Swallow Lodge

Swallow Lodge is a respite care home providing personal care to up to 8 people. The service provides support to people of all ages who have physical disability, sensory impairment or who are living with a learning disability, autism or dementia. At the time of our inspection there were 3 people using the service, however this varied daily. The care home is a purpose-built single-story building.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People’s individual communication needs were recorded. Staff received training in how to meet people’s communication needs. People could communicate with staff and understood information given to them because staff supported them consistently and understood their individual communication needs.

People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.

Right Culture:

Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

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 11 June 2022) and there were breaches of regulation.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

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

Follow up

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

About the service

Swallow Lodge is a short-term respite service providing personal and nursing care to five people at the time of the inspection. The service is registered to provide accommodation for a maximum of eight people with a learning disability. People stay at the service to receive respite care, and over a period of a year, up to 60 people use the service.

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

Right Support

The service did not support people to have maximum choice, control, be independent and have control over their own lives. Where people lacked capacity to make decisions, the provider failed to put in place documents to support decision making.

Ineffective care planning led to people experiencing increased periods of distress and restrictive practices.

A complete failure to record and monitor incidents meant there were no learning to avoid and reduce reoccurrence.

The service failed to provide a safe, well maintained environment; areas often had to be closed off from use due to risk behaviour presented by people.

Planned activities were minimal and people lacked stimulation and interaction from staff due to significant staffing issues at the service.

Medicines were not managed safely. The provider failed to put in place ‘as and when required’ (PRN) protocols for antipsychotics, meaning we could not be assured this was given appropriately.

Right Care

Peoples equality and diversity needs were not always met. Cultural needs were not understood or met.

People did not always have the opportunity to have privacy, the provider had failed to design the environment to promote this.

The service failed to protect people from poor care and abuse. Staff had failed to identify, record and report incidents, the provider had failed to monitor the quality of the service resulting in poor care and incidents of a safeguarding nature occurring.

The service did not have enough staff to meet the needs of people. Staff deployment meant people did not have suitably qualified and skilled staff to support them.

Risk management was poor. A lack of support plans and assessments in place meant people’s needs were not identified assessed or managed effectively.

Opportunities for people to engage in activities were minimal. The provider failed to personalise and plan meaningful activities for people.

Right culture

There were indicators of a closed culture and a punitive approach used by staff. Staff had a lack of support or guidance on how to support people to lead inclusive and empowered lives.

People received poor quality care, due to staff not having the required skills and abilities to meet people’s needs.

Staff did not always know the person due to a lack of training and support plans in place. This meant care was not personalised or tailored to their needs.

Staff turnover was high, meaning people received inconsistent care from staff that did not know them.

The culture of the home was negative, and staff told us they had to just get through the day. Meaning there was no drive for improvement or quality within 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

The last rating for this service was good (published 29 December 2018)

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, personalised care, dignity and respect, deprivations or liberty and leadership at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

There was a registered manager in post who was available throughout the inspection. 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 people using the service were protected from harm as the provider had robust processes in place to ensure their safety. Staff supporting people were aware of their responsibilities in relation to protecting them from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

The risks to people’s safety were clearly identified with measures in place to reduce these risks. The environment and essential equipment were well maintained and met the needs of the people who used the service.

People were supported by well-trained and competent staff in sufficient numbers to keep them safe. Their medicines were managed safely and people were protected from the risk of infection through good hygiene practices, and staff knowledge of reducing the risks of cross infection.

People’s rights were protected under the Equality Act. They were supported to maintain a healthy diet, with staff showing good knowledge of their nutritional needs. Staff were supported with appropriate training for their roles.

People received support with their health needs through well-developed links with local health professionals.

Staff sought consent from people before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness and care by staff who supported them with respect and dignity. Staff developed positive relationships with people in their care.

People could maintain relationships with people who were important to them, and relatives felt their views and opinions about their family member’s care were listened to.

The care people received was person centred and met their individual needs. People were supported to take part in a range of social activities both at the service and in the local community. There was a complaints procedure in place and people and their families knew who to complain to should they have any issues.

The service was well led, the registered manager was visible and supportive towards the people in their care, their relatives and the staff who worked at the service. The quality assurance systems in place were used effectively to monitor aspects of care. The registered manager and provider responded positively to changes and used information to improve the service and care people received.