Swan Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The provider had a proactive and positive culture of safety. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were effectively managed, and learning was used to promote safe practice. The provider had clear systems in place for recording and reporting any events that occurred.

When an accident or incident happened, staff followed an established process to document and analyse what had taken place. Actions arising from reviews were shared with the staff team and incorporated into people’s support plans where relevant. For example, where additional monitoring was needed, 24‑hour monitoring was put in place and recorded as part of the person’s support arrangements.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Preadmission assessments and transition planning were robust and ensured people experienced a safe and well-coordinated move into the service. The registered manager completed thorough assessments before anyone was admitted, enabling the service to fully understand people's needs in advance. Transition visiting was in place when possible. This included relatives where appropriate and offered opportunities for prospective residents to visit the service to help them feel comfortable and prepared. A relative told us “I came to have a look initially. We visited then with [person]; they were able to choose which room they wanted.”

People who may require hospital admission had up-to-date hospital passports in place. These documents contained essential information about individuals’ health needs, current care requirements and key contacts. This supported effective communication and continuity of care should someone need to attend hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems to safeguard people from abuse were effective and understood by staff. A safeguarding adult’s policy was in place to guide practice, and staff had completed safeguarding training. They demonstrated clear knowledge of their responsibility to report any signs of potential abuse. One member of staff told us, “I would report any concerns to [registered manager] and if they were not at work we can ring through to on call.”

People and their relatives told us they felt safe living in the home.

The service was working in line with the Mental Capacity Act (MCA).People were only deprived of their liberty when this was in their best interests and legally authorised through the Deprivation of Liberty Safeguards (DoLS). Appropriate DoLS authorisations had been applied for were in place for people who were deemed to lack capacity.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks were assessed to ensure people were safe and staff took action to manage any identified risks. Records were detailed, accurate and current.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Not all building checks were completed. We identified that they did not document regular flushes of sinks and toilets that were not frequently used. This could increase the risk of legionnaires developing. We discussed this with the registered manager who advised us they will take action.

We also identified exposed pipes in a bathroom. The garden required maintenance and removal of items that may pose a risk. We discussed this with the nominated individual and registered manager who advised they were planning to improve the garden setting as soon as possible.

Other records did show routine monitoring of electrical systems, water temperatures and fire safety equipment. Personal emergency evacuation plans(PEEPs)were stored in an accessible emergency grab bag.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s needs. The management team used a dependency tool to determine the number of staff needed to support people. Staff received appropriate training to ensure they could complete their role effectively. The registered manager was visible and able to step in if needed. A relative told us, “Staff are constantly going in and out and [person] feels safe here.”

Recruitment procedures were in place to ensure pre-employment checks were carried out before they commenced their employment. This included enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean, and people told us the home “Was kept spotless.” Staff had access to personal protective equipment (PPE) and demonstrated safe practice. Planned improvements to the laundry room had been completed to ensure better levels of infection control.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

As needed (PRN) medication was administered but the persons response to this medication was not recorded to review if the medication had been effective despite this being the process to follow in accordance with the providers administration of medicines policy. There were effective PRN protocols in place however, and the provider had documented reasons why PRN medication was administered.