About the service: Swan House Care Home is a service that provides accommodation and nursing and personal care for up to 40 older people. At the time of the inspection 38 people were using the service.

People’s experience of using this service:

Staff understood the risks to people and measures were in place to keep them safe. Systems were in place to manage people's medicines safely and to reduce the risks associated with the spread of infection.

Recruitment processes were followed to ensure staff were of good character and suitable to work at the service. Sufficient numbers of staff were employed to meet people's needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet the specific needs of people using the service.

People were provided with the care, support and equipment they needed to stay independent. Staff were kind and caring and had developed good relationships with people using the service.

People were supported to maintain their health and had access to a varied choice food and drink. People had access to a wide range of activities in the community and within the service, that reflected their specific needs and interests.

People's communication needs had been assessed and were meeting the requirements of the Accessible Information Standards. This set of standards sets out the specific approach for providers of health and social care to identify, record, share and meet the communication needs of people with a disability, impairment or sensory loss.

People's privacy, dignity and rights were respected and upheld. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible.

There were clear and effective systems in place to identify and manage risks to the service and drive improvement. There was an open culture of learning from mistakes, concerns, incidents and accidents. The manager and staff worked well with other agencies to ensure people received high quality joined up care.

Rating at last inspection:

Good (report published 18 August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

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

Swan House Care Home is registered to provide accommodation and nursing care for up to 40 people. At the time of our inspection there were 38 people living at the home. The home is a two storey premises located in the town of Chatteris close to local shops, amenities and facilities.

This unannounced inspection took place on 25 July 2016.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were knowledgeable about recognising, reporting and the recording procedures to help protect people from any, or potential, incident of harm. A sufficient number of qualified, competent and safely recruited staff were in post to meet people’s assessed needs

People’s medicines were safely administered, stored and disposed of. However, protocols for some people’s 'as and when required' medicines were not in place, not correct or out of date. This meant that staff had a lack of up-to-date guidance to manage people’s conditions, such as pain, by means of prescribed medicines.

Staff were regularly trained and assessed as being competent to safely administer people’s prescribed medicines. An effective induction, supervision and mentoring process was in place to support staff in their role.

Risk assessments and risk management strategies were in place to help ensure that people were not exposed to unnecessary risks to their health. Risk assessment reviews were completed according to each person’s needs. Systems were in place to support people in the event of an emergency such as a fire.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager, nursing, senior and care staff were knowledgeable about when an assessment of people’s mental capacity was required. Appropriate applications had been made by the registered manager to lawfully deprive of their liberty as well as people being cared for in the least restrictive manner. Authorised and renewed DoLS were adhered to. This meant that, where appropriate, people were being lawfully deprived of their liberty.

People were supported to access a range of health care services and their individual health needs were met. People’s nutritional support needs were met and people had access to refreshments and snacks. This included the provision and choice of appropriate or foods and drinks diets for those people at an increased risk of malnutrition, dehydration or weight loss.

People’s care was provided by staff who undertook this role with respect, dignity and compassion. People, or their authorised representative, were involved in the planning and delivery of their care. Information was made available for people or their relatives who may have needed an advocate or requirement to access independent advocacy.

People were given various opportunities to help identify and make key changes or suggestions about any aspects of their care. A complaints procedure was in place and actions were taken to help prevent the potential for any further complaints.

A range of audit and quality assurance procedures were in place. This was to help identify what worked well and any area that required improvement. However, these audits were not always as effective as they could have been. People, staff and visitors were encouraged to provide their feedback and views on the quality of care people received.

We carried out an unannounced comprehensive inspection of this service on 14 April 2015. During this inspection a breach of legal requirements was found. This was because the registered person had failed to notify us of incidents they are required by law to tell us about.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 8 June 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Swan House Care Home’ on our website at www.cqc.org.uk’

Swan House Care Home is a two storey building located in the residential area of Chatteris. The home provides accommodation for up to 40 people who require nursing and personal care. At the time of our inspection there were 39 people living at the home. The home is split into four main units where people are cared for according to their assessed care or nursing needs. All bedrooms are for single occupancy.

The home had a registered manager in post. They had been in post since April 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our focused inspection on 8 June 2015, we found that the provider had followed their plan which they had told us would be completed by 15 April 2015 and legal requirements had been met.

People living in the home were confident that action would be taken if an accident or incident occurred such as a fall, and that these would be reported. Staff had been trained on incident reporting and recording. Arrangements were in place to ensure that where staff deputised for the registered manager, that reporting of events was carried out.

Staff had received additional training regarding the reporting of notifiable incidents including Deprivation of Liberty Safeguards, serious injuries and suspected abuse.

Swan House Care Home is a two storey building located in the residential area of Chatteris. The home provides accommodation for up to 40 people who require nursing and personal care. At the time of our inspection there were 39 people living at the home accommodated in single occupancy rooms. The home is split into four main units where people are cared for according to their assessed care or nursing needs.

This unannounced inspection took place on 14 April 2015.

At our previous inspection on 17 June 2013 the provider was meeting all of the regulations that we assessed.

The home had a registered manager in post. They had been in post since April 2014. 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 provider had a robust recruitment process in place. This ensured that only the right staff were recruited and offered employment.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and staff were knowledgeable about when a request for a DoLS would be required. We found that appropriate applications to lawfully deprive some people of their liberty had been submitted to, and authorised by, the local authority (supervisory body). People’s ability to make decisions based on their best interests were supported by records to demonstrate where this had been assessed as being lawful.

Staff respected people’s dignity. Care was provided by staff in a caring and compassionate way. People’s requests for assistance were responded to promptly.

People’s care records were regularly reviewed to ensure they were relevant and contained accurate information about people’s assessed needs. Support for some people to undertake their hobbies and interests covered a wide spectrum of activities. People were provided with stimulation that was meaningful to them.

People were supported to access a range of health care professionals. This included GP and community nursing services. Risks to people’s health were assessed and acted upon according to each person’s needs.

People were provided with a choice of meals based upon a range of options including those people who required a soft food diet. There was a sufficient quantity of food and drinks available and people were supported to access these.

People, relatives and staff were provided with information on how to make a complaint and staff knew how to respond to any reported concerns or suggestions. Action was taken to address people’s concerns and to prevent any potential for recurrence. The availability and provision of information for Independent Mental Capacity Advocacy (IMCA) services in the home enabled people or their relatives to access these services if required.

The provider had quality assurance processes and procedures, such as audits, in place to improve, if needed, the quality and safety of people’s support and care. Five out of six people’s end of life records had not been effectively reviewed. In addition, although people had been lawfully deprived of their liberty and safely supported the registered person’s had not notified the Commission of these incidents.

We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

People told us they liked living at Swan House and that the care and support they received was meeting their needs. They also told us they were very pleased with the care staff that provided their care and support. One person said, “I feel safe living here. I have seen the doctor when I needed them. Everything is done for me and I always have plenty to eat and drink".

Care planning and the delivery of care were seen to meet people needs. Staff demonstrated they knew how to meet people’s individual needs.

Medication was being managed in a safe and appropriately recorded manner which had ensured that people had received their medication safely and as prescribed.

We found that there were enough care staff to meet people's needs, although people's mealtime needs were sometimes difficult for staff to manage.

The report shows that two managers are registered for this location. This is because we have not received an application to cancel the registration from one of the registered managers.

The home had a suitable and easily accessible complaints process.

During our visit on 27 July 2012 we spoke with eight people who each told us they were treated with respect by care staff. One person said, “I am happy with the way staff speak to me. They are usually polite and considerate”. People said that they were satisfied with their care and support and with how care staff provided their care. One person said, “I am given assistance when I need help and I can always call for care staff if I need them”. Another person said, “I think they (staff) are kind. I would like to get out more into the local community, but I don’t often get the opportunity to do this”.

People also told us they felt safe living at the home and that they were satisfied with their environment.

People we spoke with gave a range of views about their experiences whilst living at the home. Most of the people said their care was of a good standard although a low number considered that the standard of their care would be better if staff were more responsive to their individual needs and choices. Whilst we heard positive things about the staff, who people described as "Lovely", "Obliging" and "Helpful", we were told that the timely response of staff was an issue. One person said, "The care, when they get here, is good. I have been up a long time and still not had a wash." Another person told us that there was "Not enough of them (staff)." Another person said that they felt "isolated" as staff had insufficient time to spend with them in a meaningful and sociable way.

People liked their rooms and were pleased with the furniture provided. One person said their bed was comfortable and they liked their en-suite facilities.