Archived: Swanrise

Swanrise is a residential care home providing personal care to up to 6 people. The service provides support to adults with learning disabilities, autism and mental healthcare needs. At the time of our inspection there were 6 people using the service.

The layout of the building did not provide an environment where people had freedom of movement. This meant that some people were restricted to certain areas of the service, and we observed that most of the day, that is where they remained. This also impacted in some cases on people’s privacy and dignity.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

We found the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.

Right Support: Model of Care and setting that maximises people’s choice, control and independence.

Care was not always provided in a dignified manner and people's human rights were compromised. People were subject to restrictive practices without proper regard to legal processes and requirements. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had failed to mitigate the risks in relation to the internal and external environment. They had not done all that was reasonably practicable to reduce the risk and provide care in a safe way. This resulted in service users being placed at risk of harm and coming to actual harm. Infection prevention and control measures were not robust and some areas of the service were visibly dirty and unhygienic.

Right care: Care is person-centred and promotes people's dignity, privacy and human rights

Care was not provided in a person-centred way which promoted people's dignity, independence or human rights. There were not always staff with suitable skills deployed to meet the needs of people; there were identified gaps in staff training and we were not assured staff had the skills and knowledge to fill the requirements of their role. We found medicines were not always safely managed and medicine records were not always completed accurately. People's dietary and health needs were not well documented which meant we could not be assured that people had access to regular health checks, or that a healthy and balanced diet was being offered to people.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

The service lacked leadership and risk management. The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and some risks had not been mitigated. This placed people at continued risk of harm.

The systemic failings outlined in this report demonstrated the provider had failed to ensure people received a well-managed service which was safe and compassionate placing people at risk of potential harm.

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 16 December 2019).

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 the poor quality of care people were receiving. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

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

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people, staffing, risk management, medicines, nutrition and hydration, and governance at this inspection. Due to the significant concerns we found, after the inspection we continued to work closely with the local authority and safeguarding teams.

We issued a Notice of Proposal to vary the conditions of the providers registration so they were no longer authorised to carry on providing services at Swanrise. We received no representations from the provider, so we issued a Notice of Decision. This means the service is no longer in operation.

Follow up

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.

Swanrise is a residential care home providing personal care and support for adults with learning disabilities, autism and mental healthcare needs. The service is registered to accommodate up to six people and there were six people living at the service at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. However, not all of the principles had been fully applied to the service provided, to ensure 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 should also receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The new manager was working hard to ensure the principles of Registering the Right Support were applied fully. They had identified opportunities for people to live more interesting and varied lives, including offering more choice over what they took part in, and introducing goal setting into people’s care. These were in the process of implementation.

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

We observed positive interactions between people and staff. There was a stable staff team in place who knew people well.

There was a new manager in post since September 2019. Although we found improvements were still required, they had made a lot of progress with improving documentation and putting systems and processes in place which would ultimately benefit people living at Swanrise. Though not all improvements were yet embedded in practice, the manager was clear on their responsibilities and knew what was required to make the changes.

The provider had not always ensured that staff deployed were appropriately skilled; staff training was not always updated within the recommended time frame. The manager took prompt action to rectify this.

The assessment of risks affecting people and the environment in which they lived needed to be clearer. Where some risks were referred to in care plans, such as constipation and choking, risk assessments were not always in place to describe how staff should mitigate these risks.

Risks associated with falls from height, hot surfaces, and ensuring heavy furniture was secured to walls, were in the process of being addressed to ensure people’s safety.

People received their prescribed medicines from staff who were trained to administer medicines. However, not all staff were trained to administer emergency medicines if needed.

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; the policies and systems in the service supported this practice. Some improvements were however needed to ensure that documentation was clearer around decisions people could still make for themselves to maximise choice and independence, and to reflect more fully the principles of the Mental Capacity Act.

People’s nutritional needs were met and people were regularly weighed. However, the service was not using a recognised assessment tool to determine people’s risk of malnutrition. People were referred to health and social care professionals as required.

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 27 February 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, although we found some improvements had been made since the new manager came into post, the provider still remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the second time.

Why we inspected

The inspection was prompted in part due to concerns received about the service. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive, 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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, consent, staffing and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We have already met with the provider to discuss how they will make improvements to achieve a rating of Good. We will request an action and improvement plan from 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.

Swanrise 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.

Swanrise accommodates six people in one adapted building and is in close proximity to two other services owned by the same provider, staff work between the three services and people living in the services all interact with each other. One the day of our inspection five people were living in Swanrise.

At the time of the inspection the registered manager had not worked at the service since September 2018. There was no manager in place and no one had been asked to act up while a new manager was being appointed. 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.

The care service supports people living with a learning disability and should be 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. Meaning, people with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. However, it was not always evident that the provider understood these principals, there was not always enough staff on duty to promote independence and choice.

On the first day of this inspection, we found that there were not sufficient staff on duty to keep people safe. When we arrived, all the people who lived in the service had 1-1 support and there was no member of staff free to facilitate the inspection. People were still getting up and having their breakfast and they were not safe to be left. This meant that we started our inspection in the office examining care files and other records until a staff member was able to speak with us.

Later in the morning the general manager arrived, meaning the staff member could get back to supporting people. On the second day of the inspection, a decision had been taken to permanently add a floating staff member to the rota, however this person was to move between the three services within the same grounds and was not effective.

People were not always protected from risk. Risks in people’s environment were assessed and steps have been put in place to safeguard people from harm without restricting their independence unnecessary. Risks to individual people had been identified and action had been taken to protect people from harm. However, not all the risk assessments had been kept under review or had been updated.

People’s needs were assessed and they received care in line with current legislation. However, not everyone’s care records had been reviewed or updated. People’s daily activities were sometimes restricted because of staff not being available to support them. Staff did not always have the knowledge and skills they needed to carry out their roles. Training and supervisions had fallen behind.

The service had not been well led; failings in place prior to the registered manager leaving had not been identified by either the provider or the previous general manager, who had also recently left. However, we acknowledge that these have now been identified and the provider was taking action to make improvements. An acting manager had not been put in place while a new manager was being recruited, which meant that those shortfalls were not being properly addressed in a timely manner.

The staff had been safely recruited. People where protected from bullying, harassment, avoidable harm and abuse by staff that were trained to recognise abusive situations and how to report any incidents they witness or suspected.

Medicines were managed in a way that ensured that people received them safely and at the right time. Staff understood their roles and responsibilities.

People were asked for their consent by staff before supporting them in line with legislation and guidance. Apart from one occasion, we saw examples of positive interaction between the staff and people supported by the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

We saw that people received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. They took steps to investigate complaints

There was 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 supported by staff who understood safeguarding procedures and were able to recognise the signs of potential abuse.

Risks to people had been thoroughly assessed and plans put in place to manage these risks while enabling people to live their lives without unnecessary restriction.

Robust recruitment procedures had been employed to ensure that staff were suitable to work with people who used the service. There were sufficient numbers of staff deployed to meet people’s needs. Staff received comprehensive training to enable them to meet people’s needs.

People were given support to take their medicines as prescribed. People’s nutritional needs were met and they were supported to access healthcare if they needed it.

People were supported by staff who showed respect and cared for them as individuals whilst maintaining their dignity. People were encouraged to make their own decisions where possible and their consent was sought appropriately.

Staff understood the principles of the Mental Capacity Act (MCA) and worked to keep people safe while not unnecessarily restricting their freedom. Deprivation of Liberty Safeguards had been sought appropriately for some of the people living in the home.

People and those important to them were involved in planning their care, how it was delivered and their independence was promoted. People’s care was delivered in the way they wished by staff who were knowledgeable about their needs.

People who used the service and staff who supported them were able to express their views on the service. People were supported to make complaints and were confident that these would be heard and acted upon. The service maintained good communication with people who used the service and their families.

The management maintained a good overview of the service and had systems in place to monitor the safety and quality of the service. Staff were supported by the management and felt valued by the organisation.