Swan House

Updated 21 October 2021

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 Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector, with remote telephone support from an Expert by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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.

The service did not have a manager registered with the Care Quality Commission. When a manager is registered with the Care Quality Commission, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with five people using the service, eight relatives and 15 members of staff including five care assistants, two senior care assistants, two care team leaders, the deputy manager, the activities coordinator, one chef, one housekeeper, the interim manager and the manager.

We observed infection control and medicines practices, reviewed the environment and looked at five people’s records on the electronic care plan system. We also examined a variety of other records including medicine records and cleaning schedules.

After the inspection

We continued to review records shared electronically and continued to seek clarification from the provider to validate evidence found. We looked at six staff recruitment and supervision files, action plans, audits, staff rotas, safeguarding records, meeting records, policies and procedures and staff training records. We received feedback from ten professionals who had contact with the service.

Updated 21 October 2021

About the service

Swan House is a residential care home providing accommodation and personal care to 10 people aged 65 and over, at the time of the inspection. The service can support up to 32 people.

Swan House accommodates up to 32 people across two units, each of which have a small kitchen area, dining room, sitting room and communal bathrooms. The bedrooms have en-suite shower facilities. One of the units provides care to people living with dementia.

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

We found safe care and treatment was provided. People were safeguarded from risks of abuse and other risks. Safe medicines practice was followed, and people told us they received safe care. Accidents and incidents relating to people using the service were monitored to identify wider learning for the service.

People were protected from infection control risks in relation to COVID-19, although we observed some instances of poor practice. The service was responsive to our feedback. People told us staff wore personal protective equipment (PPE) to support them, and people’s mental capacity had been considered in relation to regular testing for COVID-19. Relatives were able to book appointments to visit. One relative commented, “They have a separate entrance and [we go] upstairs to a room that is cleaned every time…they are very particular about cleanliness…we can phone on video calls anytime.”

People told us they received safe care. Some people living with dementia were not able to tell us about their experiences of care. We observed communal areas at different times of day, including at meal times and during activities. Staff spoke warmly with people, offering choices of food and drink, and supporting people to engage in activities such as bingo. People appeared relaxed in the company of staff. Some people preferred to spend more time in their rooms. We observed rooms were personalised and one person using the service was supported to keep their cat with them.

Safe recruitment procedures were in place. People were supported by sufficient staff, including support from senior staff on each shift. A structured handover process was in place, to ensure incoming staff were aware of any current concerns or changes for the people they support. Staff told us they had access to training and regular supervision, however we found staff had not completed a yearly appraisal at the time of our inspection. We found the provider's policy required staff to complete moving and handling training on a three yearly basis, which was not in line with best practice guidance. We recommended the provider refer to best practice guidance in relation to the training topics, training frequencies and assessing staff competencies to review their approach.

The management of the service had improved, however there had been a significant delay in recruiting a new home manager since our last inspection. An interim manager had worked to support the service to make improvements, and the provider conducted audits and regular quality meetings to review progress. A full-time manager joined the service in August 2021 and we received positive feedback from people, staff and relatives. The manager had made a positive impression and was viewed as accessible and supportive by the staff team.

Feedback from relatives also confirmed improvements had taken place. Comments from relatives included, “General feeling that staff are more confident about what they are doing”, “Communication now is much better”, “Staff are helpful and responsive to emails; things have changed and improved since new management”, “I think it will go from strength to strength…I am very happy" and “Honestly we are happy and there is nothing I would change. They don’t have a high turnover of staff so there is continuity and that’s important."

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; however the policies and systems in the service did not always support this practice.

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 inadequate (published 12 January 2021).

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 some improvements had been made, however the provider was still in breach of regulations.

This service has been in Special Measures since January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 November 2020. Breaches of legal requirements were found in relation to safe care and treatment, safeguarding from abuse, recruitment practices, consent to care, good governance, duty of candour and in informing the Commission of incidents they are required to. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to consent to care and duty of candour.

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 inspect sooner.