Swanland House

Updated 12 August 2022

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.

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. An Expert by Experience also spoke to relatives by telephone. 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

Swanland House 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. Swanland House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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 spoke with five people who use the service and 11 relatives to ask about their experience of care provided. We also spoke with the registered manager, the nominated individual, six staff and three professionals. We looked at five care files along with a range of medication administration records (MAR), We looked at other records relating to the management of the service including recruitment, staff training and supervision, and systems for monitoring quality.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 12 August 2022

About the service

Swanland House is a residential care home providing personal and nursing care to up to 35 people. The service provides support to people with dementia, older people and younger adults. At the time of our inspection there were 19 people using the service.

Swanland House is a privately owned residential care home that operates in a Grade 11 listed building.

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

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 leadership, governance and culture did not promote the delivery of high-quality person-centred care. Managers did not lead effectively, and staff did not feel listened to or valued.

The provider did not provide consistent leadership and managers were not clear what their roles and responsibilities were. Staff told us, “[Registered manager] was supportive but was a ‘jack of all trades’ and did everything.”

The registered manager did not regularly review staffing levels and adapt them to people’s changing needs to ensure there were enough competent staff on duty. Relatives told us, “I don’t think there are enough staff” and “The home has been dreadfully short staffed.” Recruitment systems were robust and ensured the right staff were recruited to support people to stay safe.

There is limited use of systems to record, manage and report concerns about risks, safety and incidents. People were not involved in managing risk. Risk assessments were not person centred and reviewed regularly. People did not always receive their medicines as prescribed. Medicines were not stored correctly and disposed of safely.

The providers quality assurance arrangements were not strong so did not identify current and potential concerns and areas for improvement. Concerns were not investigated, and there were no opportunities for learning when things went wrong.

Staff supervision and support was inconsistent. Training and development plans were not designed around learning needs and the care and support needs of people who use the service. We have made a recommendation about supervision and appraisals.

The service monitored people’s heath, care and support needs, but did not consistently act on the issues identified. There was a process in place for referring people to external services.

Staff had an awareness and understanding of abuse and knew what to do to ensure people were protected.

The service manages the control and prevention of infection well. Staff are trained and understand their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises.

People had access to suitable outside space, a quiet area to see their visitors, an area suitable for activities and private areas where people could be alone.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 16 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the assessment and management of people’s risks. A decision was made for us to inspect and examine those risks.

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, effective and well-led sections of this full report.

Enforcement and recommendations

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 and will take further action if needed.

We have identified breaches in relation to the safety and quality of the service, the mental capacity act 2005, staffing and the overall leadership and management of the service.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

The provider is currently working with the local authority and safeguarding team to ensure records are relevant and up to date and care plans and risks assessments identify current needs and are appropriately managed.

Follow up

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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.