This inspection took place on 23 and 24 August 2018 and was unannounced.

Capricorn cottage 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.

Capricorn Cottage accommodates 34 people in one single storey building. There were 26 people living at the home on the day we visited. Twenty-two people lived there permanently and four people were at the home for respite care.

The care service was developed prior to the values that underpin Registering the Right Support were published and therefore does not conform to the best practice guidance around the number of people living within the home. However, they do conform to other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 the last inspection the service was rated as Requires Improvement at this inspection we found the provider had made the improvements needed and was now rated Good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were happy and relaxed and engaged with the staff to discuss their care needs,

Staff were safely recruited and there were enough staff to meet people’s needs. Training and support was provided to ensure staff had the skills to care for people safely. Risks to people were identified and people’s medicines were safely administered and accurate records kept. The home was clean and tidy and staff knew how to keep people safe from the risk of infection. People were able to access healthcare professionals and advice when needed.

The home was nicely decorated and each person had been supported to individualise their bedrooms. The registered manager had developed a culture of increasing people’s independence and abilities. Staff spent time with people to get to know their individual needs and used this to develop their care. Where needed technology was used to increase people’s independence. People were supported to make decisions about who they wanted involved in their care planning.

The registered manager monitored the quality and safety of care provided and took action to resolve any concerns. Incidents and complaints were investigated and changes made to stop similar incidents occurring. The views of people living at the home were used to improve the care provided.

The inspection took place on 20 April 2017 and was unannounced.

The home is registered to provide care for up to 34 people who are living with autism or learning difficulties. The home is a purpose built care home on a single level. There are kitchen and laundry facilities available for people who can be supported to be independent. There were 22 people living at the home on the day we inspected.

There was a registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

This home has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this home is now out of Special Measures.

Our last inspection took place on 5 and 7 September 2016. We found that the provider was in breach of seven regulations. Following the inspection the provider wrote to us and told us about the improvements they planned to make. At this inspection we found the provider had made the improvements needed to meet the regulations. However, although the breaches had been addressed, further improvements were required in a number of areas.

Medicines were safely stored and administered. However, where people had been identified as needing their medicine hidden in their food, this was not always the way they received their medicine. People were supported to make choices about their food and drink. Staff ensured that people received meals which suited their nutritional needs to help them maintain a healthy weight.

Risks to people were identified and care was provided to keep people safe from harm. Accidents and incidents were monitored and action taken to keep people safe. However, the registered manager had not always reviewed all the incidents in line with the provider’s policy. Staff had received training in keeping people safe from abuse, were able to recognise abuse and knew how to report it internally and to external agencies.

There were enough staff available to meet people’s needs and staff had the skills and knowledge needed to provide safe care. They were supported to develop these skills through training and received ongoing advice and support from the registered manager and deputy manager. Staff had a good understanding of the Mental Capacity Act 2005 and ensured people’s rights were protected when they were not able to make decisions for themselves.

Care plans reflected people’s needs and daily records accurately recorded the care people had received. The care provided was person centred and ensured that people had the equipment they needed. People were supported to live fulfilled lives with activities that included activities of living as well as activities for pleasure and entertainment.

People had their views of the care they received gathered in a variety of ways and this information was used to improve the quality of care people received. People also knew how to raise a complaint and complaints were dealt with in line with the provider’s policy.

There was a suite of audits in place to monitor the quality of care people received and issues identified had been actioned. However, there were some areas where issues had not been fully identified by the audits. The registered manager had not submitted notifications for all the incidents they were required to tell us about.

The registered manager was approachable and would listen to the concerns of people living at the home and staff and take action to resolve any issues r

The inspection took place on 5 and 7 September 2016 and was unannounced.

The home is registered to provide care for up to 34 people who are living with autism or learning difficulties. The home is a purpose built care home on a single level. There are kitchen and laundry facilities available for people who can be supported to be independent. There were 24 people living at the home on the days we inspected.

There should be a registered manager for the home. The last registered manager had stopped working at the home in March 2016. At our inspection we found there was a new manager in post. They had started working at the home on 15 August 2016. They confirmed that they were in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

When we inspected on 25 November 2015 we found that the provider did not ensure the care and treatment people received was appropriate, met their needs and reflected their preferences. Risk to people while receiving care were not always identified and plans to reduce risks were not effective and did not keep people safe. Furthermore, the provider had not followed the requirements of the Mental Capacity Act 2005 to ensure people’s rights were protected. After the last inspection we asked the provider to take action to make improvements to the concerns we had identified.

At this inspection we found that the provider had not made the improvements needed and had failed to ensure that previous improvements had been sustained. We found that there were now seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. You can see what action we have taken at the back of the full version of this report.

The provider had not followed the requirements in the Mental Capacity Act 2005 (MCA) to ensure people's rights were protected. Mental Capacity assessments had not been carried out to show what decisions people were able to make for themselves and best interest decisions had not been made when restrictions had been placed on people.

Staff had received training in keeping people safe from abuse. However they had not been able to recognise abuse within the home. In addition they had physically restrained one person without having a care plan in place and had not recognised that this could be classified as abuse. Furthermore staff had also administered medicines without the guidance of a care plan to chemically restrain the person.

There were not enough skilled and experienced staff available to meet people’s needs and adequate cover was not provided when staff were on leave or were sick. Staff had received training but good practice had not been reflected in the care they provided people. Additionally, shortfalls in care were not identified when staff received their supervisions. Although some staff were individually caring they lacked time and support to build caring relationships. At times this led to staff being adversarial and disrespectful with people.

Risks around people’s abilities to maintain a healthy weight were not managed and this left some people at risk of malnutrition and other at risk of poor health through obesity. In addition, mealtimes were not a pleasant experience for people and were not individualised to meet people’s needs.

Medicines were administered safely but some systems put in place to manage medicines safely were not being followed. Other risks to people were not fully identified and the care put in place did not fully protect people from the effects of the inadequate care. Care was not always planned and

The inspection took place on 25 November 2015 and was unannounced.

The home is registered to provide care for up to 34 people who are living with autism or learning difficulties. The home is a purpose built care home on a single level. There are kitchen and laundry facilities available for people who can be supported to be independent. There were 26 people living at the home on the day we inspected.

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.

When we inspected on 14 January 2015 we found that the provider did not ensure the care and treatment people received was appropriate, met their needs and reflected their preferences. There were insufficient staff to care for people and they did not receive appropriate support and training. People were not treated with respect and the provider did not support people’s autonomy, independence and involvement in the community. People were not protected from abuse or improper treatment as systems and processes had not been established to identify or investigate abuse. Systems to assess monitor and improve the quality and safety of services provided or to identify, assess and manage risks to the health, welfare and safety of people using the service were ineffective. After the last inspection we asked the provider to take action to make improvements to the concerns we had identified and this action had been taken.

However, despite considerable improvements since our last inspection there were still breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. We found that care was not always planned and delivered in a way which met people’s individual needs and risks to people were not always identified.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The provider had not followed the requirements in the Mental Capacity Act 2005 (MCA) to ensure people’s rights were protected.

The provider had taken action to improve the care provided following our previous inspection. Systems were in place to monitor the quality of the environment and service people received and we saw that the systems were effective and identified areas where improvements were needed. In addition, the provider and registered manager had worked with the local authority to identify what good care looked like, how it could be implement and what skills they and their staff needed to deliver the care.

However, risks to people while receiving care were not fully identified and some risk assessments were generic and did not reflect people’s individual abilities. In addition, care was not always planned or delivered to meet some people’s needs or to support staff to administer medicines prescribed to be taken as required safely and consistently. Some mealtimes were not a pleasant experience for people.

The staffing numbers and staff training had been reviewed and the registered manager had identified the number of staff needed to meet people’s needs. While the appropriate number of staff had been allocated to each shift, staff sickness on the day of our inspection impacted on the care people received. Training had been arranged for staff to update the skills needed to provide safe care and staff received regular supervision to su

The inspection took place on 14 January 2015 and was unannounced. The home was last inspected in January 2014 and was found to be meeting the regulations we inspected.

The home is registered to provide care for 34 people who lived with learning disabilities or autism and for older people living with a dementia. The home is a single storey building with the majority of the building accommodating people living with learning disabilities or autism. Within this area of the home is a kitchen/dining room area where people could be supported to be more independent. At one end of the building through a secure door was a four bedded unit for people living with dementia. This unit had all the facilities people needed to live including a kitchen area and a lounge/dining area, bathroom and access to secure outside space. There were 26 people with learning disabilities living at the home and four people in a separate unit living with dementia. 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. We found there were not always enough staff and staff training was not effective and did not ensure people were safe. Systems to monitor the quality of service provided had not identified shortfalls in care.

Staff had not fully understood what constituted harm to people. Although some concerns had been raised with the manager appropriate action to keep people safe had not been taken. There were not always enough staff available to ensure people received their support in a timely fashion.

Some risks to people while receiving personal care had been identified and appropriate actions had been taken. For example, people had been helped to keep their skin heathy by using soft cushions and mattresses that reduced pressure on key areas and systems ensured medication was available and administered safely. However, the risks people faced out in the community had not been included in the care plan.

The registered manager was aware of the recent changes in the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and applications had been completed appropriately.

Records showed that staff had not received training in some area which would help them support people in a more appropriate way.

Mealtimes were loud and noisy and the dining room was not a pleasant place to spend time. We saw alternatives to the set menu were available for people who could communicate effectively to request them. Staff did not always listen to people’s comments about the food.

While staff understood the individual way people communicated their needs and responded appropriately this was not always done in a kind and caring manner. Staff did not always support people’s dignity by ensuring they were dressed appropriately.

Care plans did not support progression in people. There were no goals identified for how people could be supported to be more independent. While some activities had been provided around improving people’s daily living skills, records were incomplete and did not show how effective the activities had been.

While the registered manager was available in the home they did not ensure that staff always treated people with dignity and respect. Systems in place to monitor the quality of service people received were not effective and did not identify areas where improvements were needed. There was no system in place to ensure each incident was investigated and appropriate action taken.

There were 31 people living at the home on the day of our visit, four people in the elderly dementia unit and 27 in the learning disabilities unit. We spoke with two people in the dementia unit and one of their relatives. We also spoke with two people who lived in the learning disabilities unit.

We saw staff were polite and kind to people and always asked their consent before providing any care. Where people were unable to consent we saw decisions were made in their best interest involving the care staff and professionals who were delivering their care.

People told us they liked living at Capricorn cottage. One person told us, “The home here is ever so good, you would like it here.” While a relative we spoke with said, “I have no complaints. The staff are so attentive, he has a pressure mat at night to alert staff if he gets out of bed.”

The home was clean and tidy. There were systems in place to reduce the risk of infection.

Medication was ordered and stored appropriately. Medication was administered to people in a timely manner. We saw staff were aware of signs that indicated a person may be in pain and offered pain relief appropriately.

People were asked for their views on the service provided. One person had commented, “Excellent care in all areas. I could not ask for a better place.”

Capricorn Cottage provides long term and respite care for up to 34 people with a learning disability. Capricorn Cottage was purchased on 21 May 2012 by Agemco Limited following an eight months period of administration.

Some of the people in the home were unable to answer direct questions about their care. We gathered evidence of people’s experiences of the service by reviewing their care plans, comment cards and the complaints log. During our visit we observed the care people received.

We could see there were good relationships between people using the service and members of staff. People appeared to be happy and relaxed in their surroundings. We asked one person if they were happy with their care, they said, “Oh yes.”

We saw a visiting health professional had commented on a quality assurance questionnaire, “Good atmosphere, residents appear happy and well cared for.”