Swillbrook House Residential Home was inspected on the 15 January 2019 and the inspection was unannounced.

Swillbrook House Residential Home 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.

Swillbrook House is a large country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. The property has a car park and landscaped gardens. The bedrooms are mostly single rooms with shared bathroom facilities. 15 out of 20 rooms have ensuite facilities. Bedrooms are over two floors with a small lift providing access to the upper floor.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

There was a complaints procedure available and displayed at the home. People we spoke with told us were confident any complaints they may wish to make would be addressed by the registered manager. During the inspection we were advised by an external person that they felt their complaint had not been responded to in a timely manner. We discussed this with the registered provider and reviewed the policy and saw further detail may be helpful in supporting expectations. We have made a recommendation regarding the complaints policy.

We observed medicines being administered and saw this was carried out in a person-centred way. Medicines were managed safely and staff were knowledgeable of the processes to order and receive medicines. We noted more information on ‘variable dose’ medicines would be beneficial to support staff when administering these. We have made a recommendation regarding variable dose medicines.

We spoke with the maintenance person who showed us around the home. They told us the home was in the process of being refurbished. We noted some areas of the home did not have handrails and the flooring required attention in some areas. The maintenance person and the registered manager told us this work was in progress. We have made a recommendation regarding this.

There were a variety of checks carried out to ensure that successes were recognised and areas of improvement identified. The registered manager told us the registered provider also maintained oversight of the home by carrying out checks, however these were not always documented. We have made a recommendation regarding the documentation of the registered providers oversight.

We checked to see staff were recruited safely to ensure they were suitable to work with people who may be vulnerable. We reviewed two files of staff who had recently been recruited to work at the home. We found the files contained employment checks, references and a full employment history.

We viewed care records to ensure people’s needs were assessed and risk to people who lived at the home were minimised. We found individual risk assessments were carried out in key areas such as nutrition, falls and skin integrity. Care records continued sufficient person-centred information to enable staff to support people. Care records also contained information regarding people’s preferences and wishes. People and a visitor we spoke with confirmed they were consulted in decision making and involved in care planning.

People and a visitor told us staff were respectful and caring in nature. We observed warm and affectionate interactions between people who lived at the home and staff. We found staff were gentle and kind with people and people told us they liked the st

This inspection was carried out on the 06 December 2017 and was unannounced. We revisited the home by prior arrangement on the 18 December 2017. This was to complete the inspection and to speak with the registered provider regarding the inspection findings.

Swillbrook House Residential Home is a country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. There is car parking at the home, and gardens for people to use. There are 15 bedrooms with en-suite bathrooms and five bedrooms without an en-suite bathroom. Bedrooms are over two floors with a small lift providing access to the upper floor.

On the day of inspection there were 15 people living at the home.

We last inspected Swillbrook House Residential Home in January and February 2017 and identified a breach in Regulation. We found audit systems used by the registered provider to identify shortfalls had not identified the deficits we had found on the inspection. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Good Governance.)

You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection in January and February 2017, the registered provider sent us an action plan outlining how they intended to make the required improvements. The action plan indicated improvements would be made by August 2017.

At this inspection carried out in December 2017, we found improvements had been made. We found audits had been carried out on accidents and incidents, medicines, infection control and the environment. Staff told us they were informed if changes were required.

We saw processes were in place to ensure that where people’s rights were restricted, this was done so lawfully. The registered manager had sought training in the undertaking of mental capacity assessments. They told us they were developing systems to ensure mental capacity assessments were carried out. They told us they would carry out mental capacity assessments if required and document these. We have made a recommendation regarding the carrying out and documentation of mental capacity assessments.

During the inspection we reviewed four care records of people who lived at the home. We found risk assessments were in place to minimise risk and overall, records described the support people required. We found some information within care records was not consistent and was sometimes difficult to find. We have made a recommendation regarding documenting consistent information in care records.

The registered provider had taken steps to improve the environment at the home. We saw decoration had taken place in some areas of the home. We noted this was ongoing. We have asked the registered provider to confirm with us when this work has been completed.

We found environmental risk assessments were not consistently documented. We have made a recommendation regarding improving and recording the information available to control risk.

During the inspection we spoke with four people who lived at the home. The people we spoke with told us they were happy at the home and they liked the staff. People told us they were supported in the way they agreed and they enjoyed the meals provided.

People told us their privacy and dignity was respected and they took part in activities if they wished to do so.

There were systems in place to manage medicines safely. People told us and records we viewed; indicated people received their medicines as prescribed. People we spoke with told us they were consulted regarding their medicines and we saw this took place during the inspection.

People told us they were happy living at Swillbrook House Residential Home and the care met their individual needs. We were told, “I’m quite happy with everything.” And, “I’m looked after well.” People were referred to other health professionals for further advic

This comprehensive inspection was carried out on the 30 January and 06 February 2017. The first day was unannounced.

Swillbrook House is a large country house in Bartle on the outskirts of Preston. The service is registered to provide personal care for up to 23 older people. The property has a car park and landscaped gardens. There are 15 bedrooms with ensuite facilities and five without ensuite facilities. There are three double bedrooms. Bedrooms are over two floors with a small lift providing access to the upper floor.

There was a manager in place who was registered with the Care Quality Commission. 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.

This was the first inspection of Swillbrook House since the registered provider took legal ownership of the home in December 2015. During the inspection visit we found processes to ensure people’s mental capacity was considered were not consistently followed and applications to deprive people of their liberty were not always made to the local authorities as required. We have made a recommendation regarding this.

People who lived at the home told us they felt safe. One person told us, “I feel very safe.” Staff were able to explain the actions to take if they were concerned someone was at risk of harm or abuse.

Staff were able to explain their understanding of abuse and the processes to follow if referrals to Lancashire Safeguarding Authority were required. However, we found the processes in place were not always followed in practice. We have made a recommendation regarding this.

We observed medicines being administered and saw this was carried out safely. However we saw documentation in relation to medicines was not always completed accurately. We have made a recommendation regarding the safe management of medicines.

We looked at the systems in place to identify shortfalls at the home and drive improvement. We found that when accidents or incidents occurred, the registered manager reviewed these. We spoke with staff who were able to explain the steps taken to minimise the risk of reoccurrence.

The registered manager carried out checks of medicines, care records and the environment. We found the audit systems in place were sometimes ineffective as they did not identify the shortfalls we identified on the inspection visit. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance.)

We observed care and support being provided and reviewed care records. Care records recorded the care and support people required to maintain their safety.

People told us they were involved in the planning of their care people and care was delivered in the way they wished. People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

We reviewed staff files and found there were processes that helped ensure staff were suitably recruited. Staff we spoke with confirmed checks had been carried out on their suitability for employment prior to starting work at the home.

Staff told us they received training to enable them to fulfil their roles and further training was being planned. Staff told us they were able to meet with the registered manager on an individual basis to discuss their performance. We saw evidence supervisions took place. The registered manager told us they were currently developing a system of formal supervisions.

We discussed staffing with people who lived at the home, the registered manager and relatives. We received no negative feedback. During the inspection we saw people were supported in a prompt manner and we also observed staff spending