.
People understood how to report any concern or complaints and records showed managers had fully investigated complaints in accordance with the service’s policies. During the morning of our inspection one person raised an issue with inspectors. Managers were already aware of this issue and were in the process of taking action to address and resolve the person’s concern.
The service was well maintained and decorated to a reasonable standard. People bedrooms had been personalised with ornaments, furniture and paintings. Monthly checks by maintenance personal had been completed to ensure all safety equipment was operating correctly. Fire detection equipment and utilities had been regularly tested by appropriately skilled contractors. All staff had received fire safety training and evacuation plans had been developed identifying people specific needs in the event of an emergency.
Care plans included risk assessments and guidance for staff on how to protect people from identified risks in relation to both the environment and the person specific care needs. Where areas of increased risk had been identified appropriate measures were introduced to mitigate these risks.
People told us there were enough staff available to meet their needs and said, “There is always someone there to help me.” On both days of our inspection we found that the service was fully staffed and our analysis of the service’s rotas found that planned staffing level were routinely achieved. Staff told us, “There are always at least five full time staff here” and “If short they always get it covered.” The area manager told us interviews were planned for prospective staff to fill current vacancies and staff records showed all necessary pre-employment checks had been completed for current staff.
Assessments of people’s needs were completed before they moved into the service. This was done to ensure the service could meet the person’s needs and expectations. People were encouraged to visit the service as part of the assessment process. Information gather during the assessment was combined with details supplied by commissioners and relatives to form the basis of the person’s care plan.
Care plans were sufficiently detailed and staff had good understanding of people’s individual care and support needs. Care records included information about people’s life history and background designed to help staff understand how the person life experience may impact on their current care needs.
At the beginning of each care shift there was a formal hand over meeting where staff shared information about any observed changes in people’s needs. In addition, during these meetings care staff were allocated to support named individuals. Staff told us these systems worked well and ensured they had up to date information about the people they supported.
People were complimentary of the food provided and told us, “It’s about the best food I have ever had” and “The food is beautiful.” Choices were available at meal times including vegetarian options and people told us there care staff had a good knowledge of their individual likes and preferences. The service’s menu had recently been updated in response to people request and a photo based menu was being develop to aid people’s decision making.
People were able to choose how to spend their time and some people were able to access the community independently when they wished. An activities coordinator had been recently appointed and people told us,” They have activities in the afternoon”, “There is enough to do. There is a lady who plans activities and you can take part if you wish.” During the afternoon of the second day of our inspection we saw people and support staff dancing and singing along with and visiting performers.
Information was stored securely and there were systems in place to monitor the service’s performance, gather feedback from people and their relatives and identify where improvements could be made.
Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff consistently respected people’s decisions and records demonstrated people were able to decline planned care if they wished. Where people lacked the capacity to make specific decision staff consistently acted in the person best interests. Appropriate applications had been made for the authorisation of potentially restrictive care plans.
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.
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.
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 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.