The Swallows Residential Care Home

The Swallows Residential Care Home is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

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

People, including those living with dementia, were not always safe and were placed at risk of harm. This was due to the condition of the environment, poor infection control processes, medication management and lack of consideration of fire safety measures at the service.

People were not always kept safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. The provider had not ensured that their systems and processes were effective in enabling staff to provide safe and effective care for people.

Not all staff received training in areas relevant to people's needs including their health and safety. The provider could not evidence during the inspection that all staff completed an induction when they started work at the service. People were at risk of being supported by insufficient numbers of staff at certain times of the day.

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.

Audits and checks in place had failed to identify areas of improvements we identified during this inspection.

The provider had not ensured there was adequate oversight of the service. Quality assurance systems and processes did not identify or address all of the issues found during this inspection.

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 6 July 2021) and we found a breach of Regulation 12 of the Health and Social Care Act. This was because infection control processes were not adequate. 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 security of the building and standards of care at the home. 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.

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 requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection. We have also made a number of recommendations about the provider seeking advice best practice in relation to dementia care, healthcare liaison and compliance with the Mental Capacity Act 2005.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

The Swallows Residential Care Home is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

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

Staff did not take all the actions recommended by the government to protect people from the spread of infection. There were enough staff working at the service, although there were times when no additional staff were available to supervise communal areas to ensure people were safe.

Staff assessed and when possible reduced risks to people, although they had not considered risks associated with dementia care. We have made a recommendation about seeking national guidance for these risks.

Systems to monitor how well the home was running were carried out, although not all areas for improvement were identified and we were not assured the provider’s process was effective. The provider had management arrangements in place to support the service while they were working remotely due to COVID-19. People’s and staff views about the service were sought, although formal requests from relatives had been suspended due to COVID-19.

Staff reported possible abuse and knew what to do to keep people safe. The provider obtained key recruitment checks before new staff started work. Medicines were administered as prescribed.

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

Rating at last inspection

The last rating for this service was good (report published 9 May 2018).

Why we inspected

We received concerns in relation to safeguarding people, assessing risks and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

Enforcement

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 for 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good overall. Whilst we have rated the key question of Safe ‘Requires Improvement there was no other evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of this inspection 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. The registered manager was also a partner in the provider company. We have referred to this person as the registered manager throughout this report.

People we spoke with told us they felt safe living at the home. Risks were assessed and safety of people was monitored by staff on an on going basis. Improvements were needed to fire safety arrangements; we shared this with the fire service.

There were not always sufficient staff to meet people’s needs in a timely manner. We have recommended the provider review staffing levels.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received a service that was caring. Staff knew people's needs well and were responsive and supportive. Staff treated people with dignity and respect. Staff sought to gain people's views.

The service had a complaints procedure which was made available to people and their relatives. People were happy living at the home and had no complaints.

People who lived at the home, relatives and staff told us the service was well led. Staff were aware of their roles and responsibilities and were well supported.

Further information is in the detailed findings below.

We found that staff were well supported by the provider, training and regular supervision were appropriate for their role.

We found that medications were stored in secure cupboards and trolleys but the temperature of the cabinets had been recorded by staff as being above recommended levels for the safe storage of medications on three occasions during hot weather in July 2013. Some medications were stored in a food refrigerator that we saw was above the recommended temperature level after a food delivery. There was inadequate management of the administration of medicated creams.