Swan Court

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff knew people well and understood their responsibilities on how to keep people safe. Staff deployment was flexible to manage risks and promote people’s wellbeing. All staff we spoke with were satisfied leaders acted on concerns. Leaders told us they received safeguarding awareness training, and the provider was reviewing safeguarding training requirements for managers. At our previous inspection we found systems were not in place to review whether staff had been safely recruited, including the review of DBS checks for staff. At this assessment we found enough improvements had not been made, and this was a continued breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvement had been made to ensure effective risk management and risks to people’s wellbeing had been assessed and plans were in place to inform staff how to manage these risks.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Leaders told us they received safeguarding awareness training. A concern was identified about the lack of consistency in reporting and to address this the provider arranged a workshop in safeguarding responsibilities for managers to be delivered in January 2024. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found staff obtained people’s consent, and where required, decision specific mental capacity assessments (MCAs) were undertaken to explore concerns for people’s welfare and safety. For example, the care coordinator explained an MCA was recently required to seek urgent medical support for 1 person. Staff carried out another MCA to ensure someone understood and consented to the use of a falls alarm to promote their safety. We noted from the records agency staff were not provided with training in MCA and DoLS. This could have placed people at risk of having their liberty restricted by untrained staff.

People told us they felt safe at the service, and were well supported by staff, including when they felt unwell and needed more support. People’s relatives were also satisfied their family members received safe care. One relative said, "[Person] is very vocal and [person] would have no issues telling me and I see the way [person] gets on with them and how they treat [person]."

Staff knew people well and understood their responsibilities to keep people safe. Staff told us they received safeguarding awareness training and demonstrated knowledge of whistleblowing procedures. All staff we spoke with were satisfied leaders acted on concerns. A staff member advised, “I would feel confident in approaching [care coordinator] with that information for her to act on it.”

People told us care was delivered in a safe way to meet their needs. One person advised, “Yes [I’m happy with care], very much. They help me in the bathroom, medication and washing.” One relative described how staff managed their family member’s agitation in a positive way, advising, “Staff have found a way to make [person] feel better even when they can’t understand [person]. You can see from [person’s] face that [person] is happy.” Staff were responsive when people were unwell. One person explained, “I love it here. When I have been unwell they help me very much.” A relative added, “They are very good and I don’t think he could be in a better place. They will even call a doctor for his appointments.”

Care plans and risk assessments provided relevant information to keep people safe. The service worked with other professionals to manage risks, for example around people’s nutrition. Risk assessments and care plans were personalised, updated when people’s needs changed and reflected people’s mental capacity to make their own decisions. Staff team meetings were used to share updates about risk management, including updates about people’s physical health, mobility, nutritional needs, behaviours and safety of the environment to reduce the risk of falls and infections.

Staff managed people’s safety well including through the use of technology to manage risks. For example, staff told us 1 person had a seizure alarm, another person had a falls alarm, and people had access to emergency pendant alarms. A staff member advised, “If care plans have been adjusted, we are always asked to read them.” Staff also described effective systems of communication using a written book and verbal handover process to share relevant information. Staff we spoke with, including regular agency staff, knew people well and could describe how risks relating to people’s care needs were mitigated. People were encouraged to live independently in a balanced approach to risk management. Staff consistently told us there was no use of restrictive practices.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider acknowledged some required actions relating to staff recruitment files as identified by us at the last inspection had not been fully resolved. The provider advised they were now working to ensure actions were completed. Care staff spoke positively about access to training, and ongoing support from the management of the service. Staff told us there were enough staff deployed, although staff noted sometimes time management was more difficult due to competing demands or when an incident occurred.

Staff deployment was flexible to manage risks and promote people’s wellbeing. People's views about the staff and their skills and knowledge varied. One person's relative told us, "Yes, most of them [staff] I know and I know they are very good. I am completely satisfied with them and their staff. Another person's relative said, "In my eyes there are a few carers that I don’t think they have the right skills but [care coordinator] does." One person added, "I think they need more staff."

In the action plan submitted to CQC by the provider following our previous inspection, they told us they would be compliant with requirements in relation to staff recruitment records and processes by 31 November 2021. During this assessment we found this area had not improved. Gaps in recruitment records had not been responded to by the provider until the 12 December 2023. The provider had recently reviewed the information held within the employment files. Self-declaration by staff had been added, along with notes by the provider as to why important documents were missing. However, without the correct checks, we could not be assured staff were still safe to work with people.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s medicine records were not always completed in line with the provider’s policy to promote safe administration of medicine. We found occasions where analgesic medicine was given to people with no explanation provided at the end of the medicines administration record or when a person’s prescribed fluid thickener was not consistently recorded in daily records. Staff involved in medicine administration were trained, assessed and deemed competent to administer medicines. However, staff failed to identify the above shortfalls in medicine records were not completed in line with the provider’s policy.

Staff received medicines training, and had their competency assessed before administering medicines. Staff described the process of weekly medicines stock checks, were aware of how to report stock discrepancies to the care coordinator for further investigation and reported the electronic medicines system helped to reduce the risk of administration errors. Leaders described challenges with the service’s electronic medicines system, advising the electronic devices used to record medicines administration sometimes failed to ‘sync’ data correctly. The provider agreed to review risk mitigation measures.

People and relatives told us people were supported by staff with their medicines, where this was required. A family member commented, "They prompt [person], [person] gets them at a specific time and it is the same time every time I've been." A person added, "I get them [medicines] on time." People had been involved in planning their medicines support, with medicines risk assessments considering people’s levels of independence or support required in areas such as taking prescribed medicines, ordering repeat prescriptions, collecting prescriptions, and assistance needed for administration.