Capwell Grange Care Home

Capwell Grange is a nursing and residential care home. Providing personal and nursing care to 83 people, most of whom were living with dementia and long-term physical conditions, at the time of the inspection. The service can support up to 146 people. The home is made up of five individual bungalows with each having its own manager. One of the bungalows is a rehab service supporting people to regain their independence following a period of ill health.

People’s experience of using this service and what we found

One person’s relative said, “ It has improved by 90 per cent, we were thinking of moving [family member]. But proof is in the pudding, we shall have to see.” One person told us, “I was wheeled into Capwell Grange, but I walked out. They [staff] gave me back my independence, it changed my mind what a nursing home was like.”

We found improvements had been made to the home in terms of promoting people’s safety and effectively responding to people’s nursing and health needs. People were protected against potential harm and abuse. Swift action was taken to respond to injuries and changes in people’s health needs.

However, we did identify some shortfalls in responding to potential neglect, when people first moved into the home from a hospital or another residential care home. We made a recommendation about the management of potential safeguarding concerns at the home.

Improvements had been made in the leadership of the home. The bungalows were well managed by managers who knew people's needs well. Staff were directed and supported to care for people. The deputy and registered manager monitored the quality of daily care.

The provider’s own monitoring of the service had also improved; however we did find some shortfalls in this area. We made a recommendation about the provider improving their systems to assess the service. This will help the provider to sustain the changes made.

Staff were recruited safely and given the support and training to perform well in their work. Staff received competency checks to see if they could meet people’s needs effectively or if they needed further training.

People received their medicines as prescribed. The home was clean, and the registered and deputy manager ensured staff followed up to date COVID-19 government guidance. Relatives were supported to visit their family members in a safe way.

Those with specialist diets were supported to eat and drink in a safe way. Professional input was sourced quickly when people showed signs of choking and losing weight.

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.

The environment had improved. Efforts had been made to make the bungalows look inviting and comfortable for those who lived there. This work was continuing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update. The last rating for this service was inadequate (published 24 October 2020) there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 30 September 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Capwell Grange is a nursing and residential care home providing personal and nursing care to up to 146 people.

People’s experience of using this service and what we found

We had concerns about how the service promoted people’s safety. We identified significant shortfalls with how the management team and provider were responding to COVID19. Safe processes were not always being followed to try and prevent the spread of the virus. The service was not always adhering to government guidelines in relation to COVID19. After we had visited the service and identified these concerns there was an outbreak of COVID19 at the service.

We also found people’s safety was not being considered in terms of injuries or when something went wrong. Investigations did not take place in a timely way and as a matter of course when potential harm had occurred. We needed to prompt the management team to complete investigations when something had potentially gone wrong. When we reviewed these investigation reports we found these were not always conducted in an open way.

There had been some safeguarding events at the service which had prompted us to inspect. Staff did not have a clear understanding about what abuse could look like. An internal investigation found some staff were aware of these concerns, but they had not told anyone in the management team or outside of the organisation such as the local authority or police about this abuse. There was a poor staff culture and we found evidence of institutional practice. People were not always valued and treated with dignity and respect, especially people living with dementia or with behavioural needs. We raised safeguarding referrals to the local authority about our concerns.

Concerns had been raised by the local authority about how people’s general nursing care needs were being managed at the home. Some improvements had been made as a result of the local authority identifying issues with wound care. However, we still found shortfalls in this area of care. Nurses did not receive competency checks of their practice, despite these identified concerns. Other areas of clinical practice at the service were not checked by the provider to see if staff were actually effective in their work. We also identified shortfalls in staff’s understanding and knowledge about abuse and harm.

Staff did not feel they could talk with the management team and raise issues. They did not feel supported or valued by the provider. Staff did not question practice or promote people’s rights, to ensure they were safe and happy in their daily life. This increased the risk of abuse or harm occurring. There were a number of safeguarding investigations taking place at the service.

The provider had systems to assess the quality of the service, where issues had been duly identified and reported on. However, the provider did not have effective systems to respond to these. Meaningful action plans were not created to make improvements, nor further checks completed to test if these plans had been successful.

As a result of our findings the provider placed a voluntary embargo stopping admissions for a temporary period. We were also given verbal assurances that the provider will be making positive changes to the service to improve people’s experiences, in a timely way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was requires improvement, the report was published on 25 May 2019. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Capwell Grange on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people’s nursing care and how the service was promoting people’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how the service is managed, how safe people are at this service, and staff knowledge and practice.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

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. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.or.uk.

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.