Archived: Real Life Options - Swan House

Swan House is a residential care home providing personal care to people with learning and/or physical disabilities. The service can support up to six people but at the time of the inspection, five people were using the service.

The care home accommodates people in one adapted bungalow.

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

People using the service at the time of the inspection could not tell us about their experiences of using the service. However, we observed positive interactions between people and staff and people looked comfortable with the way they were being supported.

Relatives gave us consistently good feedback on the service and, the way the staff team had ensured people could stay in the home even when their needs changed. A typical comment was, “My relative had a massive stroke last year and I was so pleased he could stay here rather than having to go to another home.”

There were enough suitably qualified and experienced staff on duty to meet people’s needs and to keep people safe. People received their medication at the right time and were supported by staff who knew them well and how to keep them safe.

The staff had worked well with external health professionals to ensure people received effective care which maintained or improved their health. Staff received training which helped them to deliver effective and personalised care.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Relatives and staff were happy with the way the service was being led and there was a clear culture amongst the staff team in providing high quality person-centred care. Audits and checks were carried out in the home to ensure standards of care were maintained.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Rating at last inspection

The last rating for this service was good (published 11 January 2017).

Why we inspected

This inspection was planned as part of our inspection programme.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected this service in December 2015. The regulations were being met but improvements were needed to staffing arrangements, risk management and people’s rights in line with the Mental Capacity Act. Arrangements for people to be able to participate in activities they enjoyed in the community needed to be improved. Care plans and assessments did not always adequately guide staff so that they could meet people’s needs effectively. This meant that the systems in place to check on and improve the quality and safety of the service were not always effective. This inspection in November 2016 found that the majority of issues had been improved and rectified

At the time of this inspection there was 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.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. Although staff understood people's needs well arrangements in place may not ensure that all known risks are well managed. The staffing arrangements ensured that safe levels of staffing were provided at all times of the day. People received the correct medication at the correct times. All medication was administered by staff who were trained to do so.

People living in this home were not able to discuss their feelings about the home with us. People seemed to be calm and relaxed when we visited. People indicated by gestures and their body language that they were happy at this home and this was confirmed by people’s relatives. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting.

Staff had received sufficient training and supervision to ensure they had up to date knowledge and skills to provide safe care. People were supported to maintain their health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

Staff were responsive to people’s needs and delivered care in line with people’s wishes. People were supported to engage in activities they asked to do. People had access to a complaints system and the registered manager responded appropriately to concerns.

There was effective leadership from the registered manager. The registered manager assessed and monitored the quality of care people received. Further action was required to improve the records of the actions taken in response to incidents occurring.

At the time of this inspection there was 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 living in this home were not able to discuss their feelings about the home with us. People seemed to be calm and relaxed when we visited. We found enough staff to cover people’s basic needs but the day-time staffing levels did not provide many opportunities for people to go out of the home. Some relatives and staff told us of concerns about the night time staffing arrangements.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. Some potential areas of risk to people had not been assessed.

People received the correct medication at the correct times. All medication was administered by staff who were trained to do so and there were systems to make sure that the medication was stored, administered and recorded in a safe way.

People could not be certain their rights in line with the Mental Capacity Act 2005 would be identified and upheld. Some people had rails attached to their beds and sensors were in use to alert staff to night time incontinence. There was no evidence to show that people had consented to their use or that best interest decisions had been made if the person lacked capacity.

People were supported to maintain good health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

New staff that had commenced had been provided with an in-house induction and had also attended the provider’s own induction on how to care for people and work safely.

People indicated by gestures and their body language that they were happy at this home and this was confirmed by people’s relatives. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting. Relatives we spoke with said that there had been a decline in their involvement in people’s review meetings and we could not see that people had had recent reviews.

It was not evident that arrangements for checking the safety and quality of the service by the registered provider were not wholly effective. There were systems for quality monitoring and assurance but these had failed to reveal shortfalls in record keeping.

We found that people's needs were assessed and they were provided with opportunities to live the lives they chose. However, some care records needed to be updated.

Staff supported people to go into the community and to participate in activities of their choice. A relative told us that people in this home had, 'loads of opportunities.' Relatives of people who lived in the home told us, 'I think it's excellent' and 'overall, his care is brilliant.'

Staff supported people to eat and drink sufficient amounts to meet their needs. People were provided with choice in relation to their food and drink. However, the records in relation to hydration were not well maintained.

There were good arrangements for the safe storage, administration and recording of medication.

There were sufficient numbers of staff, with appropriate training and experience, to meet people's needs.

Improvements were needed in the way records were stored and maintained. We saw that records were not all stored appropriately. Some care plans were in need of updating and review. Records relating to hydration were incomplete or not available.

There were no set activities on the day of inspection. Two people went out but mostly people were engaged in activities in the home. There was evidence that more activities outside the home would be appreciated.

Processes were in place to recruit staff and support training. However some training and all staff appraisals were overdue. We were advised this was under review. Staff had a good rapport with the people they cared for and showed a good knowledge of their needs. Staff told us they enjoyed working there and care was provided in a considerate manner.

Everyone we spoke to was happy with the care at Swan House. One said 'They do a marvellous job', another that they were happy their relative was there. People we observed appeared satisfied with the care they received. We saw that they were able to personalise their own rooms and that the home was clean and comfortable. The kitchen was very accessible and people were encouraged to be as independent as possible. Many had lived there for some time and were seen to have a good relationship with the carers.

Systems were in place to audit the quality of care. There was a complaints process and families knew how to complain if needed. Regular meetings were used to discuss new information and matters important to people using the service.