Swan Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in continued breach of legal regulation in relation to person-centred care and dignity and respect.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. The provider did not treat colleagues from other organisations with kindness and respect. Despite the provider telling the CQC at the last inspection they would improve the use of person-centred language, we found continued poor practice. This meant people were described in a way which was not dignified or empathetic. Records described people as ‘aggressive’, ‘soiled’, ‘so smelly’, making ‘annoying sounds’, and ‘wandering’. Continence care was discussed in shared spaces, and scented baby ‘nappy bags’ were on display in the hallway alongside PPE, which was undignified. Whilst we saw care staff were trying their best in difficult circumstances, significant provider failings did not reflect a caring service. For example, staff were not given any training in dignity and respect, and only 38% of staff had completed training in person-centred care. The Nominated Individual also routinely assigned 2 male care workers to the night shift, without considering if this met people’s gender preferences for who should support them with their personal care. Despite this, we received feedback staff were kind and compassionate. One person’s relative told us, “I think the care [person] gets is amazing they (staff) are always popping their heads in to see if [person] is alright.” Another relative said, “I think they (staff) are trying their best to be kind and caring.” Observations showed people looked generally well presented and had their personal care needs met. One relative said, “[Person] is clean and tidy and well-presented.” However, when asked how they would rate the care provided, another relative said, “It is 7 or 8 out of 10” as “sometimes [person’s] nails are grubby.”

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. Our observations showed care workers sought to support people as individuals, and there were some positive interactions. A staff member told us, “There aren't many residents (people), so the home does feel quite close-knit, but it means that you get to know everybody on an individual level and we have some great characters.” However, care plans lacked information and were generic, making this more difficult for the staff team. Leisure activities were still not personalised, and there was a limited activity schedule which may not be inclusive for people from different backgrounds and religions. For example, the activity on offer every Sunday was ‘Bible reading.’ We received mixed feedback about whether staff knew people well. One relative told us, “They (staff) know [person] well and [person] knows them.” Another relative said, “I asked recently, after the new managers took over, I asked about my [person] and they asked, ‘[person] who?’.”

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing. People still did not have the opportunity to meaningfully exercise choice, independence and control. We saw some instances of continued restrictive practice reflecting institutionalised care and a lack of understanding about people’s needs. For example, a lack of tailored activity provision meant people had limited meaningful ways to spend their day if the group activity failed to meet their interests. Despite this, we received some positive feedback people could make choices about basic everyday decisions such as what to eat or what to wear. A relative said, “[Staff] know [person] likes ice-cream and they know [person] likes mash and not chips. They (staff) let [person] have a lie in if [person] wants to.” Despite the best efforts of care staff, the provider had failed to ensure all the systems in the service supported an approach which empowered people, or treated them as unique individuals with skills, strengths and personal goals.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. Whilst observations showed some staff were able to respond well to people and provide reassurance, this was inconsistent, and particularly when people became very distressed. Records did not contain sufficient information about how to support people when expressing their emotions or communicating an unmet need, leaving staff to provide intuitive care. The provider had assured the CQC care plans would be updated following the last inspection, but this had not been completed. This reflected a failure by the provider to support staff, impacting on people as they were not protected from unnecessary distress or discomfort. For example, some records referred to people accessing ‘prohibited areas’, ‘not co-operating’, ‘a refusal to listen to instructions’, and ‘crying without any reason’. We also saw instances where there were 3 staff present during personal care without an assessed need for this level of intervention, which is restrictive practice and could increase levels of anxiety and distress. We raised our concerns with the local authority safeguarding team.

The provider did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care. At the last inspection we found staff sought to provide a good level of care but could not meet people’s individual needs due to systemic provider failures. This concern had not been addressed. Although staff were described by relatives as, “Very good with [person]” and “Incredibly kind”, there were no effective systems in place to protect staff wellbeing. The provider failed to invest in staff, and left them unsupported without consistent management, induction, training, or guidance. There were also no de-briefs to support staff if they were injured during incidents where people became distressed. At the last inspection we found staff working excessive hours, placing them at risk of stress and fatigue related mistakes. Although staff told us they received breaks, there were no complete or accurate records to show staffing levels on site and to ensure they were not working excessive hours. This included missing or incorrect staff sign-in sheets, daily care notes, staffing allocation sheets and rotas. Some staff worked in more than 1 job, but there was no information to show how many hours a week this involved. We also saw unsafe ‘on call’ arrangements at nighttime, with no record of some staff members being in the building. After our visit, the provider confirmed they would no longer allow staff to work unsafe hours. However, we could not rely on these assurances, as action promised at the last inspection had not been taken.