The Swallows Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection the provider had failed to fully assess the risks relating to the safety and wellbeing of people and the environment. This assessment showed there were improvements to the environment and systems to maintain a safe environment. Improvements were still needed to ensure a proactive approach linked to best practice and innovation and to ensure risks were adequately assessed and planned for.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst we were unable to speak with some people, we did gather feedback from a range of sources. People’s experience varied depending on their expectations and the level of their care needs. Some people were satisfied with their life at the service. Other people told us there were limited opportunities to engage in activities and social opportunities. Some people were unable to share their views verbally. Our observations demonstrated a positive approach by staff, to act in people’s best interests.

Staff had positive interactions and knew people well. Some had worked in the service for many years. Further improvements were needed to ensure that best practice was updated, shared, reviewed, learned from and embedded.

The providers processes for reviewing accidents and incidents were not always effective and did not result in improvements for people using the service. Records were not succinct and often were not clear about what was needed. In one case a review of care had not identified that further actions should be explored as time went on.

We saw support for people who needed to attend appointments and how staff worked to explain what was needed. Whilst there were pathways and professional support for end-of-life care, there was no trigger to review the experience of anyone who was not able to leave their room for a significant amount of time, or those who chose to spend time in ways that may not be in their best interests.

Staff and managers were clear about people’s needs and what they could do to support them. They told us they were supported by consultants and other professionals within health and social care. Some staff told us they would benefit from more in-depth knowledge around best practice and innovation, particularly dementia care.

Feedback from professionals was generally positive around communication. Documentation required improvement to evidence best practice and to ensure it was up to date. The local authority had completed their own assessment which included actions the provider had responded to.

People did not have hospital passports or information readily available to take to hospital with them if needed. Care records did include some references to ‘Do Not Resuscitate’ and ‘RESPECT best interests' documentation but they were not always clear about what was the most up to date. There were also some contradictions, and it was not always clear what staff needed to do directly linked with policy and process.

People told us they felt safe and relatives we spoke with told us they felt their loved ones were safe being supported by staff and did not have concerns about their safety. One person fed back that they were not sure if the service was the right place for their loved one but did not want to disrupt their life and were conscious of the impact it may have on them if they were to move.

Staff had a broad understanding of how to protect people from abuse and what action they should take if they felt someone was at risk, however, we found their knowledge would benefit from a greater understanding of the processes involved. One staff member said, “I think we have a whistle blowing policy, but I know if I had concern’s I would be listened too. I am not afraid to speak up.”

During the on-site part of our assessment, we spent time with people and the staff team. People appeared relaxed and comfortable with the staff members supporting them. When people were distressed staff spoke with them and tried to comfort and support them.

The provider had a process in place for reporting safeguards and concerns. This included sharing information with the local authority and via notifications to the Commission.

Whilst people felt safe living at The Swallows Residential Care Home, we were concerned that risks associated with people’s wellbeing and safety were not consistently identified and included in their care plans and risk assessments.

Some staff told us they felt informed about potential risks to people’s safety and that they could find this information. We found, however, that people’s care plans and risks assessments were not consistently up to date and did not always contain essential information to keep people safe and to reduce risks. Staff and leaders were aware of improvements made to the service, particularly around the environment, to help people stay safe. They did not always demonstrate if further improvements had been considered and/or independently trigger exploring different ways of doing things. This would support leadership to demonstrate how they consider all aspects of the running the service to protect and safeguard people as far as possible.

During our visit we observed people being supported to move in a safe way and staff were mainly attentive and responsive to people's needs in a safe manner. They listened and responded to people’s requests. This included ensuring a person who attended an appointment had a meal kept for them.

People’s care records did not always identify how the risks to their daily living were mitigated. The service used risk assessment tools, for example pressure care, however, this information was not used in the creation of a plan of care for the person. For example, one person was cared for in bed and at risk of pressure ulcers. Whilst staff were completing a repositioning chart in the person’s bedroom, there was no care plan to state how often the person should be assisted to change their position. Their ‘moving and handling’ care plan stated they had no such needs due to being cared for in bed and yet staff were supporting the person to move. The same person had a care plan which identified they were at risk of choking but did not indicate how the person should be safely supported to eat and drink in bed. This placed them at risk as staff did not have access to information about how to keep the person safe.

Some relatives told us people were supported in a safe environment. One relative told us, “I think my [family member] is safe, it’s not a busy care home where there are lots of people about.” We saw people move about freely within the service, access bathrooms and bedrooms. Whilst work had taken place to improve access to the garden one person told us they still found this difficult. There were accessible areas of the garden that could still pose a risk although staff confirmed no-one went out alone.

Staff told us they felt safe at work and were confident any concerns they raised about the environment would be addressed quickly. One staff member told us, “I feel [people] are safe and staff ensure they live in a safe environment.” Despite this we found some improvements such as risks present in the garden with an unsecured gate and low fence were required and the provider would need to closely monitor this as additional people move into the service.

During our on-site visit we observed an unsecured garden gate on a fire route, which led to the main road. We raised this with the provider/registered manager who immediately took action. However, they had not picked this concern up independently. In other areas of the service, we found improvements to the environment with equipment being replaced including toilet chairs, beds and flooring. There were also plans in progress for a staff area.

There were processes in place to oversee the safety of the environment such as water safety checks and fire safety checks, however, these failed to pick up environmental concerns such as the back gate being unsecured. In addition, records were not always complete, and gaps had not always been explored to ensure systems were working effectively such as the lack of fire safety testing in line with best practice guidance, Systems were not in place to demonstrate the impact of improvements, how it supported staff in their role and improved people’s experience. For example, access to the garden and the use of emergency personal alarms for all those using the service.

We received mixed feedback about the staffing levels. Some feedback reflected that staff knew people well. We were also told that more staff would enable greater interaction and focused support where some people required this. Examples included, some people requiring more staff support at meal times and improvements to interaction and positive engagement with people who were often, “just sitting with the TV on.”

We received some mixed feedback from staff about the staffing levels. Some staff felt the provider employed enough staff to support people safely. One staff member told us, “The rota works very well, and the office staff are very flexible with shifts if you needed to change about for whatever reason it’s a lovely little team we have here.” However, some staff also raised concerns that there were times in the day when staffing levels were a challenge that limited interaction with people.

Whilst staffing levels met people’s basic care needs, we did not observe staff had time to spend engaging and interacting with people as they were busy delivering care. We did not observe delays in people receiving care and support, but staff were task focused and had little time for quality engagement with people .

We found that not all staff working at night had training to administer medicines to people should they require this overnight. This meant there could be a delay if people required pain relief overnight for example. The leadership team referred to a system where a trained person could be on site to support with medication via an on-call system. Whilst they shared there had been no concerns with this process, the process did not include regular reviews or circumstances where this may need to change, for example timed medication at night and/or more regular requests for as required medication Improvements were needed to ensure an applicant’s full work history and any gaps in employment had been explored and documented prior to their recruitment. Other pre-employment checks included obtaining references and checks with the Disclosure and Barring Service (DBS) had been appropriately carried out. The DBS helps employers make safer recruitment decisions and help prevent unsuitable people from working in care services

People told us they thought the environment at The Swallows Residential Care Home was clean and well-maintained.

Staff told us the infection prevention and control practices were safe and told us they always had sufficient personal protective equipment (PPE) to ensure they could work safely.

There was a housekeeper in post and we observed the environment to be clean.

People were protected from the risk of infection as staff were following safe infection prevention practice. Personal protective equipment, such as aprons and gloves, was readily available throughout the home to prevent the risk of infection for staff and people.

People's medicines were administered by trained and competent staff and medicines were ordered, stored and disposed of safely. A recent visit by external professionals made some recommendations about localising the services process specific to the home. The provider told us they would do this.

Staff and leaders were able to explain how they supported people with medication and how they escalated any concerns. This included support from other professionals.

People received their medicines as prescribed, including ‘when required’ medicines. Staff told us they had received medicines training and their competency to safely administer medicines was regularly re-assessed. Processes and systems were in place to ensure people’s medicines were ordered, stored, and disposed of safely in line with best practice guidance. Staff worked in line with the provider's medicines management procedure. Medicines record were up to date and regularly reviewed.