Swanton House Care Centre

Swanton House Care Centre is residential care home and was providing personal and nursing care to 29 people living with a mental health condition and/or learning disability at the time of the inspection.

The care home is registered to accommodate 49 people for residential and nursing care. People may have a mental health need, a learning disability, a physical disability or a dual diagnosis. Some people are living with dementia. The service accommodates people both over and under 65 years old. People currently live in in two separate houses called Holly and Bluebell. The houses are set in large grounds and are single storey and purpose built with some self-contained accommodation. The third house, Birch is a converted period building. There was a plan to refurbish and modernise the accommodation in this building. At the time of inspection, it was only used for office space and some communal activities. Four downstairs rooms were being refurbished in order to take emergency placements.

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

People told us they felt safe at the service. There had been an improvement in staffing levels across the service to ensure that there were enough staff to support people. Staff were knowledgeable about how to keep people safe and manage risks to promote their independence. There were systems in place to monitor incidents and ensure that action was taken to prevent things going wrong in the future.

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. A competency framework for staff ensured they had the skills and knowledge they needed to support people and meet people’s needs. People told us the food was excellent and all staff were aware of people’s preferences as well special requirements in relation to their diet. The premises continued to be improved and people were consulted on how it could be adapted to meet their needs.

We observed positive relationships between staff and people living at the service. People told us staff spent time with them having a chat or providing support. Staff were very aware of promoting privacy, dignity and confidentiality and people were involved in their care and supported to be as independent as possible.

Care plans were regularly reviewed in line with people’s changing care needs. There was an active programme of activities that engaged people both within the home as well as encouraging people to be engage with the local community. Additional provision had been made since the last inspection to ensure that those people who stayed mainly in their rooms, or who didn’t like being in groups were able to engage in activities. Consideration for people’s wishes at the end of their life was recorded sensitively in a care plan called, ‘Hopes and concerns for the future.’

There was a positive, person-centred culture across the service. Staff morale was good, and staff worked well as a team. Staff told us management were open and approachable and they felt supported in their roles. Auditing processes had been considerably improved since the last inspection resulting in improvements to care and the registered manager continued to identify new areas to work on. The service worked well in partnership with other organisations and professionals to improve the health and wellbeing of people using 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 and update: The last rating for this service was Requires Improvement (published 8 August 2019) and there were multiple breaches of regulations. Following this inspection, we met with the provider to discuss how they will make changes to ensure they improve the rating to at least Good. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swanton House Care Centre 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.

People’s experience of using this service:

The service has a history of poor governance. At this inspection improvements had been made in the leadership however there remained areas of concern in the management of the service.

Audits were still not sufficiently robust to identify all areas for improvement and to identify and manage risks.

The culture within the organisation had become much more positive and staff felt supported and said that they enjoyed their jobs.

People and staff were engaged in the ongoing development of the service.

Individual risks relating to people’s care and support were not always identified and managed safely.

Incidents and accidents were not always reviewed to prevent things from happening in the future.

There were not always sufficient numbers of staff to support people and meet their needs.

Medicines were being managed safely in the home.

Staff understood how to prevent and control the spread of infection.

The policies and systems in the service did not support people to have maximum choice and control of their lives.

People’s care needs were holistically assessed, and staff had the appropriate training to enable them to meet people’s needs.

People were supported to eat and drink. The cook was knowledgeable about people’s diets and special needs with regard to food and nutrition.

The service worked well with other professionals to meet people’s healthcare needs.

There was an ongoing programme of improvement to the premises. We have made a recommendation about the decoration of the premises where people with visual impairments live.

People were not always cared for in a timely way. In Holly unit people often had to wait for their care.

The service had an activity programme in place which had been put in place since the last inspection and was tailored to meet people’s needs. However, there was further development needed in order to engage people who spent time in their room.

The service had plans to introduce training in End of Life Care for staff and had started to record peoples wishes for the future.

Rating at last inspection: The service was rated requires improvement at the last inspection. (Report published May 2018). At that inspection we found breaches of regulations 9, 10, 12, 17, 18. At this inspection we found some improvement had made. The service was no longer in breach of regulations 9 and 10, but was still in breach of regulations 12, 17 and 18 and had an additional breach of regulation 11.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement:

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve the rating of the service to at least Good. We will require them to provide an action plan detailing how this will be achieved. We will revisit the service in the future to check if improvements have been made.

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

At the last inspection, the provider agreed not to take any new admissions until they had made the improvements we had identified as part of our inspection. We also put a condition on their registration in respect to staff training as we found a high percentage of staff had inadequate or no training in some key areas of practice. We found their knowledge poor and we were not confident that they would be able to carry out their job safely.

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 overall service with particular emphasis on key questions relating to safe and well led and how they were going to meet the regulatory breaches and conditions on their registration. The action plan was submitted to us in a timely way, and updated at regular intervals. We noted over the last three years this service has not achieved an overall good rating.

Because the service was rated inadequate, it was placed in special measures. Services in special measure will be kept under review and if we have not taken immediate action to propose to cancel the provider’s registration of the service, we undertake to inspect within six months of the last inspection. The expectation is that the provider should have made significant improvement within this period.

We re-inspected this service over a number of different dates due to its complexity and size. The first date was 14 March 2018 and was unannounced. A pharmacy inspector visited on the 19 March 2018 and the lead inspector returned on the 20 March to follow up on some concerns and provide feedback. The service had nine vacancies so had 40 people living on site at the time of the inspection.

Swanton House care centre 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. The care home accommodates up to 49 people in three separate houses. Some of the accommodation is self-contained. The three houses are referred to as Holly Court and Bluebell, which are single storey and purpose built. The third house is Birch, which is a converted period building. The service accommodates people who require residential in Bluebell and in Birch and Holly Court for those requiring nursing care. People may have a mental health need, a learning disability, a physical disability or a dual diagnosis. Some people are over 65 others under 65 and some living with dementia.

At the time of the last inspection, there was no registered manager, an acting manager left shortly after the last announced inspection. According to our information, the service has not had a registered manager since 30th November 2016. Just prior to the departure of the last manager, the service employed a management consultancy team to help improve the service and achieve compliance. One member of the team agreed to stay on as manager and has submitted an application to the CQC to become the registered manager. However two fit persons interviews had to be cancelled which has resulted in the manager resubmitting their application to register. In this report, we refer to them as the general manager as they are not yet registered.

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.

The service has a manager for each house and for those houses providing nursing there are qualified nurses. The service also had regular support from the regional manager who is on site at least weekly and clinical nurse support. There is also a quality assurance advisor said on average they spent three days on site. They told us their contract was initially for three months and they came into post in September 2017

In summary, we found at this inspection the provider had worked hard to make improvements in the service and the general manager had gained the confidence of the staff. Morale had improved and there had been a real drive to improve staff training and increase staff’s knowledge, confidence and competence. This had a positive impact on people using the service. We requested the staff training matrix which demonstrated that since June of last year training in all key areas of practice for adult social care had gone from 47% of care staff to 87% of staff having completed it. The percentage of staff receiving regular supervision had also increased, with records demonstrating this was not happening frequently before.

Although clear improvement was identified, we found the whole service still required improvement in each key area with several repeated breaches. We found a number of people had not received the care and treatment we would have expected in a timely way. Some of this was due to the pressures on the emergency and primary care services. The service has provided evidence of this and had meant people received delayed treatment and were put at increased risk of dehydration and poor pressure care. We could not see how the service was working closely with other services to improve care outcomes for people. Information about people’s on-going needs and care was not adequate to enable hospital staff to care for people adequately and it was not always possible for staff at Swanton House to escort people.

Staffing at the service had considerably improved with better recruitment and retention of its own staff. Staff were better supported, inducted and trained to help ensure they had the core skills and competencies they needed to provide good care. They had also introduced house managers for the individual services, which helped to develop teams and ensure people received consistent and cohesive care. However, the service still relied heavily on outside agency staff to help ensure they had enough staff to deliver care. The general manager reported last year prior to the last inspection weekly agency usage fluctuated but could be as high as 800 hours. In the last week, they reported 260 hours of agency care. They said this was likely to continue to reduce as they had designated human resources and recruitment was robust. For people at the service this meant they were supported by lots of different staff, some of whom were not as familiar with their needs. This was particularly true at night where a higher percentage of staff were agency and we found there was poor monitoring of the standards of care people were provided at night, which could lead to unsafe, differential care. We also identified that night staff were less likely to have regular supervision or observations of practice and thus less scrutiny of their practice, which was a concern.

The service is complex due to the wide range of needs of people using the service. It is therefore difficult to provide an individualised approach particularly in relation to activities. We saw for example some people benefitting from music therapy, which was provided as a group activity and a one to one activity. Whilst some people clearly enjoyed this, others did not. Some people enjoyed the recent weekly trips but staff were limited to how many people they could take and a lot of people’s needs were not compatible. There was not the opportunity for people to have one to one support to access the community unless it was for a medical appointment. No one had one to one funding to enable staff to meet their individual needs. However the service was reviewing people's needs with the local authority and health authority to see if funding was adequate to meet their needs.

Care plans were in situ and were reviewed monthly. A few minor issues were identified with record keeping and records did not always include enough detail about people’s needs and what was important for staff to know. We saw little information about what a good day would look like for a person taking into account what was important to them and any goals or things they would like to achieve.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found people’s rights were being upheld and staff supported people in lawfully and in line with legislation around mental capacity and deprivation of liberties.

Staff understood what constituted abuse and what actions they should take to safeguard people. They were confident in raising concerns and the manager made themselves available and was responsive to feedback.

People were supported to eat and drink enough for their needs and their weights were monitored to help staff recognise any unplanned weight loss or weight gain. Staff sought advice from other health care professionals who were mostly responsive.

Staff training and support had improved but staff recruitment records could be more thorough to demonstrate that robust recruitment practices were being followed.

Medicines were administered safely and there had been a reduction in medication errors. Where these had been made, the reasons for this were investigated to help reduce the likelihood of this happening again.

Staff were mostly caring but we did identify a few isolated incidents of poor practice. However, the service had worked extremely hard to improve staffs prac

Swanton House Care Centre provides residential and nursing care for up to 49 people. It is divided into three units. Holly Court and Bluebell are single story and purpose built. Birch is a converted period building. Some people who used the service needed support with their mental health needs. For other people their needs were age related or they were living with dementia.

Both Birch and Holly Court provided nursing care whilst Bluebell provided residential care only. Those people requiring care for their age related conditions or support whilst living with dementia, lived in Birch. At the time of our inspection there were 46 people living in the home.

At the time of our inspection, there was no registered manager in post. 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. However, in order to manage the service, the provider had employed a consultancy agency six weeks prior to this inspection. This consisted of a full time manager and part time clinical lead.

We last inspected this service in April 2017 where we found widespread concerns and failure to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the April 2017 inspection, we found six breaches to the regulations. These breaches related to safe care and treatment, safeguarding people from abuse and improper treatment, the need for consent, person centred care, staffing and good governance. The provider sent us a plan to tell us about the actions they were going to take to rectify the breach of the regulations. They told us these would be completed by July 2017.

At this inspection, carried out in August 2017, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be in breach of the above six regulations. In addition, the service had failed to treat people with dignity and respect.

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

The provider had been aware of failures within the service for a number of months. The action plan, quality monitoring system and management resources they had in place to address these failures had not been sufficient. We found continued and widespread issues across the service and we had serious concerns about the health, safety and welfare of people who used it.

The risks around people’s mental health and associated behaviours had not been mitigated and managed. This put them, and others, at risk of harm or abuse. Clear strategies for supporting people living with behaviour that may challenge them and others were not consistently in place. Where they were, they were not consistently being followed by staff. In addition, the procedures in place to safeguard people were not fully effective. Staff were stretched to support people in a safe manner.

People’s basic needs were met but they did not receive person centred care that was tailored to their individual needs. Care and support was delivered in a task orientated manner. People had not been included in the planning of their care and we saw that consent was not consistently sought prior to support being provided. The social and leisure needs of all those that used the service were not being met with little in place to stimulate or interest them.

Care and support was not consistently provided in a way that maintained people’s dignity or in a manner that demonstrated respect. Staff interventions were not consistently empathetic, warm or discreet. Whilst we saw that some staff displayed kindness and compassion, others supported people without any meaningful or effective communication.

There were not enough suitably experienced, skilled or competent staff deployed to meet the needs of the people who used the service. Staff were not consistently trained to the standard the provider deemed necessary and their competency to perform their role had not been fully assessed. Clinical staff’s ability to practice had also not been assessed and they lacked the provider’s core training. Consequently, the provider could not be assured that people were receiving safe or effective support.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. People’s human rights had not been respected and the service had not complied with the Act. Conditions attached to authorised DoLS had not been met which had significantly infringed on people’s quality of life.

Medicine administration records contained gaps and not all risks associated with this task had been fully mitigated. A number of recent medicine administration errors were currently being investigated and some mitigating factors had been taken however, at the time of our inspection, a medicines audit had not been completed for over two weeks.

Records contained gaps in regards to managing people’s nutritional needs and not everyone consistently received the specialist diet they required. People had access to healthcare professionals as required. However records did not consistently demonstrate how, when or if issues were followed up in relation to healthcare needs.

Processes were in place to ensure that only those that were suitable to work in the service were employed. Procedures were also in place that mitigated the risks associated with the premises which included regular equipment maintenance and checks. The service had a complaints policy in place to address any concerns people may have although none had been recorded at the time of this inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Swanton House Care Centre provides residential and nursing care for up to 49 people. It is divided into three units. Holly Court and Bluebell are single story and purpose built. Birch is a converted period building. Some people who used the service needed support with their mental health needs. For other people their needs were age related or they were living with dementia.

Both Birch and Holly Court provided nursing care whilst Bluebell provided residential care only. Those people requiring care for their age related conditions or support whilst living with dementia, lived in Birch. At the time of our inspection there were 48 people living in the home.

At the time of our inspection, there was no registered manager in post. 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.

An application to register one of the service managers had been received by CQC and, at the time of this inspection, was being processed. However, shortly after the inspection, we received confirmation that this service manager intended to withdraw their application. They were present at this inspection.

We last inspected this service over March and April 2016 where we found that the service was not meeting one requirement of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to meeting people’s nutritional and hydration needs. The provider sent us a plan to tell us about the actions they were going to take to rectify the breach of the regulations. They told us these would be completed by June 2016. At this inspection, carried out in April 2017, we found that the service had made some improvements in regards to meeting people’s nutritional needs and were no longer in breach of this regulation.

Six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified at this inspection carried out in April 2017. These breaches related to safe care and treatment, safeguarding people from abuse and improper treatment, the need for consent, staffing, person centred care and good governance.

The provider was already aware of the issues we identified at this inspection and action plans were in place to address them. However, the concerns had been evident for some time and insufficient action had been taken to rectify them in a timely manner.

A reduced management team had had an adverse impact on the service and there were not enough resources in place to ensure a consistently good quality service was being delivered. The processes for assessing, monitoring and improving the service had not been effective.

People did not consistently receive care and support that was tailored to their individual needs. Care plans lacked accurate, up to date and person centred information that reflected people’s needs. The social and leisure needs of all those that used the service were not being met.

Risks were not always fully mitigated and managed. Clear strategies for supporting people living with behaviour that may challenge them and others were not consistently in place. The procedures in place to safeguard people were not fully effective. Staff were stretched to support people in a safe and dedicated manner.

Medicines management arrangements had not been regularly reviewed and audited and some people had not received their medicines as the prescriber had intended. This put people at risk of a decline in their mental and physical wellbeing.

Records contained gaps in regards to managing people’s nutritional needs and there was confusion over how this was managed. There was no clear process in place to effectively monitor, assess and analyse people’s nutritional and hydration intake. People had access to healthcare professionals as required. However records did not demonstrate how, when or if any issues were followed up in relation to healthcare needs.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. People’s human rights had not always been respected and the service had not been fully compliant with the Act.

Staff received an induction and regular support and supervision. However, considerable amounts of staff training were overdue and the competencies of staff to perform their roles were not assessed. Clinical staff had not been assessed in regards to their practice and also lacked up to date training. Consequently, the provider could not be assured that people were receiving safe or effective support.

Processes were in place to ensure that only those that were suitable to work in the service were employed. However, some staff raised concerns about the provider’s ability to recruit suitable managers due to the recent turnover.

Staff demonstrated a polite, respectful and caring approach although they were often too busy to engage and interact with people for more than a brief moment. People’s dignity was maintained and records were stored confidentially. People had some choice in their daily living but this was limited. People were not actively supported to achieve their goals and aspirations and not always included in planning the care and support they received.

The staff team demonstrated that they were supportive of each other and those that used the service. They were understanding of the constraints the management team were under and showed support to them. Staff morale was variable, as was team work, however staff showed us that they were committed to each other, those living in the home and the service.

A complaints policy in place to address any concerns people may have. Staff and those that used the service said they would feel comfortable in raising any concerns. There were no restrictions on the times people’s friends and relatives could visit them.

The service provides accommodation and support with personal care or nursing needs to a maximum of 49 people. It is divided into three different units, two of which are purpose built. Some people using the service needed support with their mental health needs. For other people their needs were age related or they were living with dementia. The provider set out on the home’s website and to the Care Quality Commission (CQC) that they can also provide support to people with a learning disability or autism. At the time of our inspection there were 46 people using the service.

There was a registered manager in place. A registered manager is a person who has registered with CQC 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. The current manager had completed registration with CQC in February 2016.

At our last inspection on 24 April 2014, concerns were identified that care plans did not all contain relevant information about people's needs and were not updated regularly. At this inspection we found that action had been taken so that staff had access to information about the care people required.

People experienced a service that was safe. Staffing levels had improved and people received support from staff in a timely and safe way. Staff understood their obligations to report any concerns that people may be at risk of abuse or harm. The risks to which people were exposed were assessed with guidance for staff about how to minimise these.

Medicines were managed in a safe way.

The service people received was not consistently effective. Mealtime routines did not always provide an experience conducive to encouraging people to enjoy their meals. There were shortfalls in the way that people's intake of food and drink was monitored and encouraged to ensure this was sufficient for their wellbeing and health. We have told the provider they need to make improvements in this area.

Although underpinning written assessments of people's capacity to make informed decisions were not always properly completed, staff understood their responsibilities under the Mental Capacity Act 2005 for supporting people to make decisions. Action had been taken to ensure people's rights and freedoms were protected and that any restrictions were considered to see if these were appropriate.

Staff ensured that prompt action was taken to seek advice about people's health when they became unwell.

People received support from staff who were kind and compassionate. Staff took action to intervene promptly when people became distressed and needed reassurance. They respected people's privacy and dignity.

The service was responsive to people's needs and preferences. Staff were flexible in the way they delivered care to people. They took into account individual preferences and day-to-day changes in their wellbeing before tailoring how they offered support that people needed.

Although people were not all aware of the formal process for making complaints, they were confident that any concerns they needed to raise would be dealt with properly.

People experienced a service that had not been consistently well-led. Changes in management arrangements, both within the provider's management team and within the service, compromised the ability of the service to demonstrate consistent, stable and appropriate leadership. The new arrangements needed time to consolidate to ensure identified improvements were made and sustained, taking into account the views of people using and working in the service.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:-

Is the service safe?

People living in the home told us that they felt safe. The environment was safe, clean and hygienic. Equipment used at the home was well maintained and had been regularly serviced. There were enough nursing and care staff on duty to meet the needs of the people living at the home.

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living in the service.

There was a proper process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Records, policies and procedures were held and relevant staff had been trained and knew how to submit a DoLS application.

Is the service effective?

People's health and care needs were assessed with them. Specialist dietary, mobility and equipment needs had been identified in care plans when required. People told us they received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that staff understood the care and support needs of each person. One person told us. 'This is a lovely, comfortable home and the staff will do anything to help you. You only have to ask.' Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that care workers were patient and encouraged people to be as independent as possible. People told us that the staff were often very busy but did not rush them. Our observations confirmed this. A visitor told us. 'I am so happy with the care given to my family member. The members of staff are so polite and respectful.'

Is the service responsive?

Care and risk assessments had been completed before people moved into the home and when their needs had changed. A record was held of their preferences, interests and diverse needs. People told us that staff members consulted them and encouraged them to make their own decisions. People had access to a range of planned activities and outings.

Is the service well led?

All of the staff spoken with had a good understanding of the whistleblowing policy. A variety of quality assurance processes were in place to ensure that the standard of care provided to people was monitored and improvements were made. Visitors and staff said they had felt listened to when they had made a suggestion or raised their concerns. People living in the home told us that their views were listened to and they were included in discussions about any planned changes within the home.

During our discussions with staff we found that they had a good understanding and awareness of people's care needs and preferences. They were knowledgeable about people's needs and promoted their independence.

Staff were provided with training and support to enable them to care for people living at Swanton House Care Centre.

During our inspection we were approached by the relatives of a person using the service. They told us that they thought their relative was 'safe' and that the staff were 'extremely good'. They further commented that whilst their relative had been living at Swanton House Care Centre, they had 'never had a moment of doubt or concern' about the level of care provided to them.

Our observations of the home demonstrated to us that it was clean, free from any unpleasant odours and that infection control practices were in place. For example, we observed staff wearing disposable gloves and aprons and saw cleaners undertaking their duties.

Staff were provided with training and support to enable them to care for the people living at Swanton House Care Centre appropriately.

People were given support by the provider to make a comment or complaint.