The inspection took place on 20 February 2018 and was unannounced. The last comprehensive inspection took place in February 2016, when the provider was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Swallow Wood’ on our website at www.cqc.org.uk.

Swallow Wood is a purpose built home providing nursing and personal care for to up to 38 older people with a range of support needs. It is located near the town centre close to local amenities and public transport links. At the time of our inspection 32 people were using the service.

At the time of our inspection the service had a 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 registered manager had been asked by the registered provider, to help manage another home within the group, for two and a half days per week, while they were without a manager. The absence of the registered manager for this period, had impacted on the governance of the service. The registered manager was now back at the home on a full time basis.

Audits took place to identify areas of concern. However, some of these had not been effective due to the absence of the registered manager for half a week for a period of time.

People were safe from the risk of abuse and actions were taken to address safeguarding concerns as they arose. Risks associated with people’s care needs were identified and actions put in to place to minimise that hazard. We saw sufficient numbers of staff were available to meet people’s needs in a timely manner. We looked at systems in place to ensure people’s medicines were managed in a safe way. We found some shortfalls in this area which should have been identified by the registered providers audit system.

Staff were trained well and had received an induction when they started working for the service. Staff felt supported by the registered manager and felt able to approach her to discuss issues and concerns. People had access to health care professionals when required. We looked at care records and found they sometimes lacked detail around MCA. We spoke with the registered manager who told us that most people had capacity to make decisions for themselves.

We observed staff interacting with people and found they were caring and supportive. We saw people were given choices and staff respected people’s privacy and dignity.

We looked at care records and found that some documentation was not in line with people’s current needs. Some care plan evaluations did not reflect the events in people’s lives. Activities took place on a regular basis and people told us they enjoyed them. Complaints were addressed in line with the registered provider’s policy.

Further information is in the detailed findings below.

The inspection took place on 16 and 18 February 2016 and was unannounced on the first day. We last inspected the service in September 2014 when it was found to be meeting the regulations we assessed.

Swallow Wood is a purpose built home providing nursing and personal care for to up to 38 older people with a range of support needs. It is located near Mexborough town centre, close to local amenities and public transport links. There is a well maintained garden to the rear of the home which people can easily access.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection there were 34 people living at the home.

The home had a friendly atmosphere which relatives and visiting professionals described as welcoming. Throughout our inspection we saw staff supporting people in an inclusive, caring, responsive and friendly manner. They encouraged people to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. The people we spoke with made positive comments about how staff delivered care and said they were happy with the way the home was managed and the available facilities.

People told us they felt the home was a safe place to live. We saw there were systems and processes in place to protect people from the risk of harm. Staff were knowledgeable about safeguarding people from abuse, and were able to explain the procedures to follow should there be any concerns of this kind. Assessments identified any potential risks to people, such as risk of choking, and care files contained management plans to reduce these risks.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. We saw people received their medications from staff who had been trained to carry out this role.

There was enough skilled and experienced staff on duty to meet the needs of the people living at the home at the time of our inspection. The registered manager had identified that more nursing staff was required and recruitment was underway. There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Staff had received a structured induction into how the home operated and their job role at the beginning of their employment. They had access to a varied training programme and support to help them meet the needs of the people who used the service.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. We saw specialist diets were provided if needed and the people we spoke with said they were happy with the meals available.

Where possible people’s needs had been assessed before they moved into the home. If someone was admitted at short notice staff had collated as much information as possible prior to, and on admission. People had been involved in planning their care, but this had not always been consistently recorded. Care files reflected people’s needs and preferences in satisfactory detail. Care plans and risk assessments had been reviewed on a regular basis to assess if the planned care was working, or if changes needed to be made.

The home had two dedicated activity co-ordinators who facilitated a structured programme of activities which people said they enjoyed.

The company’s complaints policy was available to people using or visiting the service. We saw that when concerns had been raised these had been investigated and resolved promptly. The people we spoke with raised no concerns.

There was a system in place to enable people to share their opinion of the service provided and the general facilities available. We also saw a structured audit system had been used to check if company polic

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

Systems were in place to make sure managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Before new staff started to work at the home robust background checks had been carried out to make sure they were suitable to work with vulnerable people.

The provider had systems in place to ensure the service was safely run. For example we saw regular audits were carried out on topics such as health and safety, care planning and medication practices.

Is the service effective?

People’s health and care needs were assessed on a regular basis. People who used the service, and their relatives, told us they had been involved in formulating plans of care and these were reviewed and updated regularly.

People received a well-balanced diet and were involved in choosing what they ate. The people we spoke with said they were happy with the meals provided. Specialist dietary needs had been assessed and catered for.

Is the service caring?

People were supported by friendly staff who had received training to meet their needs. We saw staff interacting with people in a positive manner. They encouraged them to be as independent as they were able to be, while providing support as needed.

We saw people looked well-presented and cared for. We spoke with four people who used the service and five visitors. The majority of people said they were happy with the care provided and complimented the staff for the way they supported people. One person told us, “We are very happy, staff are caring and professional here.”

Care files contained detailed information about people’s needs and preferences. We saw care and support had been provided in accordance with people’s wishes.

Is the service responsive?

Care records demonstrated that when there had been changes in people’s needs outside agencies had been involved to make sure they received the correct care and support. For example, one person who had lost weight had been referred to a dietician. Another person who had difficulty swallowing had been referred to the speech and language therapist.

People told us they had access to a variety of social activities. During our visit we saw people playing bingo and being entertained by a singer. Other people went out into the community with their families.

The home has a complaints procedure which was available to people using and visiting the service. Complaints had been recorded and action taken to address any areas needing improving.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People’s comments indicated that overall they were happy with how staff supported them and the home’s facilities.

Is the service well-led?

At the time of the inspection there was a registered manager in post who had come into post earlier in 2014. She told us the deputy manager and nursing staff provided managerial support in her absence. People we spoke with said they thought the manager was very approachable.

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys as well as internal and company audits. We saw action plans were in place to address any shortfalls, and progress was being made to address these.

Staff were clear about their roles and responsibilities. We saw staff had access to company policies and procedure to instruct and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

We observed care taking place within the home and saw that people were routinely treated with dignity and respect. Staff took steps to ensure that people’s privacy was respected.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

There were enough qualified, skilled and experienced staff to meet people’s needs. We checked the daily notes in people’s files, and saw that when plans had been made for people to go out or take part in activities, there were always sufficient staff to ensure they were supported to do so.

Staff took time to engage with people when they were providing support, and ensured that they explained care tasks to people before they commenced. Staff spoke with people in a caring and kindly manner, and carried out care tasks in a gentle and unhurried way. One person told us “they keep us happy.” Another person said: “I’m very happy, they are all fantastic.”

The inspection had not been planned to look at this area. However, through the course of the inspection it became apparent that there were concerns in relation to the provider’s compliance with outcome one. In their day to day activities around the home, we observed that staff did not take appropriate steps to ensure people’s dignity, privacy or confidentiality was respected.

Staff had received training in relation to mental capacity and consent, but the provider did not have appropriate arrangements in place for assessing whether people had the capacity to consent to their care. The provider did not evidence that, where people had capacity, their consent had been gained. The provider had also not taken the correct steps where people did not have the capacity to consent to their care.

We undertook observations and saw that the provider had not taken proper steps to ensure that each service user was protected against the risks of receiving care that was inappropriate or unsafe. Care was not delivered in a way that met people’s individual needs, and did not ensure the welfare and safety of the service user

There was a large communal lounge and dining room. Furniture and the layout of the room had been used to enhance a feeling of homeliness in the room, although the provider may find it useful to note that further work could be done in this area. In addition to the large communal lounge there were also smaller quiet lounges should people chose to use these. We looked at some of the bedrooms and we saw that these were personalised to reflect people’s tastes and preferences. The ones we checked were also large enough for people with mobility difficulties to use comfortably.

Staff we spoke with consistently told us that they did not feel they could meet people’s needs as there weren’t sufficient staff on duty. The home had recently changed its service user group and was, at the time of the inspection, taking far more people who had nursing needs. Staff told us that staffing numbers had not been increased to reflect this.

We checked care plans belonging to seven people, and saw that they contained considerable detail about each person’s care needs, medical history, activities, daily routines and preference. Each one appeared to be accurate and fit for purpose, and described how support and care should be delivered so that people were kept safe and treated according to their preferences.

During our inspection we spoke with six people who used the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about their care. We received comments such as: "I'm involved in my care, there's plenty of choice, I get up when I want and eat what I like" and "I am treated very well and get support when I need it."

People living in the home, confirmed they felt safe and said they liked the staff who looked after them. One person said: "If I have any concerns I can talk to the staff and they sort things out quickly." Another person told us: "Lovely place, staff are nice and look after me very well."

People told us they were well looked after and the staff were always helpful and patient. People also told us the standard of cleanliness was excellent in the home.

People told us the food was good and they enjoyed the activities.

One person told us they had looked at a number of homes before choosing Swallow Wood and said, “It was the best by far”.