Swillbrook House Residential Home

Swillbrook House Residential Home is a residential care home providing personal care to up 23 people. The service provides support to people who may be living with dementia and/or a disability. At the time of our inspection there were 15 people using the service

Swillbrook House is a large country house in Bartle on the outskirts of Preston. The home has a car park and landscaped gardens. Bedrooms are over two floors with a small lift providing access to the upper floor.

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

People told us they felt safe and they were supported by staff who helped them quickly if they needed this. One person commented, “I love it, it’s my home. I feel safe here yes I do.” A further person said, “I can’t imagine living anywhere else.” Checks were completed to help ensure prospective staff were suitable to work with people who may be vulnerable and staff had completed training to support their skills and knowledge. Risk assessments were carried out to help minimise the risk of avoidable harm and staff knew the help and support people needed.

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 cared for in a safe, clean and homely environment by staff who were caring and knew people’s need and wishes. Medicines were managed safely, and care records contained person centred information to guide staff on the care and support people had agreed to.

People were consulted and asked their views on the service provided. Checks and audits were carried out to identify what had gone well, or if improvements were required. Action was taken to improve the service if this was required. People told us they were happy at the home and were confident any comments or complaints they made would be listened to. One person commented, “I haven’t got any complaints.” Staff told us they felt supported by the manager and nominated individual and they were able to approach them if they needed support and guidance.

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

Rating at last inspection

The last rating for this service was requires improvement (published 07 July 2021).

At our last inspection we recommended that the provider implemented best practice in relation to the safe management of medicines, the management of individual risk and recording of recruitment information. At this inspection we found the provider had sought best practice information and improvements had been made. Medicines were managed safely, individual risk was consistently assessed, and recruitment information was complete and well documented.

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.

We carried out an unannounced focused inspection of this service on 05 and 18 May 2021. We made recommendations to support improvement.

We undertook this focused inspection to check improvements had been made. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swillbrook House Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People could not be assured medicines were always managed safely as improvements were required. We have made a recommendation about the safe management of medicines. Records did not always reflect the care people needed or received, or that prospective employee’s full employment history was explored and documented. We have made recommendations about the safe management of risk.

People told us they felt safe and staff were effectively deployed so people received support when they needed it. Risk assessments were carried out to minimise the risk of avoidable harm and staff knew the help and support people required.

People were supported in be involved in decisions about their care and given surveys to share their views. Meetings took place with people to gain their opinions and staff were able to attend staff meetings to discuss changes and give feedback on these. Care records were secure, so people’s private information was protected. Audits and checks did not always identify the shortfalls we found on the inspection.

The provider and acting manager took swift action during the inspection process to reduce risks and improve the service.

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

Rating at last inspection

The last rating for this service was good (published 08 February 2019).

Why we inspected

We undertook a focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about medicines, the provision of meals, staffing, the environment and care provided. A decision was made for us to inspect and examine those risks. We looked at the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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

The overall rating for the service has changed from good to requires improvement. 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.

We discussed our concerns with the provider who took action to ensure improvements were made and risks minimised.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swillbrook House Residential Home on our website at www.cqc.org.uk.

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.

Swillbrook House Residential Home 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.

Swillbrook House is a large country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. The property has a car park and landscaped gardens. The bedrooms are mostly single rooms with shared bathroom facilities. 15 out of 20 rooms have ensuite facilities. Bedrooms are over two floors with a small lift providing access to the upper floor.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

There was a complaints procedure available and displayed at the home. People we spoke with told us were confident any complaints they may wish to make would be addressed by the registered manager. During the inspection we were advised by an external person that they felt their complaint had not been responded to in a timely manner. We discussed this with the registered provider and reviewed the policy and saw further detail may be helpful in supporting expectations. We have made a recommendation regarding the complaints policy.

We observed medicines being administered and saw this was carried out in a person-centred way. Medicines were managed safely and staff were knowledgeable of the processes to order and receive medicines. We noted more information on ‘variable dose’ medicines would be beneficial to support staff when administering these. We have made a recommendation regarding variable dose medicines.

We spoke with the maintenance person who showed us around the home. They told us the home was in the process of being refurbished. We noted some areas of the home did not have handrails and the flooring required attention in some areas. The maintenance person and the registered manager told us this work was in progress. We have made a recommendation regarding this.

There were a variety of checks carried out to ensure that successes were recognised and areas of improvement identified. The registered manager told us the registered provider also maintained oversight of the home by carrying out checks, however these were not always documented. We have made a recommendation regarding the documentation of the registered providers oversight.

We checked to see staff were recruited safely to ensure they were suitable to work with people who may be vulnerable. We reviewed two files of staff who had recently been recruited to work at the home. We found the files contained employment checks, references and a full employment history.

We viewed care records to ensure people’s needs were assessed and risk to people who lived at the home were minimised. We found individual risk assessments were carried out in key areas such as nutrition, falls and skin integrity. Care records continued sufficient person-centred information to enable staff to support people. Care records also contained information regarding people’s preferences and wishes. People and a visitor we spoke with confirmed they were consulted in decision making and involved in care planning.

People and a visitor told us staff were respectful and caring in nature. We observed warm and affectionate interactions between people who lived at the home and staff. We found staff were gentle and kind with people and people told us they liked the staff.

We found the home was clean and tidy and staff were seen to wear protective clothing when this was required.

The registered manager told us and we saw documentation which evidenced the service sought feedback from people who lived at the home, relatives and visiting health professionals. Documentation asked people to share their opinions on what the home did well and what needed to improve. The registered manager told us they were in the process of analysing the results.

People told us they did not have to wait for help and staff were attentive to their needs. We timed two call bells which were answered promptly. Staff were seen to be patient and spent time with people chatting and supporting them when they needed help. Staff and a visitor we spoke with told us they were happy with the staffing arrangements at the home. Rotas we viewed showed staffing was arranged in advance and staff confirmed replacement staff were provided if unplanned absences occurred. The registered manager told us they would review the staffing arrangements as people’s needs changed to ensure they were sufficient.

Staff told us and we saw documentation which evidenced staff attended training to enable them to maintain and update their skills. Staff spoke positively of training and told us they felt supported to refresh and update their knowledge. We also saw evidence and staff confirmed, they had regular supervision with their line manager to discuss their performance.

People were asked to express their end of life wishes. Person centred documentation was available to plan this area of people’s care if people wanted to share their needs, wishes and preferences.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were enabled to access further professional healthcare advice when required.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. We saw people were offered a choice of meals during the inspection and we observed part of the lunchtime meal. We saw the lunchtime meal was a social occasion. People could sit where they wished, the atmosphere was relaxed and we observed people chatting. If people chose to eat alone, this was accommodated. We found staff were available to help people if they needed support.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager, registered provider or the local authority safeguarding team so people were protected. The number of the local authority safeguarding team was displayed on notice boards at the home so staff, visitors and people who used the service could raise concerns if they wished to do so.

People told us there were a range of activities provided. They said they could take part in these if they wished to do so. The registered manager told us they sought the views of people who lived at the home when deciding what activities to provide.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005 (MCA). People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

A visitor and people who lived at the home told us they could speak with the registered manager if they wished to do so and they found the manager approachable.

Further information is in the detailed findings below.

Swillbrook House Residential Home is a country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. There is car parking at the home, and gardens for people to use. There are 15 bedrooms with en-suite bathrooms and five bedrooms without an en-suite bathroom. Bedrooms are over two floors with a small lift providing access to the upper floor.

On the day of inspection there were 15 people living at the home.

We last inspected Swillbrook House Residential Home in January and February 2017 and identified a breach in Regulation. We found audit systems used by the registered provider to identify shortfalls had not identified the deficits we had found on the inspection. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Good Governance.)

You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection in January and February 2017, the registered provider sent us an action plan outlining how they intended to make the required improvements. The action plan indicated improvements would be made by August 2017.

At this inspection carried out in December 2017, we found improvements had been made. We found audits had been carried out on accidents and incidents, medicines, infection control and the environment. Staff told us they were informed if changes were required.

We saw processes were in place to ensure that where people’s rights were restricted, this was done so lawfully. The registered manager had sought training in the undertaking of mental capacity assessments. They told us they were developing systems to ensure mental capacity assessments were carried out. They told us they would carry out mental capacity assessments if required and document these. We have made a recommendation regarding the carrying out and documentation of mental capacity assessments.

During the inspection we reviewed four care records of people who lived at the home. We found risk assessments were in place to minimise risk and overall, records described the support people required. We found some information within care records was not consistent and was sometimes difficult to find. We have made a recommendation regarding documenting consistent information in care records.

The registered provider had taken steps to improve the environment at the home. We saw decoration had taken place in some areas of the home. We noted this was ongoing. We have asked the registered provider to confirm with us when this work has been completed.

We found environmental risk assessments were not consistently documented. We have made a recommendation regarding improving and recording the information available to control risk.

During the inspection we spoke with four people who lived at the home. The people we spoke with told us they were happy at the home and they liked the staff. People told us they were supported in the way they agreed and they enjoyed the meals provided.

People told us their privacy and dignity was respected and they took part in activities if they wished to do so.

There were systems in place to manage medicines safely. People told us and records we viewed; indicated people received their medicines as prescribed. People we spoke with told us they were consulted regarding their medicines and we saw this took place during the inspection.

People told us they were happy living at Swillbrook House Residential Home and the care met their individual needs. We were told, “I’m quite happy with everything.” And, “I’m looked after well.” People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. Documentation reflected the advice of health professionals.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff told us they received regular supervisions and appraisals to ensure training needs were identified. Staff told us, and we saw documentation which evidenced that staff received training and development opportunities to maintain their skills.

We viewed the kitchen and saw it was well stocked with a variety of tinned, frozen and fresh produce. All the people we spoke with told us they were happy with the meals provided and they were given an alternative if they did not like the meals offered to them.

Our observations during the inspection showed staff treated people with respect and kindness. People told us they considered staff were caring and we saw a positive rapport between staff and people who lived at the home. The registered manager told us they would support people to access advocacy service. We saw there was no literature available to guide people on this process. We have made a recommendation regarding the provision of this information.

There was a complaints policy which was understood by staff. Information on the complaints procedure was available in the reception of the home. At the time of the inspection we were told one complaint was currently being investigated.

People who lived at the home were offered the opportunity to complete surveys and meetings were available for people to participate in. People and relatives also told us they found the registered manager approachable if they wished to discuss any matters with them.

It is a legal requirement that the home conspicuously displays its last CQC rating. We noted this was available in the reception area of the home.

This is the second time the service has been rated Requires Improvement.

Swillbrook House is a large country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. The property has a car park and landscaped gardens. There are 15 bedrooms with ensuite facilities and five without ensuite facilities. There are three double bedrooms. Bedrooms are over two floors with a small lift providing access to the upper floor.

There was a manager in place who was registered with the Care Quality Commission. 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 was the first inspection of Swillbrook House since the registered provider took legal ownership of the home in December 2015. During the inspection visit we found processes to ensure people’s mental capacity was considered were not consistently followed and applications to deprive people of their liberty were not always made to the local authorities as required. We have made a recommendation regarding this.

People who lived at the home told us they felt safe. One person told us, “I feel very safe.” Staff were able to explain the actions to take if they were concerned someone was at risk of harm or abuse.

Staff were able to explain their understanding of abuse and the processes to follow if referrals to Lancashire Safeguarding Authority were required. However, we found the processes in place were not always followed in practice. We have made a recommendation regarding this.

We observed medicines being administered and saw this was carried out safely. However we saw documentation in relation to medicines was not always completed accurately. We have made a recommendation regarding the safe management of medicines.

We looked at the systems in place to identify shortfalls at the home and drive improvement. We found that when accidents or incidents occurred, the registered manager reviewed these. We spoke with staff who were able to explain the steps taken to minimise the risk of reoccurrence.

The registered manager carried out checks of medicines, care records and the environment. We found the audit systems in place were sometimes ineffective as they did not identify the shortfalls we identified on the inspection visit. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance.)

We observed care and support being provided and reviewed care records. Care records recorded the care and support people required to maintain their safety.

People told us they were involved in the planning of their care people and care was delivered in the way they wished. People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

We reviewed staff files and found there were processes that helped ensure staff were suitably recruited. Staff we spoke with confirmed checks had been carried out on their suitability for employment prior to starting work at the home.

Staff told us they received training to enable them to fulfil their roles and further training was being planned. Staff told us they were able to meet with the registered manager on an individual basis to discuss their performance. We saw evidence supervisions took place. The registered manager told us they were currently developing a system of formal supervisions.

We discussed staffing with people who lived at the home, the registered manager and relatives. We received no negative feedback. During the inspection we saw people were supported in a prompt manner and we also observed staff spending time with people if they wished them to do so.

People who lived at Swillbrook House told us they considered staff were caring. One person told us, “Staff here are very nice.” We observed people being supported with kindness and compassion.

During the inspection we observed activities taking place. We observed people joining in some ‘armchair exercises.’ We also saw staff sat with people and chatted with them and this was enjoyed by people who lived at the home.

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

People told us they had no concerns with the food at the home. We observed the lunchtime meal and saw this was a positive experience for people who lived at Swillbrook House. Staff gently encouraged people to eat and we saw people enjoyed their meal.

People who lived at the home told us they could speak with the registered manager if they wished to do so. Staff we spoke with also gave positive feedback. They told us they found the registered manager to be approachable and supportive. Relatives we spoke with also told us they found the registered manager to be approachable.

You can see the action we told the provider to take at the back of the full version of the report.