The Swallows Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Care records were very task led and did not focus on improving outcomes. Improvements were needed to ensure care records were organised and that what actions need to be taken to meet people’s individual needs and when to review were recorded. The service supported people to access healthcare effectively.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During the on site assessment it was observed that some people spent most of their time in chairs. This included eating lunch, which was identified as a preference. Care records included a routine for supporting people to change incontinence pads and visit the toilet before mealtimes. As a task led activity this did not take into account individual arrangements for movement, changes to choices about where to eat (chair, table or bedroom) and related risk assessments. The television was on in one lounge area, but it was not clear who was watching it or why and there was no engagement with it. One person enjoyed music, and this was played in the communal area. Some others enjoyed this too whilst others did not.

Staff knew how to access care records and ensured they referred to healthcare professionals when needed. Whilst people’s preferences were understood by staff, actions to minimise the impact on others was not always considered by planning the day or giving choices. Some staff told us they needed to encourage one person not to be in their room all day, but it was not clear what other choices had been explored if they did not want to be in the lounge area.

Care records were not organised to be clear what actions need to be taken to meet people’s individual needs and when to review. For example, there were numerous entries in different colour pens stating, ‘no change’ and a date. A care plan check list to show plans was in place but this was not effective and did not have the desired outcome. Some records pointed to guidance, but it was not clear how this should be interpreted for the individual. This included details around meal planning, pressure care and end of life care pathways.

The provider confirmed most people living at the service were 'not considered to have cognitive impairment or dementia to any significant degree.' and that the service was not set up to be a dementia service, although they 'would continue to care for individuals whose cognition declines'. Staff described people as having ‘short term memory loss’. This assessment identified improvements could be made by exploring up to date best practice to keep people occupied and engaged regardless of their diagnosis.

Some staff told us they would be interested in more training around conditions which effect elderly people, including dementia. Staff and leadership advised they were not part of any wider support networks linked to specific conditions. Support was mainly sourced from external health professionals or ad hoc via a GP. There was no dementia strategy in place for the service or one staff and leaders could talk to. Staff received training and had benefited from recently supporting one staff member to become a qualified ‘train the trainer’. Staff were positive about the difference this made to their learning in practice,

The service employed two consultants to help them deliver evidence-based care and support. They were unable to share with us how they identified new best practice and how they would make improvements to the service. There was no process to demonstrate how staff and leaders were up to date with best practice and how this linked to the strategy for improvement at the service. For example, where a person had a specific support need, their plan of care was not in line with best practice and their daily care notes evidenced their care plan was not relevant.

The provider sought advice from external health professionals about how to support people with complex needs, such as supporting people who may display distressed behaviour. However, there was no planning on how to ensure that those needs did not impact on the wellbeing of others. People had access to healthcare that met their needs. On the day of our on-site assessment visit one person had attended a routine hospital appointment. We observed people to be supported to attend health care appointments and access other primary care services.

Staff and leaders told us how they liaised with health and social care professionals when needed. When asked about any other support organisations they did not have any other active links, for example with local care, training or management networks. These offer wider support and help keep staff informed and updated. They are also a source of peer support and ideas to explore.

The local authority had recently carried out an association of directors of adult social services (ADASS) review of the service in November 2023. They found there were some improvements required in areas such as a key working system and improvements to ensure people’s experience of care was always fully identified within their care notes. The provider took action to address these matters.

The staff team engaged in positive communication with other health professionals. Care plans contained evidence that people had access to appointment with their dentist and optician. We also saw evidence that people had access to wider healthcare such as the Occupational Therapist, Specialist Nurses and their GP

Care plans lacked detail and did not go into depth about meaningful support for healthier lives. this included how people spent their time in the service and routines of daily living. The service is in a rural area with no transportation links which limited people’s opportunities to go out frequently. One relative told us how they were unable to accompany their relative out of the service due to there being no footpaths.

Staff told us people had access to healthcare needs to maintain their health. One staff member said, “If any [people’s] health/needs change at all in any way I will address it to management so they can speak to GP and other authorities needed and also update the care plans.”

Whilst the service followed guidance from healthcare professionals, this action was task orientated and did not always consider the overall experience of the persons life at the home and whether this was meaningful. People were supported to see healthcare professionals when they needed. We saw evidence of health and social care professionals’ involvement in people’s individual care.

Care records were very task led and did not focus on improving outcomes other than the short term. Whilst basic care and escalations were completed when needed there was no longer term strategy. For example, ensuring and exploring meaningful activity for people, moving away from a daily routine dictated by tasks and trying out best practice ideas so see what works. Whilst staff were caring and intuitively kind, this did not always ensure people had ongoing positive experiences, for example, outside of daily routines. Staff had not always explored people's previous interests and hobbies to incorporate them into their lives. Reasonable adjustments had not been explored if a person's ability to undertake activities had been affected. For example, hearing loss or fine motor skills.

Staff and leaders were able to explain how they supported people in their daily lives. However, the records did not always demonstrate this, and it was not clear how monitoring and improved outcomes was linked to the home’s improvement plan and overall strategy.

Processes to ensure care needs were clearly linked to care plans and associated assessments required improvement. Governance checks did not link to check on how outcomes were being measured and reviewed. There was no link to the overall development plan for the service or strategy.

We found people experienced a lack of consistency in the application of the Mental Capacity Act. One person had capacity to make their own choices and decisions, however one relative told how they made a restrictive choice for their family member which staff followed, despite the persons preferences. Another person could experience distress for which their care plan had guidance about how they should be supported to manage this in their best interests, however, we observed this was not followed by all staff.

Staff, leaders and a consultant clearly understood their responsibilities around consent to care and treatment. They had made referrals to external professionals for assessments and support. Despite this there were some contradictions in care plans and records were not always clear what was needed and how a decision had been reached.

We found there were limited Mental Capacity assessments in place to evidence that people’s preferences and capacity to choose had been considered. One person had a capacity assessment completed on their capacity to safely leave the service alone however, their use of bed rails had not been fully assessed to consider their best interests and if this was the least restrictive option.