Swan House is registered to provide accommodation and support for up to six people with a learning disability. There were six people living at the home when we inspected.

We last inspected this service in December 2015. The regulations were being met but improvements were needed to staffing arrangements, risk management and people’s rights in line with the Mental Capacity Act. Arrangements for people to be able to participate in activities they enjoyed in the community needed to be improved. Care plans and assessments did not always adequately guide staff so that they could meet people’s needs effectively. This meant that the systems in place to check on and improve the quality and safety of the service were not always effective. This inspection in November 2016 found that the majority of issues had been improved and rectified

At the time of this inspection there was 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.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. Although staff understood people's needs well arrangements in place may not ensure that all known risks are well managed. The staffing arrangements ensured that safe levels of staffing were provided at all times of the day. People received the correct medication at the correct times. All medication was administered by staff who were trained to do so.

People living in this home were not able to discuss their feelings about the home with us. People seemed to be calm and relaxed when we visited. People indicated by gestures and their body language that they were happy at this home and this was confirmed by people’s relatives. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting.

Staff had received sufficient training and supervision to ensure they had up to date knowledge and skills to provide safe care. People were supported to maintain their health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

Staff were responsive to people’s needs and delivered care in line with people’s wishes. People were supported to engage in activities they asked to do. People had access to a complaints system and the registered manager responded appropriately to concerns.

There was effective leadership from the registered manager. The registered manager assessed and monitored the quality of care people received. Further action was required to improve the records of the actions taken in response to incidents occurring.

Swan House is registered to provide accommodation and support for up to six people with a learning disability. There were five people living at the home when we inspected. We had last inspected this service in January 2014.

At the time of this inspection there was 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 living in this home were not able to discuss their feelings about the home with us. People seemed to be calm and relaxed when we visited. We found enough staff to cover people’s basic needs but the day-time staffing levels did not provide many opportunities for people to go out of the home. Some relatives and staff told us of concerns about the night time staffing arrangements.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. Some potential areas of risk to people had not been assessed.

People received the correct medication at the correct times. All medication was administered by staff who were trained to do so and there were systems to make sure that the medication was stored, administered and recorded in a safe way.

People could not be certain their rights in line with the Mental Capacity Act 2005 would be identified and upheld. Some people had rails attached to their beds and sensors were in use to alert staff to night time incontinence. There was no evidence to show that people had consented to their use or that best interest decisions had been made if the person lacked capacity.

People were supported to maintain good health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

New staff that had commenced had been provided with an in-house induction and had also attended the provider’s own induction on how to care for people and work safely.

People indicated by gestures and their body language that they were happy at this home and this was confirmed by people’s relatives. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting. Relatives we spoke with said that there had been a decline in their involvement in people’s review meetings and we could not see that people had had recent reviews.

It was not evident that arrangements for checking the safety and quality of the service by the registered provider were not wholly effective. There were systems for quality monitoring and assurance but these had failed to reveal shortfalls in record keeping.

We visited this home on a weekday. The registered manager of the home was not available due to sickness. We were assisted on the inspection by the deputy manager. We met several members of staff and all the people who lived in the home. We contacted two relatives of people in the home to find out their views. Due to people’s complex needs, we were unable to speak in detail with people who lived in the home. We observed staff as they interacted with people.

We found that people’s needs were assessed and they were provided with opportunities to live the lives they chose. However, some care records needed to be updated.

Staff supported people to go into the community and to participate in activities of their choice. A relative told us that people in this home had, “loads of opportunities.” Relatives of people who lived in the home told us, “I think it’s excellent” and “overall, his care is brilliant.”

Staff supported people to eat and drink sufficient amounts to meet their needs. People were provided with choice in relation to their food and drink. However, the records in relation to hydration were not well maintained.

There were good arrangements for the safe storage, administration and recording of medication.

There were sufficient numbers of staff, with appropriate training and experience, to meet people’s needs.

Improvements were needed in the way records were stored and maintained. We saw that records were not all stored appropriately. Some care plans were in need of updating and review. Records relating to hydration were incomplete or not available.

We spoke to staff and three family members, viewed staff records, policies, processes and four sets of notes and observed daily routines to gain further insight of the care provided.

There were no set activities on the day of inspection. Two people went out but mostly people were engaged in activities in the home. There was evidence that more activities outside the home would be appreciated.

Processes were in place to recruit staff and support training. However some training and all staff appraisals were overdue. We were advised this was under review. Staff had a good rapport with the people they cared for and showed a good knowledge of their needs. Staff told us they enjoyed working there and care was provided in a considerate manner.

Everyone we spoke to was happy with the care at Swan House. One said “They do a marvellous job”, another that they were happy their relative was there. People we observed appeared satisfied with the care they received. We saw that they were able to personalise their own rooms and that the home was clean and comfortable. The kitchen was very accessible and people were encouraged to be as independent as possible. Many had lived there for some time and were seen to have a good relationship with the carers.

Systems were in place to audit the quality of care. There was a complaints process and families knew how to complain if needed. Regular meetings were used to discuss new information and matters important to people using the service.