The Swallows

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has improved to good. This meant people were safe and protected from avoidable harm.

Breaches identified at the last assessment of Regulation 12 (safe care and treatment), Regulation 15 (premises and equipment), and Regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 have now been met.
 

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Since the last inspection the provider had improved processes for recording accidents and incidents. Improved recording included reflective practice reviews so that lessons were learnt and staff knew exactly what to do to minimise further occurrences. Reporting pathways were also seen to be used appropriately and CQC received timely notifications appropriately.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported with safe transitions and pathways. Comments from relatives and professionals included, “Communications from staff are very good, this means we can deliver much better co-ordinated care to people,” and “Staff communicate very well between different services and we feel our [family member] gets good joined up care, when it’s needed.”
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

At the last inspection the provider had not reported all accidents and incidents appropriately. At this inspection improvements had been made. We inspected records that evidenced accidents and incidents were now reported as required and appropriate actions taken to mitigate further re-occurrences. This meant the provider was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A person using the service told us, “I feel safe living here, I would not be here if I didn’t.” We saw information on display to help remind staff how to report any concerns. The manager showed us a safeguarding log which included referral and follow up correspondence with the local authorities safeguarding team and statutory notifications they had sent the CQC. Staff undertook a reflective briefing following any concerns so they could learn lessons and make improvements where necessary.

Records showed all staff had received training on safeguarding adults from abuse. A staff member told us, “I had training on safeguarding adults. If I witnessed or thought someone was being abused, I would report to manager right away. I could also report to the provider. If they did not take any action we have the local authority safeguarding team’s telephone number. If need be, I would contact the CQC.”

We checked whether the service was working within the principles of the MCA. We saw recent decision-specific mental capacity assessments for people who were suspected to lack capacity in specific areas. The manager showed us renewed DoLS applications made to the relevant local authorities, together with the local authority acknowledgement of receipt and were awaiting the outcomes. This meant staff were able to make decisions appropriately for people who did not have capacity to make them themselves.
 

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At the last inspection the provider did not always work well with people to understand and manage risks. Risks to people were not always identified, assessed, documented, and reviewed to ensure people’s safety and well-being. At this inspection risk assessments seen on people’s care plans were completed, detailing how risks should be mitigated and ensuring people, others, and staff were kept safe. This meant the provider was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found staff had a clear understanding of peoples care needs and risks. A staff member told us in detail how they supported people with specific medical conditions and mobility problems. They told us they worked with and followed guidance provided by professionals such as dietitians, district nurses and the local authorities fall’s team to keep people safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

At our last inspection we found that the premises and equipment were not always safe. An entry/exit keypad to the front door did not work. This meant there was a risk that people could leave the house unsupervised and this was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider took immediate action and the keypad was repaired on the same day as that inspection took place. This means people were being kept safe and the provider was no longer in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found the provider had detected and controlled potential risks in the care environment. The provider made sure the environment and equipment used was safe and regularly serviced, for example we saw certificates seen for the landlord’s gas safety, portable appliance testing, hoists and slings, legionella risk assessment, fire risk assessment, fire alarm system, fire extinguishers, lift, and call bell system was being checked monthly.

During a tour of the service, we observed the medicines room door was closed but unlocked. The medicines cabinet in the room was locked and there was no access to any medicines. An empty and unused bedroom had a notice on the door that it should be kept locked. We checked the door and found it was not locked. The room was unused. We noted all rooms we looked at had window restrictors in place, we noted significant refurbishments had been carried out since our last inspection. The hall stairs and landing, quiet lounge and 4 people’s bedrooms had been redecorated and there were plans in place to build a new shower and toilets, refurbish the main office and visitors room and upgrade the garden. We raised the issue of the unlocked rooms with the registered manager. They took immediate action by issuing a reminder to all staff and implementing a regular check around the home to ensure that all rooms were monitored and kept locked where required.

We looked in the services emergency evacuation folder. We saw the fire alarm system, fire doors, escape routes were checked on a weekly basis. Regular fire drills had been carried out at the service, 1 was recently carried out at night. People had individual emergency evacuation plans in place which highlighted the level of support they required to evacuate the building safely in the event of an emergency.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the last inspection the provider did not always follow safe recruitment practices. At this inspection we looked at recruitment records for 5 staff. Improvements had been made and we found recruitment checks were carried out appropriately. This meant staff employed were safe to work with people and the provider was no longer in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found recruitment records included application forms, full employment histories, proof of identification, employment references, health checks and right to work in the UK checks. We saw evidence that Disclosure and Barring Service (DBS) checks had been carried out. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The services training matrix indicated that staff had received training relevant to the needs of people using the service.. We saw supervision records in staff files which confirmed staff received supervision quarterly including an annual appraisal of their work performance. A staff member told us, “I am up to date with training. The training on diabetes was interesting because it gave me a better understanding of the condition. I get regular supervision; I like to know what my strengths and weaknesses are. The manager is very upfront and supportive.”

We observed there were enough staff deployed throughout the service to meet people’s needs when required. A staff member told us, “There is always enough staff to meet people’s needs. We don’t have as many people as before. I would expect that when new people come in that staff numbers will increase.”
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

At our last inspection we found parts of the service were not always clean and monitored effectively. At this inspection we observed the service was clean and tidy throughout. The service employed 3 housekeepers and a laundry person to keep the property clean. We saw a daily cleaning schedule completed by the housekeepers. This confirmed that bedrooms, toilets and communal areas were cleaned daily. We observed toilets were well stocked with soap, paper towels and pedal bins. We saw good stocks of aprons and gloves for staff to use as required. We saw records from regular infection control audits carried out by the provider. The service had received a 5-Star food hygiene rating from the food standards agency in December 2024.

Training records confirmed that all staff had received training on infection control. A staff member told us they had completed training on infection control, and they have access to gloves and aprons for supporting people with personal care. We saw records of the providers monthly infection control audits.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At the last inspection we found that for the safe administration of medicines there were no PRN (medicines to be taken as required) protocols in place for people receiving PRN medicines. At this inspection we found the provider had reviewed policy and procedures and now completed PRN protocols for people as appropriate. People received their medicines safely and as prescribed. People had individual medicines care plans in place. These covered the persons capacity to make decisions about their medicines, how they took their medicines, what they took the medicine for and what action to take if they became unwell. A person using the service told us, “The staff help me with my medicines and make sure I get them every day.” Medicines were stored in locked cabinets and medication trolleys within the home. We noted that the medicines room door had a sign stating it should be kept locked however when we went to check medicines the door was not locked. The medicines trolley was locked and could not be accessed by anyone without a key.

We brought the unlocked doorto the attention of the operations manager. They took immediate action and locked the door, they also reminded staff to keep the medicines room door locked at all times.

Medication administration records (MAR charts) were completed accurately by staff, with codes for non-administration where appropriate. PRN medicines protocols were in place to guide staff on when to administer these medicines. Regular audits of medication practices were carried out by the management team. Where issues were identified, action plans were put in place and followed up to completion

Staff had received up to date medicines administration training, and their skills and competencies were reviewed on a regular basis to ensure continued safe practice. Staff demonstrated a good understanding of medicines management principles and were knowledgeable about the medicines they administered.

Given these improvements, the provider was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014