Swarthdale Nursing Home

Updated 21 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 2 inspectors.

Service and service type

Swarthdale Residential home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Swarthdale is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided, and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spent 2 days on site observing the provision of care. We spoke with 5 people who used the service. We spoke with 9 members of staff including the registered manager, nurses, and care workers. We reviewed a range of records. This included 3 people’s care plans, and a variety of records relating to the management of the service including health and safety and quality assurance. We requested documentary evidence to review remotely following the inspection site visit.

Updated 21 July 2023

Swarthdale Nursing Home is a residential care home providing personal care to up to 43 people. The home provides care for older people with physical disabilities, people living with dementia, and frailty due to ageing. The service is a large property over two floors which has been adapted to meet people's needs. There were 23 people living in the home at the time of our inspection.

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

People were not protected against harm because all risks to their safety had not been identified and managed. Health and safety management was inadequate. Some staff had not completed required training related to providing care safely. The registered manager reported any concerns about abuse to the local authority, however, not all incidents were reported to all relevant people and reviewed appropriately. Safe systems were used when new staff were recruited.

The provider had not ensured effective oversight of the quality and safety of the service to ensure people were protected from harm. The provider had not implemented adequate reasonable adjustments to support the registered manager to carry out their duties effectively.

The provider had no effective oversight of the care home or governance arrangements to ensure people received high quality care. Staff told us there was an absence of communication from the provider and registered manager. Staff had no confidence concerns they raised would be acted upon to ensure people were cared for appropriately.

People did not always receive effective care because their needs were not always promptly reassessed or monitored as they changed. People were included in choosing their meals and mealtimes were flexible to people's wishes and preferences. The home had been adapted to meet people's needs. People were not consistently supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests. Policies and systems in the service were out of date and did not adequately involve people’s choice, independence, and best interests.

Staff were committed to providing people with person-centred care. They were open and honest with people. Interactions between staff and people were kind, caring, and respectful. People told us staff “are nice” and “they look after me very well”. However, the provider had not ensured people’s care plans adequately reflected their preferences and actively involved them in making decisions about their care, treatment, and support. The provider had not ensured people nearing the end of their life had current care plans in place or people’s preferences and choices were respected to give them a comfortable, dignified, and pain free death. People told us they did not like to bother the staff because “they’re so busy”.

People told us there was “nothing to do” and there were not enough activities to meet the needs of different people. An activity coordinator was in post but absent during our inspection and the provider had not arranged effective cover. Staff told us there were no activities for people at evenings and the weekends. Not all people living in the home knew who the registered manager was or how to complain. We saw no evidence the views of people and staff had been sought to improve the service. There was no evidence of involving people in planning activities and the provider was unable to show us records of compliments, complaints, or actions which had been taken to share learning from feedback.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities most people take for granted. ‘Right support, right care, right culture’ is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 requires improvement (published 26 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to infection control, management, and staffing, along with the results of an unannounced comprehensive inspection of this service on 20 July and 1 August 2022 where breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and establishing systems to monitor and improve the quality of the service.

We undertook this focused inspection to review the key questions of safe and well-led only. A decision was made for us to inspect and examine those risks. We inspected and found there were additional concerns with management of medicines, quality assurance, and health monitoring so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions: safe, effective, caring, responsive, and well-led.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the key question sections of this full report for details. You can see what action we have asked the provider to take at the end of this full report. The provider had taken some action to mitigate the risks and was starting to establish improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swarthdale Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 6 breaches in relation to safe care and treatment, person-centred care, need for consent, receiving and acting on complaints, staffing, and good governance at this inspection. There was 1 further recommendation in relation to staffing.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.