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Inspection carried out on 20 August 2018

During a routine inspection

This announced inspection took place on the 20 and 21 August 2018. During our previous inspection in February 2017 we found evidence of a breach of Regulation 17 of the Health and Social Care Act 2014. This was because the provider did not have a robust quality assurance system in place to effectively monitor the safety and quality of people's care.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service Safe and is the service Well-led, to at least good. During the current inspection we found improvements had been made to the safety of the service, however, we found the service was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not checked the information recorded in the quality assurance audits was accurate. Audits that had been completed did not identify the concerns we found.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

Swan Court has 12 apartments and can accommodate up to 24 people. At the time of our inspection there were 12 people living in the service. The service is registered to accommodate older people, those living with dementia, and people with sensory of physical disabilities. Each person had their own apartment which comprised of an open plan kitchen/ lounge area, bathroom and bedroom. The apartments were all on one site with a communal lounge/ dining and kitchen area, bathrooms and garden.

The service was mostly safe, although the provider had systems in place to ensure the safe recruitment of staff these had not always been followed. We have made a recommendation about this.

Staff were trained to identify signs of abuse and how to report concerns. Medicines were administered by trained staff. Records showed people received their medicines in a safe and appropriate way. Where people required additional support with maintaining their health, they were referred to health professionals such as psychologists and GPs.

People spoke positively of their experience of living in the service, they told us “The best thing about living here is the atmosphere and the other people living here.” “I do everything I want to do.”

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 supported with their nutritional and hydration needs. This included providing food and drinks that was safe for them to consume and in line with their preferences.

Care plans documented people's preferred method of communication. People had access to the information they needed in a way they could understand it. People's relatives were encouraged, where appropriate, to be involved in the planning and monitoring of the care provided.

Families and friends were encouraged and supported to maintain contact with people. This protected people from the risk of social isolation. People were treated equally, regardless of their disability, gender, sexuality, religion, race or age in line with the requirements of the Equality Act 2010. People's chosen lifestyles were respected and where staff could offer support to people they did.

People, staff and others had positive opinions about the management and leadership of the service. There was a good workplace culture and we saw the staff worked well together to ensure effective care for people. Staff comments included ““S

Inspection carried out on 15 February 2017

During a routine inspection

Swan Court consists of 12 apartments for older people. The accommodation is part of the 'Extracare' service offered by Heritage Care. Heritage Care provides support and personal care to people living at Swan Court in their own flats. At the time of this inspection, nine people were living at Swan Court.

Swan Court has a registered manager in place. The registered manager was also the registered manager of the sister service, Swan House, which is linked to Swan Court. 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 undertook an announced inspection of Swan Court on 15 February 2017.

People told us they felt safe at Swan Court. Staff understood their responsibilities in relation to safeguarding people. Staff knew how to keep people safe. One staff member said “When people are in our care, they should be safe in every aspect of their life and not under any threat of abuse”. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People said “Staff are very good, no problems. They are kind and respectful” and “They are such a good team, I don’t need to ask them anything”. People were involved in their care choices and people’s independence was actively promoted. People and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were mainly in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. Staff rotas confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People said they were happy with the level of support and care from staff. One person said “My care flows along and I am happy here”. People’s nutritional needs were met and they told us they were well supported where needed with their meals.

People told us they had no complaints and were confident they would be listened to and action would be taken if they raised a concern.

The service had systems to assess the quality of the service provided, but these were not always effective. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care, but records of incidents were not always maintained.

We have made a recommendation that staff are reminded of their responsibility to record all incidents.

Staff spoke positively about the support they received from all of the team at Swan Court. Staff supervision and other meetings were scheduled for 2017, but formal supervisions had not taken place as planned in 2016. People and staff told us all of the management team were approachable and there was a good level of communication within the service.

We have made a recommendation that staff supervisions be formally recorded.

People told us the team at Swan Court were very friendly, responsive and well managed. The service sought people’s views of their care.

We found the provider was in breach of one regulation 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 the report.

Inspection carried out on 15 December 2014

During a routine inspection

Swan Court consists of 12 apartments for older people. The accommodation is part of the 'Extracare' service offered by Heritage Care. Heritage Care provides support and personal care to people living at Swan Court in their own flats. At the time of this inspection, seven people were living at Swan Court.

Swan Court has a registered manager in place. 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 inspection took place on 15 December 2014.

The service worked in a way which ensured people were kept safe. Staff were knowledgeable on how to identify and respond to safeguarding concerns if they arose. Clear guidance and policies were available for staff, people and visitors to the service if they needed to raise a safeguarding concern. People were protected against the risks associated with medicines as the provider had ensured learning had taken place from medication errors by implementing a comprehensive system to ensure medicines were managed appropriately. Staffing levels were appropriate to the service and corresponded with the minimum staffing levels determined by the provider. People had individual fire evacuation plans to ensure they were appropriately supported and safeguarded in the event of a fire. The provider ensured they had robust recruitment checks in place to ensure where staff were employed to work, they were suitable to do so.

Staff and management were aware the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and how this affected the people they worked with. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). No people were currently subject to a DoLS. The registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Staff were knowledgeable around their roles and responsibilities when working with people around consent and the Mental Capacity Act 2005 (MCA). Staff were able to explain what the MCA and DoLS meant, and how this affected the people they worked with. Where required, mental capacity assessments were completed along with evidence of best interest meetings.

Staff received training, induction and supervisions in line with the provider’s policy. Staff told us they felt supported and had received sufficient and additional training to undertake their roles effectively. The service was well maintained and was managed in a way which respected people’s confidentiality, freedom and safety. People’s nutritional needs were met in a way which was appropriate to the nature of the service. We observed caring practice throughout the inspection and found staff promoted people’s independence. People’s feedback on staff was used to inform staff supervisions.

People’s care plans, support plans and risk assessments were detailed and comprehensive. People’s life histories and preferences were recorded to ensure people were supported in a person centred manner. The service had good links with the local doctor and district nurses to ensure people’s wellbeing was maintained. People were aware of how to make a complaint, and details of how to make a complaint were visible throughout the service and within people’s flats.

People we spoke with told us they felt staff were caring. Comments included “They are very good, there is one lovely carer”, “They are very respectful and always ring the doorbell before they come in”, and “The staff are very friendly and helpful.”

The service was well led by the care co-ordinator and registered manager. The commission had received appropriate notifications since Swan Courts last inspection in August 2013. The registered manager was aware of the requirement to inform the Care Quality Commission where a notification needed to be submitted. We saw evidence the registered manager had completed a PIR form, but this had not yet been received by the commission. Staff and people who used the service were positive about the management of the service. We saw the provider had acted in a responsive way to recent medication errors to ensure they had developed their medication practices. Regular quality monitoring of the service was undertaken including audits of medication, infection control and health and safety.

Inspection carried out on 21 August 2013

During a routine inspection

We were shown minutes of staff meetings which included a record that ‘...in respect of ensuring the tenants’ rights and choices staff discussed how to enable them to live independently.’...

One member of staff told us “The care here is very ‘family-orientated’ with one person having just come back from a holiday with their family and another who’s just been to a family event which meant a week away.”

During our inspection it was clear that the people who had used the service were treated with dignity and respect, which included all personal care taking place either in their own room or the shared bathroom. On each occasion we observed that the door was locked and that staff knocked on the door and waited to be invited to enter.

There had been no allegations of abuse within this service. However we saw minutes of meetings attended by senior staff from this and similar services across the company which demonstrated that notifications of safeguarding incidents elsewhere had been discussed and learning identified.

We spoke with people who used the service about their confidence in the staff and one person told us “We get on very well with them; they look after us and we’ve no complaints.”

It was clear, from all the documentary evidence and the discussions with people who used the service and staff, that the provider had arrangements in place which reviewed the quality of the service provided and made changes to address learning or meet changes in support needs.

Inspection carried out on 8 January 2013

During a routine inspection

We talked with three people using the service. People expressed a good level of satisfaction with the service. People told us they were reassured that staff were available at all times. They said the staff were very good and helped them to remain independent. They provided the support agreed in the care plan. One person said “If I want anything, the staff are always there to help”. They told us the staff always responded promptly when they activated their pendant call system. One person told us they felt a bit saddened they didn’t know their neighbours. They said it was rather quiet along their part of the building. They would have liked to have seen “more life”.

We found the service had arrangements in place to provide the care and support people required. The service involved people in decisions about their care. It had procedures to protect people from the risk of abuse. People were looked after by staff who were appropriately trained and supported. The provider had arrangements for monitoring the quality of the service provided to people.