Swan Court

Swan Court is an extra care housing scheme, providing personal care for up to 24 people with sensory impairment and/or physical disabilities and older people. Some people using the service were living with dementia.

At the time of our inspection five people were using the service. People using the service lived in flats, having their own private living space, kitchen facilities and bathroom. The flats were housed within one building, which was linked to a residential home on one side. People had access to a communal garden and dining area, although the use of some communal spaces had been subject to restrictions due to the COVID-19 pandemic.

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

We found risks to people using the service were not clearly identified and managed. We also identified concerns in relation to the safe management of medicines. People indicated they felt safe and spoke positively about the support they received from staff. One person told us, “I am well looked after, constant attention, the helps [staff] are very positive, and try to make life comfortable.” Another person described the staff, advising, “[They are] always helpful…I don’t know their names.”

We found the service was not effectively managed and monitored. Audits had failed to identify some of the issues we found, including concerns in relation to the safe recruitment of staff. At the time of our inspection, a manager and deputy manager provided support following the departure of the previous registered manager. The management team were motivated to make improvements and some work had commenced, such as the introduction of an electronic medicines system. There was a commitment to promoting people’s independence and reducing unnecessary paperwork. However, we found not enough improvement had been made following our last inspection.

Some people using the service experienced cognitive impairments, and we found people had varying levels of awareness in relation to the management of the service. Some people were aware of the care coordinator and provided positive feedback. One person told us, “I assume she does her job well, as I’m well looked after.” Another person added, “They are always asking if everything ok.” We received mixed feedback from relatives regarding the effectiveness of management. One relative told us, “The ladies that work there are lovely, [care coordinator’s name] is an asset…I feel they've been quite reactive rather than proactive on occasion…care is brilliant but communication isn’t.” A second relative added, “I get the sense it’s very well organised.”

Some people living at the service experienced memory loss and required significant assistance from staff. Some people did not readily accept staff support and needed encouragement with tasks such as personal care, eating and drinking. We found staff were knowledgeable about the people they support and concerns for people’s welfare were shared with appropriate agencies such as the local authority.

People using the service lived in flats and feedback showed people valued having their own personal space. Staff supported people by following a care plan which outlined daily visits. Staff remained onsite which meant they could have more frequent contact with people, and staff described spending additional time engaging with people to help mitigate the isolation people experienced during the pandemic. People could use an alarm system to seek staff assistance, for example, in the event of a fall. One person described the advantages of extra care housing for them, explaining, “I have shower, [my] own bedroom, sitting room, [my] own cooker, shopping…if I press, someone will come.”

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.

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 12 December 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 October 2019. Breaches of legal requirements were found in relation to governance of the service and safe care and treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained 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 breaches in relation to the safety of people’s care and support, the safe recruitment of staff and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Swan Court is extra care housing, providing personal care for up to 24 people with sensory and / or physical disabilities and older people, some living with dementia. People using the service lived in flats, housed within one building and linked to a residential home on one side.

At the time of the inspection six people were living in the service, four of these people received the regulated activity of personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

We found a repeated breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because checks that should have been carried out to ensure the safety of the service had not been completed regularly or accurately. This included medicine management which was not always safe as creams and lotions opening dates were not always recorded. Medicines stock control records were not always accurate. Improvements were made to the stock control records following our inspection. Water temperatures had not been recorded in line with the provider’s policy. Fire records and fire procedures were not completed in line with fire safety compliance and the provider’s policy.

We also found a repeated breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the management oversight had not identified areas for improvement we found.

There were sufficient numbers of staff available. During the last inspection we made a recommendation about the need for improvements to the recruitment procedure. During this inspection we found this had improved. Staff recruitment systems minimised the possibility of employees providing unsafe care to people. Staff were supported by senior staff and received training and supervision to enable them to carry out their role’s. Staff had a positive relationship with people using the service. People described them as “Fantastic” and “Easy to get on with.”

The premises were clean, and systems were in place to protect people from the risk of infection. People who had specialist health needs for example, diabetes or epilepsy received support from external professionals. People were satisfied by the food they were offered in the service. People were supported to enjoy their meals and their nutrition and hydration was monitored to enable people to remain healthy. People’s needs were assessed, and the environment was clean and well maintained.

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. Resident meetings were held which offered people the opportunity to have their input into the way the service operated. They also participated in reviews of their care.

People’s cultural and religious needs were acknowledged. People’s preferences and dislikes were documented. Information related to people’s health needs was included in their care plans, this assisted staff to understand the impact of their health on the care being provided.

The service supported people with their communication needs and was compliant with the Accessible Information Standards. Accidents and incidents were clearly recorded, and investigations were undertaken to ensure the risk of repetition was minimised.

People and staff told us they thought the service was well-managed. Comments included “It is a good place to work, it’s not perfect but it’s a great place.”

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 September 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 have identified breaches in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

We have issued a warning notice regarding the breach of Regulation 17 of the Health and Social Care Act 2008. This requires the service to be compliant with Regulation 17 by 31 January 2020.

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

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

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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service Safe and is the service Well-led, to at least good. During the current inspection we found improvements had been made to the safety of the service, however, we found the service was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not checked the information recorded in the quality assurance audits was accurate. Audits that had been completed did not identify the concerns we found.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

Swan Court has 12 apartments and can accommodate up to 24 people. At the time of our inspection there were 12 people living in the service. The service is registered to accommodate older people, those living with dementia, and people with sensory of physical disabilities. Each person had their own apartment which comprised of an open plan kitchen/ lounge area, bathroom and bedroom. The apartments were all on one site with a communal lounge/ dining and kitchen area, bathrooms and garden.

The service was mostly safe, although the provider had systems in place to ensure the safe recruitment of staff these had not always been followed. We have made a recommendation about this.

Staff were trained to identify signs of abuse and how to report concerns. Medicines were administered by trained staff. Records showed people received their medicines in a safe and appropriate way. Where people required additional support with maintaining their health, they were referred to health professionals such as psychologists and GPs.

People spoke positively of their experience of living in the service, they told us “The best thing about living here is the atmosphere and the other people living here.” “I do everything I want to do.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported with their nutritional and hydration needs. This included providing food and drinks that was safe for them to consume and in line with their preferences.

Care plans documented people's preferred method of communication. People had access to the information they needed in a way they could understand it. People's relatives were encouraged, where appropriate, to be involved in the planning and monitoring of the care provided.

Families and friends were encouraged and supported to maintain contact with people. This protected people from the risk of social isolation. People were treated equally, regardless of their disability, gender, sexuality, religion, race or age in line with the requirements of the Equality Act 2010. People's chosen lifestyles were respected and where staff could offer support to people they did.

People, staff and others had positive opinions about the management and leadership of the service. There was a good workplace culture and we saw the staff worked well together to ensure effective care for people. Staff comments included ““She [care coordinator] has had a lot to get her head around, personally I think she is doing really well.” “The best thing about this service is my relationship with the residents and staff, but mostly with the residents.” “I think it is really well managed, especially with everything that can happen in a day.”

Swan Court has a registered manager in place. The registered manager was also the registered manager of the sister service, Swan House, which is linked to Swan Court. 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. We undertook an announced inspection of Swan Court on 15 February 2017.

People told us they felt safe at Swan Court. Staff understood their responsibilities in relation to safeguarding people. Staff knew how to keep people safe. One staff member said “When people are in our care, they should be safe in every aspect of their life and not under any threat of abuse”. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People said “Staff are very good, no problems. They are kind and respectful” and “They are such a good team, I don’t need to ask them anything”. People were involved in their care choices and people’s independence was actively promoted. People and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were mainly in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. Staff rotas confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People said they were happy with the level of support and care from staff. One person said “My care flows along and I am happy here”. People’s nutritional needs were met and they told us they were well supported where needed with their meals.

People told us they had no complaints and were confident they would be listened to and action would be taken if they raised a concern.

The service had systems to assess the quality of the service provided, but these were not always effective. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care, but records of incidents were not always maintained.

We have made a recommendation that staff are reminded of their responsibility to record all incidents.

Staff spoke positively about the support they received from all of the team at Swan Court. Staff supervision and other meetings were scheduled for 2017, but formal supervisions had not taken place as planned in 2016. People and staff told us all of the management team were approachable and there was a good level of communication within the service.

We have made a recommendation that staff supervisions be formally recorded.

People told us the team at Swan Court were very friendly, responsive and well managed. The service sought people’s views of their care.

We found the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

One member of staff told us 'The care here is very 'family-orientated' with one person having just come back from a holiday with their family and another who's just been to a family event which meant a week away.'

During our inspection it was clear that the people who had used the service were treated with dignity and respect, which included all personal care taking place either in their own room or the shared bathroom. On each occasion we observed that the door was locked and that staff knocked on the door and waited to be invited to enter.

There had been no allegations of abuse within this service. However we saw minutes of meetings attended by senior staff from this and similar services across the company which demonstrated that notifications of safeguarding incidents elsewhere had been discussed and learning identified.

We spoke with people who used the service about their confidence in the staff and one person told us 'We get on very well with them; they look after us and we've no complaints.'

It was clear, from all the documentary evidence and the discussions with people who used the service and staff, that the provider had arrangements in place which reviewed the quality of the service provided and made changes to address learning or meet changes in support needs.

We found the service had arrangements in place to provide the care and support people required. The service involved people in decisions about their care. It had procedures to protect people from the risk of abuse. People were looked after by staff who were appropriately trained and supported. The provider had arrangements for monitoring the quality of the service provided to people.