Swan Court

Swan Court is a residential care home providing personal and nursing care for up to eight people with a learning disability. There were five people living there at the at the time of our visit. Swan court accommodates people in one adapted building, they have their own apartments as well as shared communal spaces.

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

Infection prevention procedures were in place but there were some concerns around the monitoring of staff COVID-19 testing and how some staff refusals to be tested were being managed. Staff were recruited safely, and medicines were managed safely. Relatives told us that they felt their loved ones were safe.

Quality assurance checks were in place but had not identified some of the concerns raised during the inspection. The management were responsive to concerns highlighted and some changes were made immediately. Staff and relatives spoke highly of the new registered manager and the deputy manager. Relatives gave mixed views on the outcomes for their loved ones. Most told us they were happy with the care people received. One person told us; “I know that [my relative] is happy, I ask if [they] are happy and [they] say “yes I am happy, I want to stay here.” Another relative told us their loved one had made slow progress and may be bored at times but felt that improvements had begun since the new registered manager had joined the service.

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; most of the policies and systems in the service supported this practice.

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 that 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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human

rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

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 requires improvement (published February 12, 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to infection control and about people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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.

We have found evidence that the provider needs to make improvements. Please see the safe 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. Although we found risk management around staff testing for Covid-19 to protect people from harm was not robust, at the time of inspection there had been no significant impact on people from this risk.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swan Court 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to governance systems for infection prevention risks at this inspection. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Swan Court is a care home providing personal care for up to eight people with a learning disability and or autistic spectrum disorder. At the time of our inspection there were seven people living at the service. Swan Court is a purpose-built accommodation and consists of eight flats that include a bedroom, lounge and bathroom as well as kitchens in some instances. There are also internal communal areas and a garden people can access.

Some parts of the service have been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Swan Court was registered for eight people which is larger than current best practice guidance. The service was within a larger building which included a supported living service for people with learning disabilities. However, there was a separate entrance and garden and the location of the service enabled people to have easy access to the local community. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Records were not consistently updated in response to incidents and changes in need. Some aspects of medicine management required improvement. Some systems in place to monitor the quality and safety of the service were inconsistent. Relatives were involved in decisions about people’s care but there was limited action taken to gain their views on the service as a whole.

Relatives told us people were safe. Staff had received safeguarding training and knew how to escalate suspicions of abuse. Staff were recruited safely and there were sufficient staff to meet people’s needs. Incidents and accidents were recorded, and action taken to mitigate the risk to the individuals involved. Relatives and staff spoke positively about the management at the service and staff felt supported.

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 07 November 2018).

Why we inspected

We received concerns in relation to the safety and care provided to people by staff employed by the provider. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this report.

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

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.

This was the first inspection of the service since they were registered to provide personal care on 2017 and there has been no previous rating for the service.

Swan Court is a 'care home'. People in care homes receive accommodation and 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.

Swan Court was built for purpose, and consists of eight flats that include bedroom, lounge and bathrooms as well as kitchens in some instances. There is also a variety of internal and external communal space people can access if wished. The provider has a café (open to the public) located next door that people living at the home could use.

The service provides personal care to younger adults that have learning disabilities/autistic spectrum disorders or poor mental health combined with the former. On the day we visited the site there was seven people receiving personal care and accommodation.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a registered manager, although there was an acting manager who has now applied to register with CQC. They were present during our inspection. 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.

Risks to people were clearly identified in risk assessments and we saw staff understood these, and followed them when supporting people. We saw there was sufficient staff available to support people and keep them safe. The provider had made us aware of any allegations of abuse at the service and responded appropriately to these. Staff could tell us what abuse looked like and how they should respond. We found people’s medicines were managed safely. Appropriate checks were carried out on prospective staff before they commence work with people.

People’s consent was sought by staff with any restrictions to their liberty agreed with the local authority, with these agreements followed by staff. People were supported by staff on a day to day basis to have maximum choice and control of their and we saw staff supported them in the least restrictive way possible; the policies in the service supported this practice. People were supported by staff that were trained, and the provider had begun building on staff skills and knowledge with further, more in depth training. People could access community healthcare as needed. People were involved and supported to choose and prepare their meals where able. People were given support with their dietary and fluid intake to promote their health.

People were supported by staff who demonstrated they were kind and caring when supporting people. People were consistently treated with dignity and respect. People's independence was promoted within their daily routines. People could express their views and choices regarding their daily living. People could maintain friendships and contact with families, and had support from advocates where needed.

People were involved in drawing up their care plans through use of accessible information that reflected the person’s communication needs. We saw care plans reflected people’s needs, wishes and preferences, and the views of representatives were considered. People’s needs likes, dislikes and personal preferences were understood by staff although based on the views of some health care professionals this has taken longer for people with more complex needs. People had access to leisure opportunities they liked and they could readily access these. People were comfortable in the presence of staff and could express dissatisfaction that staff would respond to. Relatives were confident they could approach the provider with any concerns and that these would be responded to.

The provider recognised with people having moved into Swan Court in a relatively short space of time progress to meet some people’s individual aims may not have taken place as quickly as hoped, but staff were confident better progress was now being made. There were some mixed views from stakeholders as to the how effective and well managed people’s care was, although we saw staff interaction with people indicated that the provider was learning and improving people’s individual experiences and quality of life. There were systems in place for governance of the service so areas in need of improvement were identified and people were better protected from potential risk. People were relaxed with managers and staff. Relatives knew who the managers were and were confident they could approach them. Staff felt well supported and informed by the management team. The provider understood their legal responsibilities and had methods to ensure they were up to date with changes in the law and good practice.