Swanholme Court

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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were assessed before they moved into the home and reviewed on an ongoing basis. Staff described how information was gathered through assessments before people moved in and visits, which helped ensure people’s needs could be met. Care plans were developed to guide staff and were accessible through electronic systems.

Relatives told us they were generally involved in assessing and reviewing people’s needs. They described being asked for information about people’s preferences and history, and some had been involved in care planning and reviews. However, experiences of involvement were not consistent, with some relatives reporting limited participation in these processes.

Reviews of care were taking place, and staff described regular updates and oversight by senior staff. However, review notes were not always meaningful, with some records showing repetition and limited evidence of how care had been evaluated or updated. This reduced assurance that reviews were effectively informing care planning.

A new approach to reviewing care, including a ‘resident of the day’ system, was being introduced to strengthen how people’s needs were reviewed and updated. There were also plans in place for the new registered manager to review care plans with people and their relatives to ensure they were accurate and reflective of people’s needs.

Care and support were delivered in line with recognised guidance and best practice. Staff had access to training relevant to people’s needs and described how they would seek advice from healthcare professionals when needed, which supported the delivery of appropriate care.

Relatives told us staff understood people’s health conditions and supported them appropriately. They described staff explaining changes and responding to people’s needs, which helped them feel reassured about the care provided.

Recognised assessment tools were used to support people’s health needs. Systems were in place to identify and monitor risks related to nutrition and health conditions. Kitchen staff were aware of people’s specific dietary needs, including those relating to swallowing difficulties and long-term conditions such as diabetes, and understood how to meet these safely. Guidance from professionals such as speech and language therapists (SALT) was followed.

There were systems in place to gather information about people’s dietary needs from admission and to keep this under review. Changes were communicated to kitchen staff, which helped ensure meals remained appropriate and in line with people’s current needs.

Staff worked together to provide coordinated care and support for people. Staff described how they communicated with each other and escalated concerns to senior staff or external professionals when needed. There were systems in place to support joint working, including shared care records and processes for referring to other services, which helped support continuity of care.

Relatives told us staff generally worked well together and kept them informed about changes, which helped them feel reassured about the care their family members received.

However, communication between staff teams was not always consistent. Staff described challenges in sharing information, particularly during shift changes and periods where staff had been away from the service, such as annual leave. There was also a reliance on electronic systems which staff felt was not always sufficient on its own. This meant important updates were not always communicated effectively and staff did not always have the same level of understanding about people’s needs, which could affect consistency of care.

People were supported to maintain and improve their health and wellbeing. Staff described how they monitored people’s health and responded to changes, including seeking advice from healthcare professionals when needed. Referrals were made to appropriate services, which helped ensure people received timely support.

Relatives told us staff supported people to maintain their health and wellbeing. They said staff understood people’s needs, monitored their health and responded when concerns were identified.

People’s health needs were understood and supported in practice. Staff were aware of conditions such as diabetes and issues relating to nutrition and described how they supported people in line with guidance. Where risks were identified, these were monitored and action was taken to promote people’s health and wellbeing.

There were opportunities for people to remain active and engaged, including a range of activities and access to the community. Staff supported people to attend appointments and maintain links with healthcare services.

Systems were in place to monitor people’s outcomes and review the quality of care provided. Staff described how they monitored changes in people’s health, such as weight, nutrition and general wellbeing, and took action when concerns were identified. Referrals were made to healthcare professionals where needed, which helped support people to achieve positive outcomes.

Relatives told us staff monitored people’s health and took action when concerns were identified. They described staff responding to changes and involving healthcare professionals when needed.

Information about people’s care and outcomes was recorded and reviewed, including through care plan reviews and oversight by senior staff. Processes were in place to regularly review people’s needs and make changes where required. Improvements were being made to strengthen this area, including a more structured approach to care plan reviews and increased management oversight to ensure changes in people’s needs were clearly reflected and monitored. This supported the ongoing monitoring of people’s health and wellbeing and helped ensure care remained responsive to their needs.

Staff supported people to make decisions about their care and treatment and sought consent before providing support. People were involved in day-to-day choices and staff described how they respected people’s preferences and rights.

Relatives told us staff involved people in day‑to‑day decisions and respected their preferences. They described staff explaining what they were doing and supporting people to make choices where possible.

Where people could not make specific decisions, processes were in place in line with the Mental Capacity Act 2005 (MCA). Assessments of capacity and best interest decisions were completed, although these were not always sufficiently detailed to clearly demonstrate how decisions had been reached. In some cases, records did not fully show how people had been supported to understand decisions or whether less restrictive options had been considered. For example, one person had equipment in place to reduce risk in bed, however a mental capacity assessment and best interest decision had not been clearly recorded, despite discussions having taken place with relatives. This meant it was not always possible to be assured decisions were consistently recorded in line with MCA principles.

Despite this, we observed staff working in line with the principles of the MCA in practice, supporting people in a way that respected their rights and involved them in decisions as much as possible.