Archived: Swan House

Swan House is a care home registered to provide personal and nursing care for up to 45 people living in one purpose-built building, divided into two separate units. The home accommodates people living with dementia at different stages in its progression and people living with a range of complex health care needs. At the time of our inspection there was 40 people living at the home.

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

Risks were not consistently managed, and systems and processes were not always effective for mitigating ongoing risk to people. The providers quality assurance system had not always identified where improvements were needed or where improvements had been identified action on these was not always timely.

People said they felt safe and were comfortable around staff. Relatives told us they felt their family members were safe. Many people and relatives told us that more staff was needed to meet their needs.

Staff knew people needs and demonstrated a good understanding of the level of assistance people required. Staff were observed to be kind and caring. Staff spoke to people with dignity and respect and took the time to support and encourage people.

Staff received the training they needed so they had the skills and knowledge to meet people’s needs. Staff had been recruited safely.

People were supported to access external healthcare professionals to maintain their health and wellbeing. People were supported to have enough to eat and drink and appropriate referrals had been made to healthcare professionals where people had specific dietary needs.

Staff knew the importance of giving people choices. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to plan for and receive appropriate end of life care. There were systems in place for people and relatives to give their feedback on the service.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion and belief. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.

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

Rating at last inspection and update.

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 12 safe care and treatment and regulation 17 good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may return sooner.

We undertook this unannounced focussed inspection on 09 August 2018. We inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. No risks, concerns or significant improvement were identified in the remaining key questions of is the service: effective, caring or responsive. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Swan House on our website at www.cqc.org.uk

Swan House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Swan House accommodates 45 people in one adapted building. At the time of our inspection 39 people were living at the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe. Risks to people had been assessed and monitored to protect people from the risk of avoidable harm. Staff were aware how to protect people from the risk of abuse and effective reporting systems were in place. Adequate numbers of staff were available to meet people’s needs. People received their medicines safely and there were effective systems in place to monitor medicine administration. The home environment was clean and well maintained and there were systems in place to monitor and audit infection control practices.

People and staff were complimentary about the leadership and management of the home and said the registered manager was friendly and approachable. People and staff felt supported to share their views and concerns. There were systems in place to monitor the quality of service provided to people.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe living at the home and were supported by staff who received training in how to recognise signs or harm or abuse. People’s risks had been assessed and staff knew what action to take to keep people safe. People received their medicines as prescribed.

People were supported by sufficient numbers of staff who had been safely recruited. Staff received induction, training and support from the management team. People were asked for their consent before staff provided care. Staff understood people’s rights and choices when supporting them. People told us they had a choice of meals and had sufficient to eat and drink. People had access to healthcare professionals when needed.

People were supported by staff who were kind and caring and who treated them with dignity and respect. Staff knew people well and supported people to maintain their independence. People felt listened to and able to raise concerns they may have.

Staff understood their roles and responsibilities and felt supported by the registered manager. Processes were in place to listen to and respond to people’s experiences of the service and audit systems were in place to monitor the quality of care being provided.

At the time of our inspection, 31 people were using the service.

We spoke with six people who used the service, the registered manager and five members of staff. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Prior to our inspection, we spoke with two social care professionals and reviewed information we held about the service.

We observed how people were supported and how staff spoke with people.

We looked at five people’s care records to see if they were accurate and up to date.

Below is a summary of what we found. The summary describes what we observed, the records we looked and what the staff told us.

Based on the information we received we asked if this service was safe and effective?

Is the service safe?

People were not always supported to move in a safe way. Risk assessments were in place which recorded how people should be supported to move, although we saw people being supported without moving equipment and in a manner which could cause them harm.

We saw systems were in place to manage and monitor how the staffing was provided to ensure people received the agreed level of support. The staff we spoke with told us there was generally enough staff on duty to meet people’s needs. We saw that staff were available and people never had to wait long if they needed any support.

Is the service effective?

People made decisions about their daily care including what they wanted to eat and their daily routine. People’s capacity to consent was not assessed and relatives were asked to consent for major decisions. There was no evidence that decisions were made in peoples best interests in accordance with legal guidelines.

During our unannounced inspection in June 2013, we made a compliance action in one area. This meant the provider had to make improvements. We said that people were not involved in discussions about their care and treatment or able to influence how the service was run. We said improvements were needed to ensure that people had their dignity respected. We also found people needed more personalised activities to support their well-being. Our visit was to establish that these improvements had been made.

We found that all necessary actions required had been taken. One person who used the service said: 'I'm alright here ' I don't want to go anywhere else'. One relative we spoke with told us: 'I am really happy with the care they give to my relative'.

29 people were in residence when we visited. We spoke with eleven people living in the home, seven visitors and eight staff.

Some people were unable to speak with us either because of frailty or personal preference. However, when care and support was provided, we observed good interaction between staff and people who used the service.

We saw three people who looked unkempt. One person we spoke with told us: 'I do like to be dressed properly. Sometimes it's only half done; I do not like looking like this'. This meant that people who used the service did not always have their views listened to.

We saw that care records provided clear information to staff about how to meet the needs of the individuals who used the service.

Two people we spoke with told us the care they received was good. One visitor told us: "The care is marvellous".

We saw that people had a choice of food each day. We saw staff supporting people who needed help to eat their meals.

We found effective systems were in place for storing, recording and handling medicines.

We found staff received sufficient training to meet the needs of the people who used the service.

We checked how the home assessed its own quality and safety and saw effective monitoring systems were well recorded.

People told us, "Staff here are lovely and very supportive". They told us that staff were respectful and provided assistance when they needed it. People told us that they had no complaints, and that their relatives were always well dressed, and well cared for.

We found that care plans and risk assessments were kept under review. This meant that people received the care they needed.

We saw that the management and administration of people's medicines was undertaken safely which meant that people received their medicines as prescribed.

We saw that the service had a robust safeguarding system in place, including regular training for staff. The system used for holding people's personal monies ensured that it was safely and securely held. This meant that people living at the service were

appropriately protected, and people's money and property were safe.

We saw that the service had a quality assurance system in place ensuring that people received safe and appropriate care that met their needs.

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