Swiss Cottage provides accommodation and nursing care for up to 82 people with a wide range of care needs. At the time of our inspection there were 49 people living at the service, many of whom were living with dementia and other conditions.

Following our previous comprehensive inspection in February 2017, we gave this location an overall rating of ‘Inadequate’ and was therefore placed into ‘special measures’. We carried out a focused inspection in May 2017 to check they had met legal requirements. We found a number of breaches continued.

At that inspection we found that people’s risk assessments were in place for each person. We found that some work had been completed but was yet to be audited and signed off by the manager. The risk assessments we reviewed as part of this inspection showed some improvements in the details contained within the documents but work was still required in this area to ensure every person had current, detailed assessments in place to reduce the risk of them coming to harm. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that medicines were not managed safely. On the residential unit, we found stock carried over from one month to the next was not always recorded. This made it difficult to maintain an accurate record of overall stock of individual medicines for each person. While boxed and liquid medicines were dated to show the date they were opened, this was not the case for inhalers. The records for one person who was prescribed a specific medicine did not include any details of the correct procedure to ensure this medicine was administered safely and as prescribed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People had not been involved in the development of their care plans. They did not accurately reflect people’s current needs and lacked personalisation. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Activities provision was poor and did not support people to maintain their interests and hobbies. People cared for in their bedrooms were isolated, with little to do other than watching television. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

The service did not provide appropriate food to people with specific dietary needs and support offered to people at meal times was poor and not in line with their care plans. This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We identified a significant lack of training and supervision for staff. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although the ratio of staff to people had increased, the deployment of staff was not meeting the needs of people using the service. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that, although improvements had been made in some areas, continuing breaches were identified in relation to medicines management, staffing, the way in which people's food and hydration needs were met and in the provision of a person centred service. We saw that the provider had plans in place to further improve the service and was monitoring this work to ensure it was completed to a good standard and in a timely manner. However, this work was not completed

at the time of the inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

You can read the report from this comprehensive inspection by selecting the 'all reports' link for Swiss Cottage on our website at www.cqc.org.uk.

We carried out this unannounced comprehensive inspection on 30 and 31 October 2017, to see if the provider ha

We carried out an unannounced comprehensive inspection of this service on 21 February 2017. A number of breaches of legal requirements were found. As a result the service was rated ‘Inadequate’ and placed into special measures. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this unannounced focused inspection on 12 May 2017 to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Swiss Cottage Care Home on our website at www.cqc.org.uk.

The service is a nursing home and provides accommodation and personal or nursing care for up to 84 people with a range of needs including those associated with dementia and with life limiting health conditions. At the time of our inspection there were 47 people living at the home. The service consists of three units ; one supporting people with non- nursing needs, one for people with nursing needs associated with dementia and a third for people with nursing needs related to other primary health conditions.

The service did not have a registered manager. The previous registered manager had left the service in October 2016. A manager had been appointed a few weeks prior to the inspection in February 2017, but left the service shortly after the inspection before becoming registered. At this inspection we found a new manager had been in post for five days and had started the process of applying to become the registered manager. 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, but these were not always sufficiently detailed. Medicines were not managed safely in the residential unit because carried forward stock was not always recorded and some medicines were not dated to indicate when they had been opened. Some medicine protocols were not completed fully.

Staff were not deployed effectively to provide for people’s needs. People reported that some staff did not meet their needs effectively. A programme of training for staff was in the process of being implemented to address the shortfall in staff skills and knowledge.

A service wide review of care plans was underway, although new care plans had not been implemented yet. People and their families did not feel involved in the planning or review of their care. However, some care plans looked at showed more personalised information than at the previous comprehensive inspection. The requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

Activities were provided although these did not meet the needs of some people we spoke with. People and relatives felt there were not enough activities provided and some people felt bored. People were supported to have enough to eat and drink but people with specific dietary requirements did not have their needs met effectively. Support at mealtimes was varied across units with some people having a better mealtime experience than others.

The provider had systems in place to monitor the quality of the service which identified areas for improvement and suggested remedial actions to be taken. Staff were able to contribute to the development of the service through team meetings and understood the visions and values of the service. People and their relatives had opportunities to share their views and make suggestions about how the service could

This inspection visit took place on 21 February 2017 and was unannounced. When we last inspected the service in June to August 2016 we found that the service did not meet the fundamental standards in respect of person centred care, consent to care or treatment, safe care and treatment, good governance and staffing. During this inspection we found that the service was still not meeting these fundamental standards. In addition the service also did not meet the fundamental standard in respect of premises and equipment as the home was poorly maintained and visibly unclean in places.

At the time of our inspection the service provided accommodation for 65 people who need nursing or personal care.

The service did not have a registered manager in post. The previous registered manager had left the service in October 2016, although they had not cancelled their registration. A new manager had been appointed and was in the process of applying to become the registered manager. 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 home had not been cleaned to an acceptable standard to prevent the risk of infection or provide an environment free from unpleasant odours. Procedures intended to reduce the risk of an acquired infection were not always followed by staff.

People did not always receive their medicines as they had been prescribed and medicines administration records were not always correctly completed. Staff did not always ensure that medicines had been taken when they were signed off as having been administered. Stocks of medicines held did not always correspond with the amount recorded. Protocols in place for medicines administration were inadequate.

There were insufficient staff to respond to people’s needs in a timely way. Staff had not received appropriate training to identify and support people’s needs. Staff performance was not routinely reviewed.

Personalised risk assessments were in place but these were often confusing, contradictory and not updated as people’s physical and mental health needs and the associated risks changed. Care plans were not person centred and people were not involved in the review of these. Documentation was often inaccurate, undated and very difficult to read.

People’s privacy and dignity was not protected. Doors to people’s rooms were routinely left open and people in their beds were exposed to the view of visitors passing their room. People were not always dressed appropriately when they were in communal areas. People had mixed opinions as to the caring attitude of the staff that cared for them.

People also had mixed opinions about the food provided, which did not meet everybody’s nutritional requirements. People were not always supported appropriately to eat their food. People were also not supported to maintain their interests and hobbies. People cared for in bed were isolated and lonely.

The quality assurance system was ineffective. The provider had failed to ensure that appropriate action had been taken to address the breaches in regulations that had been identified during the inspection in August 2016 or to identify further areas for improvement.

During this inspection we identified that there were breaches of a number 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provide

We carried out an unannounced inspection at Swiss Cottage Care Home on 28 June 2016 and 6 July 2016. Because we received information of concern in the following these visits we carried out further visits on 2 August 2016 and 15 August 2016.

The home provides accommodation, support and treatment for up to 84 people who require nursing and personal care; some of whom may be living with dementia. At the start of our inspection there were 62 people living at the home but this had increased to 65 during the latter part of our inspection. People lived in three units at the home, dependant on their care needs. The first was a residential unit for people who required personal care in which 20 people lived. The second was a unit for people who required nursing care and the third unit accommodated people who required nursing care but were also living with a dementia.

The home had a registered manager in place at the start of our inspection but they left the service after the initial two days of the inspection. 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. Following the registered manager’s departure management of the home was overseen by the provider’s Home Support Manager and their Regional Operations Manager. In their absence the home was managed by the recently appointed Agency and Recruitment Co-Ordinator, who had worked at the home for a number of years previously as the deputy manager. They had left the post in February 2016.

People told us that they felt safe at the home because there were people around. However, there were insufficient trained, experienced staff to always provide the care and support people needed at the time they required it. As a result people had to wait for assistance to be provided, be this with personal care or assistance to eat their meals. There were discrepancies with the stocks of medicines held and we were not assured that people had received their medicines as they had been prescribed.

People’s needs had been assessed prior to their admission but there were not always care plans in place to show how all the identified needs were to be addressed. Where they were in place, care plans did not always give staff sufficient information to ensure that the planned care addressed the identified needs of the individual. Similarly the assessments of risks identified as arising from people’s care and treatment had not always been completed. People were not always supported to maintain their interests and hobbies and people who were living with severe dementia were unable to participate in the activities arranged. People who were nursed in their rooms were at high risk of experiencing social isolation.

There was no evidence that people had consented to the care provided or, where they lacked capacity to make or understand decisions, that those made on their behalf had been in accordance with the requirements of the Mental Capacity Act 2005 (MCA).

The recruitment procedures in place gave the provider assurance that the staff recruited were suitable for the posts they applied for. Staff were provided with appropriate induction and on-going training. They were supported by regular supervision and appraisal meetings at which they were able to discuss their performance and training needs. They were encouraged to make suggestions for improvements to the service.

People found the staff to be caring and kind. Staff promoted their dignity and independence and treated them with respect. People and their relatives were aware of the complaints system and complaints had been dealt with in accordance with the provider’s policy.

Although there was an apparently robust quality monitoring system in place this had not always been ef

We carried out an unannounced comprehensive inspection of this service on 10 October 2014 and found the service to be good. After that inspection we received information of concern in relation to staffing levels, safeguarding and the cleanliness of the home. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Swiss Cottage Care Home on our website at www.cqc.org.uk

During this inspection we found that there was enough qualified, trained staff to provide the care and support that people need. The levels of staffing on each unit had been determined on the basis of the needs of the people who lived on the unit.

Staff were aware of the safeguarding process. Risks to which people were exposed had been identified and steps taken to reduce the level of risk to them.

The home was clean with no unpleasant odours detected. There were effective infection control procedures in place. Issues around repairs and redecoration had been identified by the maintenance person and plans were in place to rectify these.

We carried out an unannounced inspection at Swiss Cottage Care Home on 10 October 2014.

The home provides accommodation, support and treatment for up to 85 people who require nursing and personal care; some of whom may be living with dementia. At the time of our inspection there were 52 people living at the home. They lived in three units at the home, dependant on their care needs. The first was a residential unit for people who required personal care. Twenty people were living on this unit on the day of our inspection. The second was a unit for people who required nursing care and 20 people also were living on this unit. The third unit accommodated the remaining 12 people who required nursing care but were also living with a dementia. A fourth unit at the home was not in use at the time of our inspection.

The home had a registered manager in place. 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 manager and staff at the home complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People were protected from the risk of abuse as the provider had taken reasonable steps to identify the possibility of abuse and to prevent abuse from happening.

People were protected from the risk of harm whilst living at the home. Personalised risks were identified and strategies were in place to reduce these as much as possible. People were involved in deciding the level of risk to which they were exposed. There were processes in place to manage the risks arising from the operation of the home.

Medicines were stored and administered in line with current guidance and regulations and appropriate arrangements were in place in relation to the recording of medicines.

People’s needs had been assessed and care and support was planned and delivered in line with their individual care plans. There was enough staff to meet people's needs. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Appropriate recruitment processes were in place to ensure that staff were suitable to work with the people who lived at the home.

The staff were very caring and ensured people’s privacy and dignity were protected. They knew the people they were caring for well and were able to communicate with people who were unable to express themselves verbally.

There was plenty of choice of nutritious food and drink. Snacks and drinks were available at any time of the day. People were supported to ensure that they had enough to eat and drink.

People were also supported to access healthcare services and staff accompanied them to healthcare appointments. A GP visited the home daily to see people who were concerned about their health.

There were systems in place to provide assurance as to the quality of the care provision and gain feedback from people and relatives. Staff supported and respected the manager at the home.