Archived: Swanborough House

Swanborough House is a residential care home providing personal care and accommodation for up to 31 people with acquired brain injuries. At the time of the inspection the service was supporting 31 people. Accommodation is provided on two upper floors with the ground floor dedicated to communal and therapy spaces.

People’s experience of using this service and what we found

The environment of the service was poor and there had been a lack of investment in the building. Carpets were thread bare in places and heavily stained. The lounge was single glazed, notably cool in areas and its roof was leaking. In people’s bedrooms we found examples of torn carpets, damaged furniture, and tired décor. Relative’s told us, “It is pretty past it, it is showing it's age” and “The building is not the best, it does not sell itself on how it looks but the people are the priority”.

The service’s quality assurance systems had identified these issues but there had been a lack of appropriate action and investment by the providers previous leadership to make the necessary improvements.

There have been significant changes to the leadership of the provided since our last inspection. The previous chief executive departed in May 2019 and replaced by a new senior leadership team.

The new leadership team had begun making improvements to the service’s environment prior to our inspection. The kitchens and laundry had been refurbished and dangerous areas of glassing replaced. A bathroom was being significantly upgraded and a bedroom redecorated during our inspection. In addition, an extensive remodelling of the service was planned to include an extension and upgrading of all bedrooms. Staff told us, “We are having all these fantastic improvements now which we have been asking for years and years. It has changed a lot” and “There has been a lot of improvements.”

The providers failure to invest in the service had impacted on staff morale and culture. During the lunchtime meal people had to wait while staff collected their lunches, and this adversely impacted on one person’s desert options. In addition, a failure to support one person to achieve a recognised goal had caused them significant frustration.

The registered manager was well respected by staff and relatives. They told us, “[The registered manager] is very nice, you can ask her anything”, “The manager is very supportive, she is very very helpful” and “I have a great deal of respect for the [Registered manager].”

Staff had been recruited safely and appropriate induction training was provided. All staff received regular supervision and training updates to ensure they had the skills necessary to meet people’s support needs. We have made a recommendation in relation to specific training for staff on how to support people when anxious.

People told us they were well cared for and staff responded promptly to people requests for assistance.

Care plans were accurate and up to date. They provided staff with enough guidance to ensure people’s needs were met. Staff said, “I think there is enough information in the care plan and they are working to make them more detailed.” While relatives told us, “I get a copy of the care plan sent to me every month and I go through it and sign to say I am happy with it. It is accurate.”

People were able to engage with a range of activities and therapies each day. People told us, “The entertainment is good, there is activities every day” and “I get to choose to go or not, there is a good range [of activities].” There was minibus available to enable people to access the community and visit local sites of interest.

Enforcement

We have identified breaches in relation to the environment of the service, the providers quality assurance process and failures to consistently respect people’s dignity.

Please see the action we have told the provider to take at the end of this report.

Rating at last inspection

At our previous inspection the service was rated Good. (Published 30 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found that improvements had been made. The overall rating for Swanborough House has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been sustained.

Swanborough House provides accommodation, care and rehabilitation for up to 31 people aged over 18 with acquired brain injury. On the day of our inspection there were 29 people living at Swanborough House. Some people stay for a structured time specific period of rehabilitation, but others are living more permanently at the service due to their specific needs in relation to their acquired brain injury. The service follows the Rudolph Steiner philosophy of holistic living. All catering, furnishings, decor and therapies offered follow this philosophy.

People told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People felt staff were skilled to meet their needs and provide effective care. One person told us, “I have lots of seizures. I used to be at home with my Mum, but it wasn’t fair on her, so I came here. I like it, they look after me and know what to do for me”.

People were encouraged to express their views and feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us, “It’s all organic, so it’s better for you”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. One member of staff told us, “[Registered manager] is strict with supervisions. The team will ask her if they have a concern. She tells staff not to wait for supervision. She uses the Skills for Care as a guide when carrying out supervisions”.

Everyone we spoke with spoke highly of the caring and respectful attitude of the staff team which we observed throughout the inspection. One person told us, “I like living here, people are nice and friendly”.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People and staff found the management team approachable and professional. A member of staff said, “I’ve seen lots of changes in the last 12 months since our new manager has come. She’s very good and supportive of us. I like her and I think she will be good for the home”.

We have made a recommendation in relation to adapted occupational therapy settings in neuro-rehabilitation.

Further information is in the detailed findings below.

There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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.

During the inspection we saw that people were not routinely offered day to day choices around their care. They did not always have their independence promoted, and some had their dignity and privacy compromised. The manager told us, “I am aware there are some restrictions around choice. This is something I am looking at”. We have identified this as an area of practice that needs improvement.

Medicines were managed and administered safely. People’s medicines were stored safely and in line with legal regulations. People received their medicines on time. However, adequate guidance was not in place for the use of ‘as required’ medicines and care plans failed to demonstrate the steps required before administering the medicine. This therefore placed people at risk of receiving medicine that they did not require. We have identified this as an area of practice that needs improvement.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards. People’s consent to their care and treatment was assessed and staff had a good understanding of the Mental Capacity Act 2005 (MCA). However, we could not always see evidence of involvement with the individual or their representatives in how their decisions had been made. We have identified this as an area of practice that needs improvement.

We saw that regular staff meeting took place. Staff were encouraged to ask questions, discuss suggestions and address problems or concerns with management. However, we identified concerns in relation to feedback from staff being acted upon by the provider. We have identified this as an area of practice that needs improvement.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I really do feel safe, yes”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Risks were thoroughly assessed and planned for. Accidents and incidents had been recorded and appropriate action had been taken. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is very good here. We get a good variety”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the use of buccal midazolam to stop seizures and the care of people with an acquired brain injury (ABI). Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “We have had specific training for working here, such as catheter care and how to manage challenging behaviour”.

Care plans provided detailed information about people and were personalised to reflect that person’s rehabilitation programme. The care plans were reviewed regularly to reflect the person’s change in need and the progress that they had made. People and their families were involved as part of these reviews. There was a range of interesting and social activities on offer at the home, which people could participate in if they chose.

The management team promoted a positive culture where person centred practice was promoted and people’s rehabilitation was planned and monitored. There was a motivated and committed team of staff. One member of staff said “We discuss people’s needs with colleagues and what has happened during the day. We are an international team and we are a good team. I really enjoy working with my colleagues”. There was a range of audit tools and processes in place to monitor the care and support that was provided. This ensured the management team were assessing the quality of the care and support provided.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us 'Yes I like it here and I would give it 8 out of 10'.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service.

The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

The service also had a system in place to effectively deal with comments and complaints.

We saw that people had been involved in making decisions about their care and treatment. We found staff to be knowledgeable, well trained and supported in order to meet people's needs. People had not always been assessed before they moved in and this put them at risk of not having their needs met.

People's care needs had been planned, reviewed and delivered in line with their individual care plan. People who use the service were protected from the risk of abuse and told us that they felt safe at the service. People were protected by the service's recruitment procedures. There were systems in place to identify, assess and manage risks to people who used the service.