Swillbrook House Residential Home was inspected on the 15 January 2019 and the inspection was unannounced. Swillbrook House Residential Home 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.
Swillbrook House is a large country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. The property has a car park and landscaped gardens. The bedrooms are mostly single rooms with shared bathroom facilities. 15 out of 20 rooms have ensuite facilities. Bedrooms are over two floors with a small lift providing access to the upper floor.
At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.
There was a complaints procedure available and displayed at the home. People we spoke with told us were confident any complaints they may wish to make would be addressed by the registered manager. During the inspection we were advised by an external person that they felt their complaint had not been responded to in a timely manner. We discussed this with the registered provider and reviewed the policy and saw further detail may be helpful in supporting expectations. We have made a recommendation regarding the complaints policy.
We observed medicines being administered and saw this was carried out in a person-centred way. Medicines were managed safely and staff were knowledgeable of the processes to order and receive medicines. We noted more information on ‘variable dose’ medicines would be beneficial to support staff when administering these. We have made a recommendation regarding variable dose medicines.
We spoke with the maintenance person who showed us around the home. They told us the home was in the process of being refurbished. We noted some areas of the home did not have handrails and the flooring required attention in some areas. The maintenance person and the registered manager told us this work was in progress. We have made a recommendation regarding this.
There were a variety of checks carried out to ensure that successes were recognised and areas of improvement identified. The registered manager told us the registered provider also maintained oversight of the home by carrying out checks, however these were not always documented. We have made a recommendation regarding the documentation of the registered providers oversight.
We checked to see staff were recruited safely to ensure they were suitable to work with people who may be vulnerable. We reviewed two files of staff who had recently been recruited to work at the home. We found the files contained employment checks, references and a full employment history.
We viewed care records to ensure people’s needs were assessed and risk to people who lived at the home were minimised. We found individual risk assessments were carried out in key areas such as nutrition, falls and skin integrity. Care records continued sufficient person-centred information to enable staff to support people. Care records also contained information regarding people’s preferences and wishes. People and a visitor we spoke with confirmed they were consulted in decision making and involved in care planning.
People and a visitor told us staff were respectful and caring in nature. We observed warm and affectionate interactions between people who lived at the home and staff. We found staff were gentle and kind with people and people told us they liked the staff.
We found the home was clean and tidy and staff were seen to wear protective clothing when this was required.
The registered manager told us and we saw documentation which evidenced the service sought feedback from people who lived at the home, relatives and visiting health professionals. Documentation asked people to share their opinions on what the home did well and what needed to improve. The registered manager told us they were in the process of analysing the results.
People told us they did not have to wait for help and staff were attentive to their needs. We timed two call bells which were answered promptly. Staff were seen to be patient and spent time with people chatting and supporting them when they needed help. Staff and a visitor we spoke with told us they were happy with the staffing arrangements at the home. Rotas we viewed showed staffing was arranged in advance and staff confirmed replacement staff were provided if unplanned absences occurred. The registered manager told us they would review the staffing arrangements as people’s needs changed to ensure they were sufficient.
Staff told us and we saw documentation which evidenced staff attended training to enable them to maintain and update their skills. Staff spoke positively of training and told us they felt supported to refresh and update their knowledge. We also saw evidence and staff confirmed, they had regular supervision with their line manager to discuss their performance.
People were asked to express their end of life wishes. Person centred documentation was available to plan this area of people’s care if people wanted to share their needs, wishes and preferences.
People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were enabled to access further professional healthcare advice when required.
People told us they had a choice of meals to choose from and they enjoyed the meals provided. We saw people were offered a choice of meals during the inspection and we observed part of the lunchtime meal. We saw the lunchtime meal was a social occasion. People could sit where they wished, the atmosphere was relaxed and we observed people chatting. If people chose to eat alone, this was accommodated. We found staff were available to help people if they needed support.
Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager, registered provider or the local authority safeguarding team so people were protected. The number of the local authority safeguarding team was displayed on notice boards at the home so staff, visitors and people who used the service could raise concerns if they wished to do so.
People told us there were a range of activities provided. They said they could take part in these if they wished to do so. The registered manager told us they sought the views of people who lived at the home when deciding what activities to provide.
The registered manager demonstrated their understanding of the Mental Capacity Act 2005 (MCA). People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
A visitor and people who lived at the home told us they could speak with the registered manager if they wished to do so and they found the manager approachable.
Further information is in the detailed findings below.