Swan House

Swan House is a care home providing nursing and personal care for up to 45 people. The service provides support to people who are both residential and nursing care. Some of the people in the home were live with dementia. People have access to their own bedroom along with communal spaces including lounges. The home is split between 2 floors, the lower provides residential care and the upper floor provides nursing care. At the time of our inspection 28 people were living in the home.

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

This was a targeted inspection that considered the assessment, monitoring and management of risk and the clinical leadership and oversight of the service. Our inspection focused only on people who were receiving nursing care at the service. Based on our inspection of these areas we found:

People remained at risk of preventable harm from falling and choking. Safe systems were not in place to enable staff to effectively identify when peoples’ health was deteriorating, which meant people were at risk of not receiving timely medical support to keep them well.

Effective systems were not in place to consistently identify safety and quality concerns. This meant prompt and effective action was not taken to improve safety and quality.

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

Rating at last inspection and update

The last rating for the service was inadequate and there were breaches of regulation (published 19 January 2024). The service was placed into special measures and we followed our agreed regulatory response.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on ongoing concerns from people who visited the service relating to the safety and quality of the care provided. We had also received concerns about the management of peoples’ health when their health deteriorated. A decision was made for us to inspect and examine those risks.

The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and the clinical oversight at the service at this inspection.

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

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Swan House is a care home providing personal care for up to 45 people. The service provides support to people who are both residential and nursing care. Some of the people in the home are living with dementia. People have access to their own bedroom along with communal spaces including lounges. The home is split between 2 floors, lower is residential and the upper is nursing care. At the time of our inspection 40 people were living in the home.

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

The service was not safe. Risks to people were not monitored or reviewed after incidents or changes occurred and people were not protected from harm. Care plans and risk assessments lacked detailed, and actions implemented to keep people safe were not followed. People did not always receive pain relief when needed and medicines were not always safely managed, as stock checks were inaccurate, and bottles opened were not dated.

There were not enough suitably recruited staff to support people. The lack of leadership in the home meant the staff were not safely deployed, and they did not have the training, skills or knowledge to support people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Safeguarding procedures were in place and followed to report concerns there was a lack of accountability in the home with regards to this.

The systems in place to monitor the home, the care people received were not effective as they had failed to identify concerns. There was lack of learning lessons as action had not been taken since the last inspection to make the necessary improvements to comply with a warning notice . The home was not well managed. There was a lack of understanding from staff on their roles and there was no leadership in the home, placing people at risk.

The home was clean on the day of our inspection. Signage had been used to support people living with dementia.

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 the service was requires improvements (Published 13 November 2023)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to how people’s risks were managed, staffing and their training, how people consented to their care, the lack of governance and leadership in the home. The diets that people received.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Swan House is a residential care home providing regulated activities, these include personal and nursing care to up to 45 people. The service provides support to people who require nursing care, residential elderly care and people who have a diagnosis of dementia. At the time of our inspection there were 41 people using the service.

Swan House is split between 2 floors. The bottom floor is residential care and upstairs is where nursing care is provided. The home has had adaptions such as a lift put in place to assist people with mobility needs. Each bedroom has an individual toilet facility and showers and baths are communal.

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

People at risk of falls did not always have effective measures in place to mitigate the potential risk of being harmed.

Risk assessments were not always person centred to match the person’s individual needs, meaning there was a potential risks had not been identified to match people’s individual needs.

At the time of this inspection the home had a shortage of staff, this at times impacted to the quality of care provided. Where recruitment was taking place essential recruitment checks did not always happen to ensure the home was recruiting staff who were correctly skilled to provide the care required.

Infection control within the home needed to be improved to provide a more hygienic environment and to decrease any unpleasant odours within the home.

Some activities were taking place within the home, however improvement was required to ensure more meaningful activities took place to meet people’s spiritual needs.

People told us the carers were kind and caring and they felt safe with the care they received. Some staff had a good rapport with people.

Staff were responsive to people’s health needs and if a person was identified as requiring input from a health professional this was conducted in a timely manner. The home had regular input from health professionals.

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.

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 the service under the previous provider was requires improvement (Published 9 March 2020). This is the first inspection of this service under the new provider.

Why we inspected

The inspection was prompted in part due to concerns received about management oversight, staffing levels, infection control and training provided to staff. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-Led sections of this full report.

The provider took action after our inspection to mitigate the risks we identified. For example, the home has now employed new staff to prevent the use of agency staff.

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

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

Enforcement and Recommendations

We have identified breaches in relation to Regulation 9 (Person centred care), Regulation 11 (Consent), Regulation 12 (Safe Care and treatment), Regulation 17 (Good governance), and Regulation 19 (Fit and proper persons employed) at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.