Swerford House

Swerford House is a care home providing accommodation and personal care to seven people with a range of learning disabilities at the time of the inspection. Some people were living with autism and everyone required support with behaviours that challenged. The service can support up to seven people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The registered manager and staff were exceptionally responsive and worked continuously to make improvements to the service and provide people with high quality care. Since our last inspection staff had worked with people to enhance their communication in innovative ways which enabled them to support people to reduce any behaviours which could have challenged. As a result, people were communicating for the first time, and learning new skills, such as counting.

People were living fulfilled lives and had been able to achieve things for the first time including life skills, taking part in activities and going on holiday for the first time. Relatives told us of the significant improvements in people’s quality of life as a result of the support provided by the staff at Swerford house.

People had been supported to reduce the incidents of behaviour that could challenge, and as a result reduce the physical interventions staff used when supporting them. Some people had previously displayed very high levels of behaviour which could challenge, which had reduced significantly, and on some months, people did not display any of these behaviours.

People’s care centred around their needs and preferences. Staff treated each person with compassion and kindness, and continuously used feedback either verbally or based on how people presented to improve the service.

A relative told us they were involved in their loved one’s support, and feedback was positive in relation to the difference and the positive impact staff and the managers had on people’s lives.

People were safe living at Swerford house; accidents and incidents were minimal, and staff worked to reduce the likelihood of issues re-occurring. People had been supported to reduce the amount of medicine they took, which improved their quality of life, and allowed them to be more active.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 15 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Swerford House is registered to provide accommodation and personal care for up to five people. People living at the service had a range of learning disabilities. Some people were living with autism and everyone required support with behaviours that challenged.

The service was in a rural location, with large, safe grounds surrounding the property. Downstairs there was a kitchen, dining room, lounge and quiet room. Each person had their own bedroom.

The service had a registered manager in post. A registered manager is a person who is 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 kept their medicines in a locked safe in their bedrooms and staff supported them to take their medicines safely. Some people were prescribed creams to keep their skin healthy. There were no body maps to show staff where to apply the cream. This was an area for improvement.

People were encouraged to be as independent as possible. People had accessed new activities and were doing things that they had never done before. One person had recently been to see their favourite band in concert and another person had been on holiday for the first time. There were pictures displayed all around the service showing people out in the community and having fun. People’s relatives told us they were pleased and proud of their achievements.

Detailed assessments were carried out before people moved into the service and people’s care plans were accurate and up to date, reflecting the care and support people needed. People became distressed if there was a change in their routine so there was step by step guidance in place for staff telling them how people liked to get up in the morning, and the different routes they liked to walk when out.

People were relaxed in the company of staff and their relatives told us that staff were kind and caring. Staff knew people well and offered people reassurance and support throughout our inspection. People were treated with dignity and respect.

People met monthly with staff they knew well to review their care and support and what they had achieved that month. During these meetings staff asked people if they were happy and documented their responses to ensure people’s views on the service were taken into account. Some people needed support with their communication but staff used signs and symbols to help them make their needs known.

The registered manager documented and investigated any complaints. Relatives told us that they could raise any concerns with staff or the registered manager and they were confident they would be dealt with appropriately.

Staff and relatives told us they thought the service was well led. Staff told us they were well supported by the registered manager and there was an open and inclusive ethos within the service. The registered manager told us, “We want…to increase people’s independence...We want to encourage them to participate in more activities.”

Risks relating to people’s care and support had been assessed and minimised when possible. Some people displayed behaviours that challenged, particularly when they were anxious or upset. There were clear guidelines in place for staff, on how to manage these behaviours and how to help people remain calm.

Staff completed incident forms when any accident or incident occurred. The registered manager analysed these for any trends to see if any adjustment was needed to people’s support. Staff regularly had the opportunity to discuss incidents after they occurred to look if they could have managed a situation differently.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

Staff had the induction and training needed to carry out their roles. All staff had received training in how to manage people’s behaviours safely, and how to prevent behaviours from occurring. Staff met regularly with their manager to discuss their training and development needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there were any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.

People were able to access their kitchen, whenever they wanted and were supported to prepare meals and drinks of their choosing. People were supported to eat a healthy and balanced diet.

Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. Staff followed guidance and advice given by health care professionals. One healthcare professional told us that staff only used medicine to keep people calm as a last resort.

The registered manager was experienced in working with people with learning disabilities and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

The registered manager regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. These were collated and analysed and the results were displayed within the service so everyone could read them. When areas of improvement were made, these were acted on and people’s views were listened to.

Through direct observation, discussions with staff and records we, viewed we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills. Daily reports were written showing things such as, what a person had done that day, what support they had and what they had eaten

During the inspection we were able to observe people who used the service being supported with their hobbies and interests. People also took part in many every day activities. These included going for a walk and shopping. People were also supported to carry out household chores such as hoovering and laundry.

To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spoke with relatives of people living within the service. All spoken with expressed a positive view of the service and were happy with the quality of care given and future opportunities for their relative.