Swansea Terrace

Swansea Terrace provides accommodation and personal care, including nursing care for up to 44 people in single bedrooms with partial ensuite facilities. Rooms are on the ground and first floor. There are two lifts and stairs for access. Communal areas are on the ground floor. There was a paved area at the rear with some seating for people to access. At the time of inspection there were 36 people in the home,

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

People had not always received safe care because assessed risks had not been consistently managed. Alerts on the care records system which indicated people had missed support with repositioning or had not had enough to drink, had not been responded to in all of the cases we reviewed.

People had not received their medicines safely. Diabetes care was inconsistent and not enough information was available to guide staff to recognise increased risks related to blood sugar levels. Medicine stocks were not properly monitored which meant some people did not always have enough. Oversight of medicine records had not been safely maintained by managers.

People had not been supported to drink enough. Everyone assessed as needing support to drink had missed their fluid targets. Some people felt they did not get enough of the right foods in relation to their dietary wishes. We observed people enjoyed the food they were served at lunch times.

People were supported by staff who had been safely recruited. The provider followed a system to assess how many staff were needed to maintain people's care safely, however, we found staff were not able to meet all of people's needs.

People's needs had been assessed using an electronic system. Staff accessed care records on handsets. Some assessments and care plans did not contain enough information to guide staff.

People's health needs had been assessed, however we found some records had not always been updated. People had access to health screening, including a visiting optician.

People did not receive consistent high-quality person-centred care because managers had not ensured there was enough oversight of the quality of care and care records. Recent changes to the management structure in the home had impacted on this. The provider and interim manager were committed to working with partners and following their own action plan to achieve the necessary improvements.

People and their relatives had mixed views about how well the home was managed. The home's regular staff were praised as being knowledgeable and caring. People's relatives did not feel they had been asked for their feedback recently however, this was an area the provider had already identified as needing to be addressed.

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

Why we inspected

The inspection was prompted in part due to concerns received about the availability of registered nurses on each shift, the quality of clinical care in relation to; safe medicine administration, wound care and access to community health services. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The provider had already begun responding to some of these concerns and had developed their own action plan.

The overall rating for the service has changed from good to requires improvement, based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to; the management of risks, safe management of medicines, supporting people to eat and drink enough, management oversight and governance. We have made a recommendation about care assessments and planning.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

¿ The systems in place allowed people to be admitted to the home safely. Each unit was separated to prevent cross infection. There was no movement of staff or residents between units.

¿ There was an established staff team to provide continuity of support on the designated unit.

¿ National guidance was followed on the use of personal protective equipment (PPE). There was clear signage on the correct use of PPE and handwashing techniques and staff had received appropriate infection control and prevention training.

¿ A detailed risk assessment was in place for ensuring safe visits, this included a booking system, to allow for social distancing, visitor agreement form, health screening and use of PPE. Alternative measures to visits, such as video calls, were being used.

¿ Contingency plans were in place should there be a staff shortage. Additional housekeeping and governance tasks had been completed to ensure the home was clean and hygienic.

¿ There were detailed risk assessments to manage and minimise the risks Covid 19 presented to people who used the service, staff and visitors.

¿ Staff had been consulted with about their specific risks or concerns.

¿ Social media and electronic tablets were used to communicate with health professionals to promote people’s physical health.

¿ A robust system was in place for staff and other professionals to follow when entering and leaving the building.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Swansea Terrace provides treatment of disease, disorder or injury, accommodation and personal care for 44 older people. At the time of our inspection the home had 35 people living there. The home is located close to Preston city centre. There are two large lounges/dining spaces, communal bathrooms and en-suite washing facilities.

People’s experience of using this service:

The registered manager had sustained the improvements implemented at our last inspection. Standards, systems and procedures were embedded to demonstrate good practice in safety and leadership over time. Everyone we spoke with said the home had developed and enhanced their welfare. An employee told us, “Things are better than they have been for a while. I am enjoying it now more than ever. I love what I do.”

Staff had good awareness of potential risks to people because the registered manager completed assessments aimed at minimising the risk of unsafe care.

The provider had good systems to maintain people’s safety and welfare at Swansea Terrace. A relative stated, “[My relative] is safe, I go home feeling reassured she is well looked after.” Staff had a good understanding about the principles of safeguarding people from abuse and poor care.

The registered manager completed a weekly dependency tool to check staffing levels continued to meet people’s needs. One person stated, “Yes, there's enough staff. They are patient and I don't feel like I am taking their time up.” Staff had a good range of training and competency-testing to enhance their skills and expertise. One employee said, “Yes, [the registered manager] checks our competency regularly and then we have a question and answer session.”

The registered manager had good protocols to ensure people’s medicines were managed safely. One person told us, “The nurse gives me my medication. I prefer that because it keeps me safe.”

People and relatives stated staff completed timely referrals to other healthcare services and kept them updated. A relative said, “They got this thing called the SALT team out who assessed [my relative]. Now she has a soft diet and is doing much better.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. A staff member stated, “We must always first respect the resident's choice in this matter.”

Care records held support plans to guide staff to each person’s nutritional needs and level of assistance. A visiting professional told us they were impressed with how well staff kept documents up-to-date and monitored their nutrition and support. People were offered a variety of meals and could choose alternatives if they did not like what was on the menu.

People confirmed staff were caring when supporting them. One person said, “Yes, the staff are very caring.” The registered manager ensured staff had equality and diversity training as part of their commitment to provide a respectful and individualised service. A visiting professional added they found staff were friendly and approachable.

The management team assessed people’s needs before admission and on an ongoing basis to guide staff to be responsive to each individual’s needs. Care records included detailed information about each person’s preferences and backgrounds to help staff understand their requirements.

People told us the management team was visible and kind. One person said, “[The registered manager] is lovely, she has a caring nature about her.” Staff commented they felt valued and the registered manager worked with them in the development of Swansea Terrace. One staff member said, “We have staff meetings and go through anything that needs to be given out, share opinions and suggestions, trying different ways to do things and make improvements.”

Rating at last inspection: At the last inspection the service was rated requires improvement (published 13 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any issues or concerns are identified we may inspect sooner.

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

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

There is a registered manager at the service. 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.

At the last inspection of the service we found 6 breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. These breaches were Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. During this inspection we checked to see if there had been improvements at the service. We found all the breaches of regulation had been improved.

We found the home was clean and tidy. Staff told us they were provided with personal protective equipment. We found moving and handling was seen to have improved. We looked at how the service was managing medicines at this inspection. We found improvements had been made.

We saw a staff dependency tool was being used appropriately to determine how many staff were required. Staffing levels had improved and agency staff had not been used for five months. We found people were protected by suitable procedures for the recruitment of staff.

We found that maintenance checks were completed and there had been improvements. A range of checks were carried out on a regular basis to help ensure the safety of the property and equipment was maintained.

We looked at how accidents and incidents were being managed. There was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these. People told us they felt safe. The service had procedures to minimise the potential risk of abuse or unsafe care.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff received supervision and appraisals and told us they felt supported. Staff training was ongoing and evidence was seen of staff completing training. We saw evidence people's care and support was delivered in line with legislation and evidence based guidance.

We found in depth assessments were carried out by the registered manager before any person received a service. Peoples needs for nutrition and fluids had been considered. Files contained likes and dislikes with regards to food and drink. We observed people eating in a relaxed manner and they seemed to enjoy their meals. People told us, “We have a good choice at meal times.”

We received consistently positive feedback about the staff and about the care people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights.

Staff were highly motivated and described their work with a clear sense of pride and enthusiasm.

We looked at what arrangements the service had taken to identify record and meet communication and support needs of people with a disability, impairment or sensory loss. Care plans seen confirmed the services assessment procedures identified information about whether the person had communication needs.

Each person had a care plan which was tailored to meet their individual needs. We saw care records were written in a person centred way. People told us they were encouraged to raise any concerns or complaints. The service had a complaints procedure.

We found the management team carried out audits and reviews of the quality of care. We found some concerns with the oversight of supplementary recording which management addressed during the inspection.

Staff we talked with demonstrated they had a good understanding of their roles and responsibilities. We found the service had clear lines of responsibility and accountability with a structured management team in place.

The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management team were receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

Whilst the service had improved since the last inspection. Standards need to be embedded to demonstrate good practice over time. We will check this during our next planned comprehensive inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The last inspection of this service took place over two days on 02 and 06 June 2016. The service was awarded a rating of ‘Requires Improvement’ and we identified no breaches of regulation at this inspection.

This inspection visit at Swansea Terrace was undertaken on 02 and 07 August 2017 and was unannounced.

The service is required to have 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. At the time of our inspection the service did not have a registered manager. A manager had been employed who was in the process of registering with CQC.

During the inspection the environment was found to be unclean in a number of areas. We found there were no clinical waste bins where these were required. We saw bathroom equipment that was rusty. Some of the bins around the premises were overflowing and did not always contain a bin liner.

We observed unsafe practice when one member of staff was supporting a person who lived at the home with their lunch. The person was asleep and the staff member put food into their mouth and gently “shook” them awake to swallow it. This posed a high risk of choking for the individual.

We observed poor moving and handling throughout the inspection visit. People who required hoisting had full body slings which should be positioned level with the back of people’s knees for support. However we observed this was not always the case.

We observed the lunchtime medicines round and found people were not asked if they required pain relief prior to being given pain relief medicines. In addition we noted one person refused one of their medicines. We checked the records and saw the persons medicines had not been reviewed to see if there was an alternative medicine they could take.

We looked at people’s care plans and found gaps in information regarding people’s medicine regimes. We saw support plans to guide staff when giving medicines which are taken “as needed”. However these did not contain all the relevant and necessary information for the staff to give the medicines appropriately and safely.

Topical cream administration was found not to be safe. The topical cream charts were inconsistent. We found instructions for the topical creams had not been transferred to the cream charts accurately. This resulted in creams not being applied as directed.

The concerns with infection control, medicines management and unsafe practices amounted to a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

Staffing levels were observed to have direct impact on peoples care and treatment. Although people told us they felt safe, everyone we spoke with raised concerns about staffing levels.

The concerns we found with staffing arrangements amounted to a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We asked to look at the recruitment records for three people who worked at the home and found the provider had not made sure suitable referencing was obtained prior to agreement of employment.

The concerns we found with recruitment amounted to a breach of regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

People's privacy and dignity were not always respected and promoted. We observed very little interaction between staff and residents during our inspection visit. Interactions were task focused; we observed two incidents which impacted on people’s dignity.

The above concerns amounted to a breach of regulation 10 (Dignity and respect) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

Person centred information was not always followed; we found that people were not being bathed in accordance to their wishes.

The above concerns amounted to a breach of regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

Systems were completed to demonstrate regular checks had been undertaken looking at care files and daily records. However, checks were not always robust and effective. The provider had not ensured the processes they had to monitor quality and identify areas for improvement were effectively implemented. We found examples of audits which had been completed in June 2017 however the actions documented had not yet been acted on.

These shortfalls in quality assurance amounted to a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance). Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We made a recommendation around maintenance safety checks.

We made a recommendation around complaints and informal concerns.

The care records we looked at told us about people’s dietary preferences. People told us they were able to make choices in relation to food and drink and we observed them being offered a variety of options. People we spoke with said, “The food is not bad, they will accommodate you.”

There were activities for the people to engage in and people were supported and encouraged to take part. One person told us, “I like living here and being involved in the activities, my family visit when they can.”

We received positive feedback about staff from people who lived at Swansea Terrace. One person told us, “Staff are very good with me, they are kind.” Another person said, “I love all the staff, they look after me.”

Staff supervision was not always consistent at the service. Some of the staff we spoke with said they had not received supervision for some time and documentation supported this. We noted supervisions were undertaken following incidents and was reactive rather than proactive. One member of staff we spoke with told us they had never received supervision in their time at the service. However staff told us that they felt supported in their role.

People told us the manager at Swansea terrace was approachable. One relative told us, “The new manager is approachable.” One staff member told us, “I like the manager; I get on well with them. They are approachable and very helpful with personal stuff as well as work.”

We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection in October 2015, we found a number of significant breaches of legal requirements. As such, we took urgent action to ensure improvements were made. The service was placed into special measures. Since October 2015, we have monitored closely the improvements that have been made through contact with the provider, the local authority and clinical commissioning group. During this inspection we checked to see what improvements had been made.

Swansea Terrace is registered to provide 24 hour nursing and personal care for up to 44 people and is located close to Preston city centre. There are two large communal rooms, communal bathrooms and en-suite washing facilities. At the time of our inspection there were 31 people who were using the service.

The service is required to have 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. At the time of our inspection the service did not have a registered manager. A manager had been employed who was in the process of registering with CQC.

During our last inspection in October 2015, the service was found not to be meeting legal requirements in relation to: protecting people against the risks of avoidable harm and abuse, staffing, safe management of medicines, cleanliness and infection control, obtaining valid consent, meeting people's nutritional needs, privacy and dignity, person-centred care, good governance and statutory notifications about significant events at the service.

During this inspection, we found the provider had made significant improvements in all areas.

People were protected against the risks of avoidable harm and abuse. Following our last inspection, staff had all received training to help them recognise abuse and what action to take if they suspected abuse. The service had completed risk assessments relating to individuals' needs and the environment with plans to mitigate such risks.

Staffing levels at the home had been increased and staff were better deployed. This had led to a culture change at the home from a task-driven culture to one that was more centred on providing a good level of care to people. People were cared for by staff who had the knowledge, skills, experience and support to carry out their role. However, some staff had not received regular supervision and appraisal.

The service was operating effective systems for the safe management of people's medicines. However, we found some hand-written entries on records had not been checked and countersigned to ensure accuracy.

The service was operating effective systems with regard to cleanliness and infection control. Bathrooms were no longer cluttered and work had been carried out to seal flooring in certain areas of the home to aid with thorough cleaning and disinfection.

The service sought consent in line with legislation. However, consent documentation was not always completed fully. We have made a recommendation about this. People and, where appropriate, those close to them were involved in the assessment and planning process. This helped to ensure people's written plans of care accurately reflected their needs and preferences.

The change in staffing levels and the better organisation of staff meant staff had more time to spend with people and had begun to develop positive and caring relationships. It was clear staff knew people well.

People were supported to eat and drink enough to meet their needs. The service approached external professionals for guidance and advice as appropriate and incorporated this into people's plans of care.

People's privacy and dignity was maintained and promoted at all times.

The home employed an activities coordinator who explored people's interests and aimed to provide meaningful activities at the home. A variety of social events had taken place at the home since our last inspection.

The service had begun to hold regular meetings for residents, relatives and staff, for them to discuss ideas, make suggestions or raise concerns about the service with management. The service had undertaken formal satisfaction surveys to gain feedback about the quality of the service.

The home had a range of audits and checks that were operated effectively to assess, monitor and improve the quality of the service provided to people.

The service had clear lines of responsibility and accountability. Leadership at the home, although there was some instability due to the number of managers since our last inspection, was good. All the staff spoke highly of the provider and managers within the organisation.

It is noted that significant improvements had been made, however improvements are still required to embed good practice in relation to staff supervision, recording of medication administration and meetings for residents, relatives and staff.

Swansea Terrace is registered to provide 24 hour nursing and personal care for up to 44 people and is located close to Preston city centre. There are two large communal rooms, communal bathrooms and en-suite washing facilities. at the time of our inspection there were 40 people who were using the service.

The service is required to have 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 were not protected against the risks of avoidable harm and abuse. Staff had not been discharging their responsibilities with regards to safeguarding people who lived at the home. The service had not ensured that assessments of risk and associated risk management plans were up to date and accurately reflected people's circumstances. This left people vulnerable to significant risks to their health and well-being.

Staffing levels at the home were not adequate to provide people with safe and effective care. People were not cared for by staff who had the knowledge, skills, experience and support to carry out their roles. Staff did not receive appropriate supervision, appraisal or training to enable them to fulfil their responsibilities.

The service was not operating effective systems for the proper and safe management of medicines. Some people had gone without important medicines for significant periods of time due to a breakdown in the service's systems and poor communication between staff.

The home was not operating effective systems to assess risks around cleanliness and infection control. Bathrooms and shower rooms were found to be cluttered and had inadequate floor coverings which prevented thorough cleaning and disinfection.

The service did not always seek consent in line with legislation. People or, where appropriate, their representatives were not routinely involved in the assessment of people's needs or the care planning process. People's written plans of care did not reflect accurately their needs and preferences.

Staff had a caring approach to the people they cared for, but due to low numbers of staff and a task-focussed culture at the home, positive, caring relationships between staff and people who lived at the home had not been developed.

People were not supported to eat and drink enough to meet their needs. We found some people had gone without food and fluid for significant periods of time. People were put at serious risk because professional guidance had not been followed by the service.

People were able to access healthcare services. However, the home did not always make referrals to professionals or follow them up in a timely manner. When guidance or advice was received from other healthcare professionals, it was not always incorporated into people's plans of care.

People's privacy was maintained during personal care interventions. However, we found people's dignity was not always promoted and maintained.

The home employed an activities coordinator. However, much of their time was spent delivering care to people, which meant the level of activities provided by the home was inadequate. People were not enabled to participate in activities which were meaningful to them. Some people were left in their bedrooms without any stimulation or interaction for long periods of time.

The service did not hold regular meetings for residents, relatives or staff, for them to discuss ideas, make suggestions or raise concerns about the service with management. The service did not operate any formal surveys or other mechanism for gaining feedback about the quality of the service.

Systems and process that were in place to assess, monitor and improve the quality of the service were not being operated effectively. We found significant gaps in audits and safety checks. Where audits and checks had identified issues, the service was unable to demonstrate any action taken to address them.

The service did not have clear lines of responsibility and accountability at all levels. Leadership at each level of the service was poor and staff were not fully aware of what was expected of them. The registered manager had identified concerns with regard to the culture of the staff team, but had not taken any action to address the issues.

The service had not notified CQC of significant events which had taken place at the home since our last inspection.

We found multiple breaches of regulations and took urgent enforcement action against the service. You can see what action we took at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Where we found risks to people's safety and well-being, we made referrals to the Local Safeguarding Authority in order to help protect them from risks of harm.

People we spoke to living at Swansea Terrace told us they were happy with their care, though some people said they still experienced delays in staff assisting them with their personal care. We saw that staff were being recruited to fill some vacancies but the majority of vacancies were filled. Some vacancies were due to staff leaving recently.

We saw that people were involved in a variety of activities and they were offered a choice of how they had support with their personal care

We were able to speak to people and observe their care as well as interactions between them and staff. We saw that staff were friendly and responsive to requests from people when they wanted a drink or help with their care.

We found areas of non compliance in meeting the health needs of people, staffing and keeping accurate records.

People we spoke to living at Swansea Terrace told us they were generally happy with their care and happy with the way the service was run. People told us that the staffing levels in the home could be improved.

We were able to speak to people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Swansea Terrace and that staff respected them. One person told us, 'It's very comfortable, better than I expected. The staff have been polite and very helpful".

We found family members were happy with the care of their relations and they praised staff's commitment.