Swanton House Care Centre Also known as 1-126608129

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Meetings, resident of the day and care plan reviews were held to help ensure people's needs were documented and reflected any changes in people's needs. We found however that care plan reviews were not always up to date or clearly identified changes or concerns in regards to people's needs. For example, where a person had a number of seizures this was not noted in their monthly review of their epilepsy care plan to ensure all of the information had been considered.

We received mixed feedback from relatives about their involvement in care plans and reviews with some feeling very well informed and others not so, but this was also dependent on how involved relatives were in their family member’s care. Records did not clearly show us who had been consulted in the design and update of the care plan.

Some plans referred to key workers, but the registered manager said this system was not in place. However, core teams headed up by unit managers and team leaders worked in each unit which gave consistent oversight and meant people and relatives always had familiar face to refer too.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Annual reviews were up to date and there was evidence that staff discussed with people their needs but recording of this was not robust in their individual records.

Staff understood people’s needs and received training to help them meet the needs of people they were supporting to improve their mental health and understand the needs of autistic people and people with a learning disability. Nurses oversaw people’s clinical needs and accessed external support when needed.

The provider did not always work effectively across teams and services to support people. Assessment of needs were completed but we found information sharing with other partners limited, because Information was sometimes out of date or inaccurate.

Assessments of need were completed and kept under review with care plans documenting how that need should be met. However, we found some information was out of date or inaccurate which could result in inconsistencies in people’s care particularly when moving services. The handover process did not assure us all staff were sufficiently updated in regard to changes in people’s needs.

The provider mostly supported people to manage their health and well-being, and mostly supported people to maximize their independence, choice, and control. Staff tried to support people to live healthier lives, or where possible, reduce their future needs for care and support.

Swanton house provided accommodation and support to people with often multiple health needs and chronic conditions which needed long term management. Whilst we had concerns about hospital admissions and whether these were avoidable, we were assured by the GP who knew people well and provided consistent support to the home. The GP confirmed that some people made poor lifestyle choices which could compromise their health like smoking and people knew the risks.

Whilst people were able to make these choices, Care plans did not give sufficient details on how to support people to live well. Oral health care assessments were in place but there was a lack of dental provision in the area (due to a national shortage) which made it vitally important to review these assessments regularly which they were not and flag concerns about the lack of provision as required.

We also noted that one person did not have a bowel motion for six days before any actions were recorded.

We identified a number of potential risks on site which included: poor posture and staff supervision when people were eating which could increase the risk of choking.

People were supported by staff who knew them well and who were able to pick up on changes in their needs and discuss in the first instance with their GP.The GP and other specialists knew people well and had built key relationship with them and staff.

People’s medicines were regularly reviewed to ensure they remained appropriate for use. The service had a low incident of falls and a low incident of skin care issues. Smoking was managed with the agreement of people to reduce the number of cigarettes smoked and to seek alternatives where appropriate. Staff recorded people’s weight and monitored food and fluids as required. We reviewed weights which showed unintentional weight loss was followed up with the GP or other health care professional.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Whilst people spoken with had settled well at the service and the registered manager told us there had been a decline in more extreme behaviours, we found some behaviours were not recorded or monitored. We also found that although health and care reviews were held regularly care plan reviews did not clearly show the involvement of people or how these reviews were used to set and achieve clear objectives for people. Whilst people’s day to day needs were being met forward planning was lacking to help ensure the service remained appropriate to people’s needs and wishes.

Managers and teams’ leaders were reviewing care plans, but we found some of the monthly reviews did not provide a summary of the previous month. For example, one review failed to summarise the fact that the person had three seizures the previous month and was seen by medical professionals. We were unable to see the outcome of the GP visit and the care plan and risk assessment had not been updated. Another person had a social care plan stating many things they liked to do but the monthly summary sheet just recorded no change. It did not summarise the activities they had completed in the previous month which would help us make a judgement about how their needs were being met.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We were not assured how the provider was working in line with the principles of the Mental Capacity Act 2005. Information sharing and governance was poor. Care plans were not uniform and varied in information. We saw a lack of recorded consent and consultation for decisions made on people’s behalf. We were concerned that for one person, an epilepsy monitor was being used without a clear record of how it was in the persons best interest and the least restrictive way to keep them safe. Other restrictive practices like bedrails were documented but we could not see who the assessor was as their name was recorded but not their role.