Swan Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in continued breach of legal regulation in relation to consent and capacity, staffing, and person-centred care.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. Whilst nobody new had joined the service since our last inspection due to a local authority commissioning embargo, re-assessments did not always take place when people’s needs changed. We found continued shortfalls and inconsistencies in care planning documents, reflecting an ineffective assessment process. There was no evidence to show how people were involved in developing their own care plans, and no information about people’s aims, ambitions and ways to enhance and enrich their wellbeing. We received mixed feedback about whether relatives were involved in planning and reviews, with some involvement on a more informal basis. One person’s relative said, “We are not involved formally in updates about [person], they (staff) tell me when I go.” Another person’s relative told us, “The home doesn’t involve us in reviews or assessments, but social services do.” During the inspection, the provider acknowledged our concerns about generic and inconsistent care planning and told us they would review these documents and provide an update to the CQC. However, no information was supplied before people were supported by the local authority or their relatives to move out of the location into the care of other services.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care was still not consistently being provided in alignment with national best practice guidance, including on how to support people living with dementia. We found training records showed only 62% of staff had received training in dementia care, which meant staff were left to provide intuitive support rather than following an evidence-based approach. However, improvements had been made to the mealtime experience, and we saw pictorial menus on display to support people to choose what to eat. Meals were nutritious and well presented, and we received positive feedback in this area. A relative said, “[Person] had shepherd’s pie and then apple pie and custard, for many years [person] would hardly eat anything.” There was also a selection of snacks and drinks made available throughout the day.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Handovers took place for the staff team to share information about people’s needs, but we found some gaps in these records. Care plans and risk assessments were not accurate or personalised enough to support good team working. Despite this, we received some positive feedback from professionals who worked with the service day-to-day that staff were familiar with people’s needs. One professional said, “Communication is improving; that's an area that could be improved further, however, information shared by the service is generally accurate.” However, we also received concern from other stakeholders about a failure to work well together to support good outcomes, particularly during the transition process as people moved out of Swan Care Home.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. The service made referrals to other services, such as the chiropodist, occupational therapist, dementia support services, and the district nursing team. There was also a regular ward round from the GP. A relative said, “[Swan Care Home] will have a chiropodist in, and the optician and the GPs are up in the village; they come down and make sure if everything is alright if there are any concerns.” However, shortfalls in the provider’s own monitoring processes and records posed a risk people’s needs might not be identified and escalated in a timely way. We also received mixed feedback about whether relatives were informed of any deteriorations in health. One relative told us, “[Staff] called me 2 weeks ago as [person] was complaining of being in pain, [person] had an infection and [staff] called an ambulance.” However, this was not consistent, as another relative told us, “We don’t get to know if [person] isn’t very well.”

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Quality of life metrics were not proactively monitored, and we saw the provider recorded basic personal care such as ‘hair brushing’, ‘shaving’ and ‘hair washing’ as distinct leisure activities. Notes on the electronic daily care notes system were not always contemporaneous or made by the staff member providing care and therefore did not give an accurate reflection of support provided. Care plans and risk assessments did not provide the level of detail needed to guide staff on what clinical outcomes were being sought. For example, records showed 1 person was on a fluid watch as they were unable to recognise hunger or thirst due to their healthcare condition. There was no record of what fluid total should be achieved for the person each day, and no evidence low fluid intake had been reviewed or escalated to reduce the risk of dehydration. We found staff were checking pressure relieving air mattresses with no information as to what pressure they should be set at or the frequency of checks required, making this process ineffective in reducing the risk of pressure injuries. We also saw there were multiple gaps and inconsistencies in repositioning records, and care plans failed to include key advice from professionals such as district nurses about how frequently support should take place. This placed people at risk their clinical outcomes would not be met.

The provider did not tell people about their rights around consent or respect their rights when delivering care and treatment. At the last inspection, the provider had failed to assess people’s capacity to consent to all aspects of their own care and treatment. At this inspection we found decision-specific Mental Capacity Assessments (MCAs) were not being completed effectively to protect people’s rights within a legal framework. For example, 1 person’s care records showed they had refused important healthcare treatment, but there were no MCAs in place to show the provider had ensured the person had the capacity to make this decision. There was also no evidence of how staff had communicated with the person to ensure they fully understood the risks and benefits to give informed consent. We found continued risk indicators of a closed, institutionalised culture. Since the last inspection, the provider had installed video and audio Closed-Circuit Video (CCTV) in all shared parts of the building. Where people lacked the mental ability to give their consent to the surveillance the provider had not followed the requirements of an MCA assessment and associated code of practice to ensure this was in people’s best interest. The Nominated Individual was the only person able to access the footage, which they told us was to review accidents and incidents. As there was no formal analysis of incidents or evidence of CCTV having been used in this way, the provider could not demonstrate how CCTV was the least restrictive option to meet this purported safety objective.