Swan Hill House Residential Home

Swan Hill House Residential Home is a residential care home providing personal care to a maximum of 28 people. The service provides support to older people. At the time of our inspection there were 25 people using the service. Accommodation is provided in one adapted building over 4 floors and 4 bedrooms are for shared occupancy.

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

People were not fully protected from risks associated with the safe management and administration of their medicines. However, the provider acted immediately following the inspection to address the issues raised. People shared mixed views about staffing levels, however we found no evidence that people were at risk of harm. People told us they felt safe living at the home and with the staff who supported them. Staff had been trained to recognise and report any signs of abuse. The provider’s systems for the recruitment of staff helped to protect people from harm. Risks to people were assessed and there were plans in place to mitigate risks in relation to people’s health and well-being. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the provider's policies and procedures supported this practice. People’s protected characteristics were assessed and understood and respected by staff. The provider followed current government guidance in relation to infection control and prevention and management of risks relating to COVID-19.

The provider’s quality assurance systems were not always effective in identifying or improving the quality and safety of the service provided. Audits and checks had not identified the shortfalls found at this inspection. Systems to monitor the competency of staff had not been effective in identifying or addressing areas for improvement. Staff told us they did not receive regular supervisions where they could discuss their role and performance. People were provided with opportunities to express their views about the service provided on a daily basis and through regular surveys. People and staff told us they found the registered manager and deputy manager approachable. The registered manager understood their legal responsibilities and of their responsibility to be open and honest when things go wrong. The provider worked in partnership with health and social care professionals to achieve good outcomes for people.

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 27 February 2019).

Why we inspected

We received concerns in relation to the management of the home, staff recruitment, staffing levels, environmental risks and infection, prevention and control procedures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 good to requires improvement based on the findings of this inspection.

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

Enforcement

We have found breaches in relation to the safe management and administration of people's medicines and good governance at this inspection.

Please see the safe and well-led sections of this full report. The provider took immediate action during and following the inspection to address some of the issues raised.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

People told us that they felt safe living at Swan Hill House. People were cared for by enough staff who understood how to keep people safe from harm and abuse. People told us that they received their medicines on time however medicines were not always managed safely and some improvements were needed to the current system for medicine management.

Staff were kind and treated people with dignity and respect. People were supported to make their own choices and were encouraged to be as independent as possible. Staff understood people’s preferences and care was delivered in line with people’s wishes and needs.

People told us that the management team were approachable and people knew how to make a complaint. The registered manager carried out health and safety checks of the premises and equipment. Accidents and incidents were recorded and action taken where necessary to keep people safe.

More information is in the full report

Rating at last inspection:

At our last inspection (report published 28 September 2016) all of the key questions were rated Good and the service was rated as Good overall. At this inspection, the key question Safe has changed to Requires Improvement however this has not changed the overall rating and this remains Good.

About the service:

Swan Hill House is a residential home that provides accommodation with personal care for up to 28 older people. At the time of our inspection, there were 27 people using the service. Swan Hill House is a Georgian town house situated in Shrewsbury town and people have easy access to the town centre.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

Swan Hill House is registered to provide accommodation with personal care for up to a maximum of 28 people. There were 28 people living at the home on the day of our inspection. The home is situated close to Shrewsbury town centre and offers easy accessibility into the town.

There was a registered manager in post who was present during our 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.

People felt safe living at the home as staff were always available to support them when needed. The registered manager monitored staffing levels and adapted these in line with changes in people’s needs. People were supported in a calm and unrushed manner.

Staff had received training on how to keep people safe and knew how to recognise the different signs of abuse. They knew how to protect people from further harm and who to report concerns to. The registered manager followed safe recruitment procedures to ensure staff were suitable to work with people living at the home.

Staff were aware of the risks associated with people’s needs and took action to minimise these without restricting them from doing things they enjoyed doing.

People received support to take their medicine when needed and accurate records were maintained. Staff monitored people’s health and arranged health care appointments as and when required.

People were confident that staff had the skills and knowledge to meet their individual needs. Staff felt well supported and received training that was relevant to their role and to further their development.

Staff sought people’s consent before supporting them. Staff provided information to people in a way they could understand to enable to make informed decisions about their care and treatment. Where people were unable to make certain decisions for themselves these had been made in their best interest by people who knew them well.

People were impressed by the choice and quality of food provided. Where required people received support to eat their meals independently.

Staff treated people with kindness and compassion. People were offered choice and felt listened to. Staff promoted people’s dignity and independence. Staff spoke with and about people with respect.

People’s needs were assessed prior to moving into the home and reviewed at regular intervals to ensure they reflected their needs and preferences. People were encouraged to follow their interests and could spend their time as they liked.

People felt able to talk to staff or management if they had any concerns or complaints and were confident that these would be dealt with promptly.

There was an open and honest culture at the home where people and staff were encouraged, and felt comfortable, to express their views. The registered manager promoted excellent care standards and led by example. Staff were proud to work at the home and felt valued. The registered manager carried out a range of checks to monitor the quality and safety of the service and used their findings to make necessary improvements.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with eight people who used the service, two relatives, two staff and the registered manager. We also reviewed records relating to the management of the home which included four care records.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Risks to people had been identified and managed in a way that ensured people's safety. These were regularly reviewed and care records updated.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had been submitted by the provider.

People's capacity to make their own decisions had been assessed. Where people could not make a specific decision without support we saw appropriate professionals had been involved in making that decision on their behalf.

Is the service effective?

People told us their needs were met by staff and they were involved in discussions and decisions made about their own care and support.

We saw evidence that the provider worked closely with other health professionals to ensure there was a joined up approach to meeting people's current care needs.

Is the service caring?

People told us staff respected their privacy and dignity and were caring towards them. We saw that people who used the service were comfortable talking with staff.

When we observed staff supporting people we saw they treated them with respect and kindness.

Is the service responsive?

People's individual needs had been assessed before care was provided and these were updated regularly. Where people's health needs changed the provider contacted the appropriate health professionals to meet these needs.

A variety of activities were provided for people to attend. People we spoke with told us they enjoyed these activities and were able to choose which ones they took part in.

Is the service well led?

People and relatives told us the provider listened to them and did what they said they would do. They told us they were able to freely talk about any issues or concerns they had and these were dealt with quickly.

The provider told us they were present at the home most days. They were able to demonstrate they were fully involved in the care and welfare of people and the day to day running of the service.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'They are marvellous' and another said, 'I'm very happy here'.

We spoke with 14 people who used the service, and seven members of staff. Some people were not able to share their views with us. We spent time with them in communal areas, as well having lunch with them or meeting them in their bedrooms. We also spoke with a local authority professional who had arranged to visit the home on the day we inspected it.

We saw how care and support plans had improved. People who received a service had been involved and consulted so they could agree to the detail and contents of this paperwork.

People said they were very happy with the choice and quality of food. We saw they received appropriate support at meal times to make this a dignified experience.

People told us they were happy and felt safe. Relatives agreed. One person commented, 'It's excellent here."

Staff said they were confident to recognise and report abuse. They told us their training made sure they knew what to do if they ever had concerns about a person's welfare. Staff agreed that regular support and monitoring of their performance made sure people were cared for properly.

When people made complaints they were fully acted upon. Prompt remedial action was taken when concerns were raised.

We saw that records lacked detailed information about the good care people said they had received.