Archived: Swiss Cottage Care Home

Updated 28 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 3 inspectors, a medicines inspector and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Swiss Cottage is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Swiss Cottage is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 9 August 2023 and ended on 31 August 2023. We visited the service on 9 August 2023 and 17 August 2023.

What we did before the inspection

We spoke with the local authority to gain their views of the home and looked at the information we held about the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service and 15 relatives about their experience of the care provided. We spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service.

We spoke with 22 staff including domestic staff, maintenance staff, kitchen staff, care staff, nurses, the registered manager and the regional operations manager.

We reviewed 17 people’s care records. We looked at 3 staff files in relation to recruitment practices. We reviewed various records relating to the management of the service including training records, quality assurance reports and accidents and incidents.

Updated 28 October 2023

About the service

Swiss Cottage is a residential care home providing personal and nursing care to up to 85 people. The service provides support to older people, some of whom are living with dementia. The home consists of 4 units, of which 2 were used. At the time of our inspection there were 30 people using the service.

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

People were not always protected from abuse and improper treatment. People did not always receive safe care as individual and environmental risks were not always well managed. Learning could not always occur from incidents and accidents or when people experienced emotional distress due to a lack of reporting. There were shortfalls in infection prevention and control. Topical medicines and thickening agents were not always safely managed. There were enough staff deployed, however they did not always work effectively to meet people's needs. Relatives felt staffing levels had improved. People were able to receive visitors without restriction.

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. Although, the policies and systems in the service supported this practice, they were not always operated effectively.

People did not always have their health needs met or well monitored and were at greater risk of weight loss due to unmet nutrition needs. Food was not always appetising, and people were not always offered choice and variety in what they ate. Staff had received training and supervision, but this had not resulted in safe practices.

People were not always treated with dignity and respect. For example, personal information was displayed on people's walls, which informed passers-by of confidential information about their needs. People's gender preferences about who supported them with personal care were not always upheld.

Records showed people's hygiene preferences were not maintained. Care plans did not always contain person-centred information about people’s past histories and preferences. People did not receive regular support to take part in meaningful activities.

Systems and processes continued to be ineffective and did not ensure people received a quality service. The provider did not always follow their own policies relating to areas such as infection prevention and control, falls management and safeguarding. There was not an effective system to review and ensure care plans were accurate. The provider had not submitted all required notifications to CQC. However, relatives were kept up to date. People, relatives and staff felt the registered manager was approachable.

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 inadequate (published 22 February 2023). The provider completed an action plan and we had continued to impose conditions on their registration at this location. At this inspection we found the provider remained in breach of regulations. This service has been in Special Measures since 11 September 2021.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement

We have found breaches in relation to people’s safety, safeguarding, person-centred care, dignity and respect, nutrition, handling complaints and good governance.

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 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 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 of 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.