Swanland House

Swanland House is a residential care home providing personal and nursing care to up to 35 people. The service provides support to people with dementia, older people and younger adults. At the time of our inspection there were 19 people using the service.

Swanland House is a privately owned residential care home that operates in a Grade 11 listed building.

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

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; the policies and systems in the service did not support this practice.

The leadership, governance and culture did not promote the delivery of high-quality person-centred care. Managers did not lead effectively, and staff did not feel listened to or valued.

The provider did not provide consistent leadership and managers were not clear what their roles and responsibilities were. Staff told us, “[Registered manager] was supportive but was a ‘jack of all trades’ and did everything.”

The registered manager did not regularly review staffing levels and adapt them to people’s changing needs to ensure there were enough competent staff on duty. Relatives told us, “I don’t think there are enough staff” and “The home has been dreadfully short staffed.” Recruitment systems were robust and ensured the right staff were recruited to support people to stay safe.

There is limited use of systems to record, manage and report concerns about risks, safety and incidents. People were not involved in managing risk. Risk assessments were not person centred and reviewed regularly. People did not always receive their medicines as prescribed. Medicines were not stored correctly and disposed of safely.

The providers quality assurance arrangements were not strong so did not identify current and potential concerns and areas for improvement. Concerns were not investigated, and there were no opportunities for learning when things went wrong.

Staff supervision and support was inconsistent. Training and development plans were not designed around learning needs and the care and support needs of people who use the service. We have made a recommendation about supervision and appraisals.

The service monitored people’s heath, care and support needs, but did not consistently act on the issues identified. There was a process in place for referring people to external services.

Staff had an awareness and understanding of abuse and knew what to do to ensure people were protected.

The service manages the control and prevention of infection well. Staff are trained and understand their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises.

People had access to suitable outside space, a quiet area to see their visitors, an area suitable for activities and private areas where people could be alone.

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

Rating at last inspection

The last rating for this service was good (published 16 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the assessment and management of people’s risks. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement and recommendations

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 the safety and quality of the service, the mental capacity act 2005, staffing and the overall leadership and management of the service.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

The provider is currently working with the local authority and safeguarding team to ensure records are relevant and up to date and care plans and risks assessments identify current needs and are appropriately managed.

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

We found the following examples of good practice.

Visits were arranged in line with government guidance.

Staff were wearing personal protective equipment (PPE) in line with government guidance.

People and staff were part of a regular testing programme.

Staff had received training in infection prevention and control (IPC).

Staff had received the COVID-19 vaccination as a condition of their deployment.

Swanland House is a care home providing personal care for up to 26 people. There were 17 people living in the home at the time of the inspection.

We found the following examples of good practice.

¿ The provider had implemented effective systems for monitoring signs and symptoms of covid-19.

¿ The provider was in the process of having an external visiting room with separate entrance and exits and full Perspex screen to separate the room to allow for safe visiting.

¿ Effective plans were in place to enable zoning of the units and people would have dedicated staff to support them to reduce the risk of the virus spreading in the event of a Covid-19 outbreak.

Further information is in the detailed findings below.

Swanland House is a residential care home that provides accommodation and support to a maximum of 21 older people, some of whom may be living with dementia. The service is a privately owned residential care home that operates in a Grade II listed building. The home is surrounded by well kept gardens in the village of Swanland in east Yorkshire.

Staff interacted with people at every available opportunity and understood the importance of researching people's history and interests. This information was utilised to provide engaging activities and events that people enjoyed.

Staff were knowledgeable and knew people very well, taking a proactive approach to ensure changes in care needs were updated without delays to support people as they had chosen.

People’s support plans were concise and person-centred. Staff supported people to enjoy one to one and group activities, encouraging relatives to join in when they could to create a homely atmosphere.

People were protected from avoidable harm and abuse. Systems and processes were in place to record and action any outcomes where safeguarding concerns had been raised.

Assessments of risks associated with people’s care and support and for their environment had been completed. Assessments and support plans were in place and regularly reviewed to ensure people received safe care and support without undue restrictions in place.

The provider maintained safe staffing levels and recruitment included pre-employment checks to ensure people were of suitable character to work in a care home environment.

Systems and processes ensured safe management of medicines and infection control.

People received appropriate care and support to meet their individual needs because staff were supported to develop their existing skills and knowledge alongside regular supervisions to carry out their role.

People were 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 told us that staff maintained their privacy and dignity whilst promoting their independence when possible. We observed practices that supported this information.

Staff were knowledgeable about supporting people's diverse needs and how to promote equality in the home. Staff knew people well ensuring their care and support reflected their wishes and preferences.

Systems and processes were in place to support people should they need to raise a complaint. Relatives told us that the registered manager was proactive in dealing with any concerns.

The provider sought feedback from people and their relatives to improve the service and lives of people living at the home. People's relatives or representatives were invited to participate in the running of their care provision.

Quality assurance systems were in place to drive improvements within the service. The registered manager knew the people living at the service and their relatives; this had built strong foundations for ensuring all aspects of people's needs were met. Staff told us the manager was approachable and extremely supportive, this added to the friendly and welcoming atmosphere of the home.

Further information is in the detailed findings below.