About the service:

Swansea Terrace provides treatment of disease, disorder or injury, accommodation and personal care for 44 older people. At the time of our inspection the home had 35 people living there. The home is located close to Preston city centre. There are two large lounges/dining spaces, communal bathrooms and en-suite washing facilities.

People’s experience of using this service:

The registered manager had sustained the improvements implemented at our last inspection. Standards, systems and procedures were embedded to demonstrate good practice in safety and leadership over time. Everyone we spoke with said the home had developed and enhanced their welfare. An employee told us, “Things are better than they have been for a while. I am enjoying it now more than ever. I love what I do.”

Staff had good awareness of potential risks to people because the registered manager completed assessments aimed at minimising the risk of unsafe care.

The provider had good systems to maintain people’s safety and welfare at Swansea Terrace. A relative stated, “[My relative] is safe, I go home feeling reassured she is well looked after.” Staff had a good understanding about the principles of safeguarding people from abuse and poor care.

The registered manager completed a weekly dependency tool to check staffing levels continued to meet people’s needs. One person stated, “Yes, there's enough staff. They are patient and I don't feel like I am taking their time up.” Staff had a good range of training and competency-testing to enhance their skills and expertise. One employee said, “Yes, [the registered manager] checks our competency regularly and then we have a question and answer session.”

The registered manager had good protocols to ensure people’s medicines were managed safely. One person told us, “The nurse gives me my medication. I prefer that because it keeps me safe.”

People and relatives stated staff completed timely referrals to other healthcare services and kept them updated. A relative said, “They got this thing called the SALT team out who assessed [my relative]. Now she has a soft diet and is doing much better.”

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. A staff member stated, “We must always first respect the resident's choice in this matter.”

Care records held support plans to guide staff to each person’s nutritional needs and level of assistance. A visiting professional told us they were impressed with how well staff kept documents up-to-date and monitored their nutrition and support. People were offered a variety of meals and could choose alternatives if they did not like what was on the menu.

People confirmed staff were caring when supporting them. One person said, “Yes, the staff are very caring.” The registered manager ensured staff had equality and diversity training as part of their commitment to provide a respectful and individualised service. A visiting professional added they found staff were friendly and approachable.

The management team assessed people’s needs before admission and on an ongoing basis to guide staff to be responsive to each individual’s needs. Care records included detailed information about each person’s preferences and backgrounds to help staff understand their requirements.

People told us the management team was visible and kind. One person said, “[The registered manager] is lovely, she has a caring nature about her.” Staff commented they felt valued and the registered manager worked with them in the development of Swansea Terrace. One staff member said, “We have staff meetings and go through anything that needs to be given out, share opinions and suggestions, trying different ways to do things and make improvements.”

Rating at last inspection: At the last inspection the service was rated requires improvement (published 1

Swansea Terrace provides support for people who require residential or nursing care. The home is located close to Preston city centre. There are two large communal rooms, communal bathrooms and en-suite washing facilities.

Swansea Terrace is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There is a registered manager at the service. 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.

At the last inspection of the service we found 6 breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. These breaches were Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. During this inspection we checked to see if there had been improvements at the service. We found all the breaches of regulation had been improved.

We found the home was clean and tidy. Staff told us they were provided with personal protective equipment. We found moving and handling was seen to have improved. We looked at how the service was managing medicines at this inspection. We found improvements had been made.

We saw a staff dependency tool was being used appropriately to determine how many staff were required. Staffing levels had improved and agency staff had not been used for five months. We found people were protected by suitable procedures for the recruitment of staff.

We found that maintenance checks were completed and there had been improvements. A range of checks were carried out on a regular basis to help ensure the safety of the property and equipment was maintained.

We looked at how accidents and incidents were being managed. There was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these. People told us they felt safe. The service had procedures to minimise the potential risk of abuse or unsafe care.

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

Staff received supervision and appraisals and told us they felt supported. Staff training was ongoing and evidence was seen of staff completing training. We saw evidence people's care and support was delivered in line with legislation and evidence based guidance.

We found in depth assessments were carried out by the registered manager before any person received a service. Peoples needs for nutrition and fluids had been considered. Files contained likes and dislikes with regards to food and drink. We observed people eating in a relaxed manner and they seemed to enjoy their meals. People told us, “We have a good choice at meal times.”

We received consistently positive feedback about the staff and about the care people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights.

Staff were highly motivated and described their work with a clear sense of pride and enthusiasm.

We looked at what arrangements the service had taken to identify record and meet communication and support needs of people with a disability, impairment or sensory loss. Care plans seen confirmed the services assessment procedures identified information

Swansea Terrace is registered to provide 24 hour nursing and personal care for up to 44 people and is located close to Preston city centre. There are two large communal rooms, communal bathrooms and en-suite washing facilities. At the time of our inspection there were 31 people who lived at the home.

The last inspection of this service took place over two days on 02 and 06 June 2016. The service was awarded a rating of ‘Requires Improvement’ and we identified no breaches of regulation at this inspection.

This inspection visit at Swansea Terrace was undertaken on 02 and 07 August 2017 and was unannounced.

The service is required to have 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. At the time of our inspection the service did not have a registered manager. A manager had been employed who was in the process of registering with CQC.

During the inspection the environment was found to be unclean in a number of areas. We found there were no clinical waste bins where these were required. We saw bathroom equipment that was rusty. Some of the bins around the premises were overflowing and did not always contain a bin liner.

We observed unsafe practice when one member of staff was supporting a person who lived at the home with their lunch. The person was asleep and the staff member put food into their mouth and gently “shook” them awake to swallow it. This posed a high risk of choking for the individual.

We observed poor moving and handling throughout the inspection visit. People who required hoisting had full body slings which should be positioned level with the back of people’s knees for support. However we observed this was not always the case.

We observed the lunchtime medicines round and found people were not asked if they required pain relief prior to being given pain relief medicines. In addition we noted one person refused one of their medicines. We checked the records and saw the persons medicines had not been reviewed to see if there was an alternative medicine they could take.

We looked at people’s care plans and found gaps in information regarding people’s medicine regimes. We saw support plans to guide staff when giving medicines which are taken “as needed”. However these did not contain all the relevant and necessary information for the staff to give the medicines appropriately and safely.

Topical cream administration was found not to be safe. The topical cream charts were inconsistent. We found instructions for the topical creams had not been transferred to the cream charts accurately. This resulted in creams not being applied as directed.

The concerns with infection control, medicines management and unsafe practices amounted to a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

Staffing levels were observed to have direct impact on peoples care and treatment. Although people told us they felt safe, everyone we spoke with raised concerns about staffing levels.

The concerns we found with staffing arrangements amounted to a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We asked to look at the recruitment records for three people who worked at the home and found the provider had not made sure suitable referencing was obtained prior to agreement of employment.

The concerns we found with recruitment amoun

This inspection took place on 02 & 06 June 2016 and was unannounced.

At our last inspection in October 2015, we found a number of significant breaches of legal requirements. As such, we took urgent action to ensure improvements were made. The service was placed into special measures. Since October 2015, we have monitored closely the improvements that have been made through contact with the provider, the local authority and clinical commissioning group. During this inspection we checked to see what improvements had been made.

Swansea Terrace is registered to provide 24 hour nursing and personal care for up to 44 people and is located close to Preston city centre. There are two large communal rooms, communal bathrooms and en-suite washing facilities. At the time of our inspection there were 31 people who were using the service.

The service is required to have 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. At the time of our inspection the service did not have a registered manager. A manager had been employed who was in the process of registering with CQC.

During our last inspection in October 2015, the service was found not to be meeting legal requirements in relation to: protecting people against the risks of avoidable harm and abuse, staffing, safe management of medicines, cleanliness and infection control, obtaining valid consent, meeting people's nutritional needs, privacy and dignity, person-centred care, good governance and statutory notifications about significant events at the service.

During this inspection, we found the provider had made significant improvements in all areas.

People were protected against the risks of avoidable harm and abuse. Following our last inspection, staff had all received training to help them recognise abuse and what action to take if they suspected abuse. The service had completed risk assessments relating to individuals' needs and the environment with plans to mitigate such risks.

Staffing levels at the home had been increased and staff were better deployed. This had led to a culture change at the home from a task-driven culture to one that was more centred on providing a good level of care to people. People were cared for by staff who had the knowledge, skills, experience and support to carry out their role. However, some staff had not received regular supervision and appraisal.

The service was operating effective systems for the safe management of people's medicines. However, we found some hand-written entries on records had not been checked and countersigned to ensure accuracy.

The service was operating effective systems with regard to cleanliness and infection control. Bathrooms were no longer cluttered and work had been carried out to seal flooring in certain areas of the home to aid with thorough cleaning and disinfection.

The service sought consent in line with legislation. However, consent documentation was not always completed fully. We have made a recommendation about this. People and, where appropriate, those close to them were involved in the assessment and planning process. This helped to ensure people's written plans of care accurately reflected their needs and preferences.

The change in staffing levels and the better organisation of staff meant staff had more time to spend with people and had begun to develop positive and caring relationships. It was clear staff knew people well.

People were supported to eat and drink enough to meet their needs. The service approached external professionals for guidance and advice as appropriate and incorporated this into people's plans of care.

People's privacy and dignity was maintained and promoted at all times.

This inspection took place on 08, 09, 12 and 16 October 2015 and was unannounced.

Swansea Terrace is registered to provide 24 hour nursing and personal care for up to 44 people and is located close to Preston city centre. There are two large communal rooms, communal bathrooms and en-suite washing facilities. at the time of our inspection there were 40 people who were using the service.

The service is required to have 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.

People were not protected against the risks of avoidable harm and abuse. Staff had not been discharging their responsibilities with regards to safeguarding people who lived at the home. The service had not ensured that assessments of risk and associated risk management plans were up to date and accurately reflected people's circumstances. This left people vulnerable to significant risks to their health and well-being.

Staffing levels at the home were not adequate to provide people with safe and effective care. People were not cared for by staff who had the knowledge, skills, experience and support to carry out their roles. Staff did not receive appropriate supervision, appraisal or training to enable them to fulfil their responsibilities.

The service was not operating effective systems for the proper and safe management of medicines. Some people had gone without important medicines for significant periods of time due to a breakdown in the service's systems and poor communication between staff.

The home was not operating effective systems to assess risks around cleanliness and infection control. Bathrooms and shower rooms were found to be cluttered and had inadequate floor coverings which prevented thorough cleaning and disinfection.

The service did not always seek consent in line with legislation. People or, where appropriate, their representatives were not routinely involved in the assessment of people's needs or the care planning process. People's written plans of care did not reflect accurately their needs and preferences.

Staff had a caring approach to the people they cared for, but due to low numbers of staff and a task-focussed culture at the home, positive, caring relationships between staff and people who lived at the home had not been developed.

People were not supported to eat and drink enough to meet their needs. We found some people had gone without food and fluid for significant periods of time. People were put at serious risk because professional guidance had not been followed by the service.

People were able to access healthcare services. However, the home did not always make referrals to professionals or follow them up in a timely manner. When guidance or advice was received from other healthcare professionals, it was not always incorporated into people's plans of care.

People's privacy was maintained during personal care interventions. However, we found people's dignity was not always promoted and maintained.

The home employed an activities coordinator. However, much of their time was spent delivering care to people, which meant the level of activities provided by the home was inadequate. People were not enabled to participate in activities which were meaningful to them. Some people were left in their bedrooms without any stimulation or interaction for long periods of time.

The service did not hold regular meetings for residents, relatives or staff, for them to discuss ideas, make suggestions or raise concerns about the service with management. The service did not operate any formal surveys or other mechanism for gaining feedback about the quality of the service.

Systems and process that were in place to assess, monitor and

We did this inspection as a follow up inspection to monitor areas of non compliance we identified during our visit to the service in April 2013. We also received some concerns about staffing levels at the home. We looked at outcomes 4,13 and 21.at our last inspection we found areas of non compliance in meeting the health needs of people, staffing and keeping accurate records and at this inspection noted improvements in these outcomes. At this inspection we also noted further improvements were to be made.

People we spoke to living at Swansea Terrace told us they were happy with their care, though some people said they still experienced delays in staff assisting them with their personal care. We saw that staff were being recruited to fill some vacancies but the majority of vacancies were filled. Some vacancies were due to staff leaving recently.

We saw that people were involved in a variety of activities and they were offered a choice of how they had support with their personal care

We were able to speak to people and observe their care as well as interactions between them and staff. We saw that staff were friendly and responsive to requests from people when they wanted a drink or help with their care.

We brought forward this scheduled inspection because of concerns raised about the care of people living at the home. We looked at outcomes 1, 4, 7, 9, 13, 16 and 21. We found that people were generally treated with dignity and respect and they made positive comments about their care and the quality of food provided at the home. Since the home was purchased by Flightcare Limited in 2012 we saw that there has been major investment in improving the environment, equipment and furniture available to people living at the home. A new manager had been appointed before the inspection and we saw that the manager had started to introduce new systems into the home to monitor staff performance and the quality of care provided.

We found areas of non compliance in meeting the health needs of people, staffing and keeping accurate records.

People we spoke to living at Swansea Terrace told us they were generally happy with their care and happy with the way the service was run. People told us that the staffing levels in the home could be improved.

We were able to speak to people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Swansea Terrace and that staff respected them. One person told us, “It’s very comfortable, better than I expected. The staff have been polite and very helpful".

We found family members were happy with the care of their relations and they praised staff's commitment.