We carried out this inspection on 12 July 2017 and our visit was unannounced.

Swallows Meadow Court provides accommodation and nursing care for up to 70 people. There are four units providing residential, nursing and care for people who may have a diagnosis of dementia. The home specialises in providing end of life care to people. There were 68 people living at the home on the day of our inspection.

We last inspected this service on 16 and 17 June 2015 and gave the home a rating of ‘Outstanding’ in caring and ‘Good’ overall. At this inspection we found the ratings remained the same.

There was a registered manager in post at the service. 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, deputy manager, provider and staff team continued to make sure people were cared for in an environment where people were supported to carry on living their lives as they wished. People continued to be encouraged and supported to pursue their interests and hobbies, as well as maintaining relationships important to them.

Staff continued to demonstrate they had an understanding of the visions and values of the home which were to ensure people remained as comfortable and well cared for as possible. This included providing compassionate care for people nearing the end of their life and included support for their family members. People were treated with respect and dignity at Swallows Meadows Court. Family members and friends were encouraged to visit as often as they wished.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where people’s care plans included restrictions on people’s right, choices or liberties, the registered manager had applied to the Supervisory Body for the authority to do this in people’s best interests.

People told us they felt safe at Swallows Meadow Court. The registered manager and staff understood how to protect people they supported from abuse, and knew what procedures to follow to report any concerns. Staff had a good understanding of risks associated with people’s care needs and how to support them.

There were enough staff at Swallows Meadow Court to support people safely and at the times they preferred. Recruitment procedures made sure staff were of a suitable character to care for people at the home.

Medicines were stored and administered safely, and people received their medicines as prescribed. Regular audits were carried out of medicines to ensure they were managed in line with good practice guidelines.

People were supported to attend health care appointments to maintain their health and well-being and received support with food and drinks that took account of their preferences and dietary needs. People’s health needs were regularly monitored and they were referred to external healthcare professionals when a need was identified and especially when people were at end of life.

Staff were caring, kind and supportive and ensured people’s privacy and dignity needs were met. People were encouraged and supported to maintain their independence. The management team and staff had a good understanding of people’s individual needs and preferences.

The registered manager and staff were focussed to ensure a person nearing the end of their life was comfortable and pain free. Staff worked collaboratively with other healthcare professionals and agencies to provide support to the person and their family and friends. Families were supported to be involved in their relation’s care planning and were kept regularly informed with any changes.

People were supported to pursue their hobbies and interests both within and outside the hom

During our inspection visit we were supported by an ‘expert by experience’ (ex by ex) who spoke with three people and three visitors. The ex by ex asked people about their experiences of living in the home. Inspectors also spoke with people, staff and a visiting health professional. They were all complimentary of the home. Comments included: “To see my mum happy here, it has made my life happier too.” “The home is very good.”

People looked well cared for and we observed there were sufficient staff to meet people's needs. We observed staff to be friendly and approachable towards people.

We saw both care staff and nursing staff were supported with ongoing training to maintain their skills and ensure they could care for people safely. A visiting doctor we spoke with told us, “The nursing care here is spectacular.”

People told us they were satisfied with the food provided. We saw good systems in place to support people with their meals and dietary needs. External professional support had been sought to make sure people could be supported safely and appropriately.

We saw there were systems in place to respond to complaints and those received had been responded to in a timely manner.

When we inspected this service in February 2012 we found that improvements were needed. We undertook this inspection to check if the provider had taken action to improve the service.

Overall, we found that the provider had made the improvements necessary to meet the compliance actions we issued following the last inspection.

We made an unannounced visit to this care home on 21 June 2012.

We spoke with ten of the 58 people using the service at the time of our inspection and one of their relatives. People spoken with told us they were satisfied with the care they received. Their comments included,

“Staff are kind and polite.”

“I am quite happy and content.”

“I feel safe and happy here.”

“They do what I need them to do. They arrange for the priest to come and give me communion, which is very important to me.”

We spoke with the registered manager, the deputy manager, three nurses and three care staff. We looked at some records relating to the running of the home, such as the staff duty rota and training records.

Some people using the service had complex care needs, which meant they might have difficulty talking to us about their experiences. We spent time in one of the lounges closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

We saw some sensitive staff interactions with people using the service. For example, we observed that most staff bent down to people sitting in chairs to speak with them face to face at their level. We observed some staff spending time talking with people at a pace and level appropriate for the person.

We observed staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs.

People that were being cared for in bed had been made as comfortable as possible with pillows, blankets and call bells close to hand.

It was evident from our observations that people had received the support they needed to maintain their personal appearance and hygiene. People looked groomed and appropriately dressed. We noticed that people’s skin and fingernails were clean.

We spoke with six people living in the home, two relatives and a friend visiting people in the home. We spoke with two nurses and three care workers and the registered manager.

The people we spoke with were positive about their life at Swallows Meadow.

One person told us that the care workers were good. She told us that they had made her birthday very special. The person said she kept active and particularly enjoyed computer lessons at the home. She told us she enjoyed her food.

Another person was not complimentary about the food and told us it was not the home cooking he had enjoyed previously. He said that he thought the staff did their best. He told us that he was treated with kindness.

A third person described his care as “Pretty good, you know”. He appreciated getting medical attention and dental care. He told us that care workers were kind on the whole, but that they sometimes appeared under strain. He described the meals as “good average”. He said he had had better, but that the breakfasts were particularly good. He told us he did enjoy the activities. He said that if he had concerns, he would go to the home manager.

People were happy with the activities available in the home. One person told us that they had been out on some trips in the minibus. We observed an activity during our visit that people enjoyed.

Relatives and visitors told us they had no concerns about the way people were being looked after.

Staff were knowledgeable about what constituted abuse and poor practice and were clear about how to report this should it occur. They were happy with the staffing levels and felt supported.

We inspected this service on 16 & 17 June 2015 and this inspection was unannounced.

There was a registered manager in post at the service. 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 service provides accommodation and nursing care for up to 70 people. There are four units providing residential, nursing and care for people who may have a diagnosis of dementia. The home specialises in providing end of life care to people. There were 63 people living at the home on the day of our inspection.

The registered manager, provider and staff team made sure people were cared for in an environment where people were supported to carry on living their lives as they wished. People were encouraged and supported to pursue their interests and hobbies, as well maintaining relationships important to them. Staff demonstrated an understanding of the principles of the home which were to ensure people remained as comfortable and well cared for as possible. People were treated as individuals and were valued and treated respectfully at Swallows Meadows Court. Family members and friends were encouraged to visit as often as they wished and people from the local community were welcomed into the home to provide a range of activities that met people’s needs.

There was a team approach to ensure people’s health and wellbeing was maintained, with every member of staff who worked at the home considered an important member of the team. All staff, whatever their position, were provided with essential training that supported them to meet people’s needs. Staff were trained so they knew how to care for people with dementia.

People spoke highly of the level of commitment and care provided by staff, and during our visit we saw there were enough staff to respond to people’s individual needs. Staff understood to report any concerns they had about people to management and told us they felt confident to report any poor practice within the home. We observed staff approached people with respect, dignity and friendliness which encouraged people to have meaningful interaction with them.

The provider took a positive approach to risk management and supported people as far as possible to continue to do the things they chose. Staff knew people’s individual levels of independence and supported people to do as much for themselves as they could.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained and experienced staff.

The registered manager understood their responsibilities under the Mental Capacity Act 2005. When decisions had been made about a person’s care where they lacked capacity, these had been made in the person’s best interests. Improvements were required to ensure records of decisions reached were kept. People’s health needs were regularly monitored and they were referred to external healthcare professionals when a need was identified and especially when people were at end of life. There were processes to ensure people received sufficient to eat and drink and people were complimentary about the choice and quality of food.

Staff had a good understanding of people’s individual needs and preferences. Where people were at end of life, the staff and culture of the provider ensured people’s privacy and dignity was maintained. The registered manager and staff had a strong commitment to provide people and their friends and family with support to ensure a person’s end of life, was as peaceful and pain free as possible. Families were supported to be involved, individual needs and preferences were understood and people’s privacy and dignity maintained.

People told us they would raise any concerns or complaints with staff or managers. People were encouraged to share their views about the quality of service provided through regular meetings, ‘drop in’ sessions and through quality surveys.

The provider was a member of several recognised good practice initiatives and worked with fellow organisations to develop innovative and creative ways of supporting people, especially those who were at end of life.