This inspection took place on 12 and 13 December 2017 and was unannounced and carried out by one inspector. Previous inspection of the service took place in June 2016 where the Commission highlighted some concerns and imposed conditions on the service as to drive improvement within the service.

At the last inspection in June 2016, the service was rated Good overall with requires improvement in the effective domain. The service had failed to meet the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 legislation. Appropriate mental capacity assessments had not always been undertaken nor DoLS applications made which were necessary to lawfully deprive a person of their liberty, acting in their best interests. At this inspection, we found the service remained Good in all areas and the service had made improvements in the effective domain.

Swan care residential home is a ‘care home’. Swan Care Residential Home is set in the tranquil Village of Tillingham within the county of Essex. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was safe. The service carried out appropriate recruitment checks before staff commenced employment. There were sufficient staff on duty to meet the needs of people and keep them safe from potential harm or abuse. The service assessed and reviewed people’s health and wellbeing to minimise risk to health. The service had a good management and monitoring structure in place for the management of people’s medicines.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The service supported people to eat and drink enough this ensured people maintained a balanced diet.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. The service undertook regular care plans reviews and changes were made when needed. People were supported to follow their interests and participate in social activities. The service responded to complaints received in a timely manner.

The service was Well Led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis. The manager told us that current systems and processes where being updated and improved.

This inspection took place on the 24th and 27th June 2016 and was unannounced. The service was last inspected on 30th May 2014 and was found to be compliant in all areas.

Swan Residential Care Home is registered to provide accommodation and personal care for up to 20 people some of whom may be living with dementia. At the time of our inspection 20 people were using the service.

The service has 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.

Staff were aware of risks to people and knew how to support them safely.

Suitable arrangements were in place for medicines to be stored and administered safely.

There were sufficient numbers of staff who had the necessary skills and experience to meet people’s needs effectively.

The service had failed to meet the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 legislation. Appropriate mental capacity assessments had not always been undertaken nor DoLS applications made which were necessary to lawfully deprive a person of their liberty, acting in their best interests.

A choice of food and drink was available that reflected people’s nutritional needs, and took into account their preferences.

People were supported to maintain their health and wellbeing as had regular and timely access to wide range of healthcare professionals as needed.

Staff were caring and had good relationships with people and were attentive to their needs.

People were treated with kindness and respect by staff who knew them well and who listened to them, respecting their views and preferences.

People’s privacy and dignity was respected at all times.

People were supported to maintain routines and relationships that were important to them.

The registered manager promoted an honest and open culture within the home with the emphasis of ensuring that people, relatives and staff felt a sense of belonging and ownership and felt part of a family.

There were systems in place to ensure the quality and safety of the service and to drive improvements and respond appropriately to complaints and feedback.

The people who lived at Swan Care Residential Home at the time of our inspection had a range of needs including those associated with dementia. Where people were unable to tell us directly about their experiences, we observed that they appeared calm, relaxed and comfortable.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the provider greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The service understood the requirements of the Mental Capacity Act 2005, its Codes of Practice and Deprivation of Liberty Safeguards. Normal assessment and care planning arrangements considered people’s capacity, needs and abilities. Where people were unable to make day to day or significant decisions, we saw that Mental Capacity Act (MCA) 2005 assessments had been undertaken and reviewed. Where it was necessary, best interest decisions taken on behalf of people who did not have capacity were taken through formal assessment with relevant healthcare professionals, in accordance with legal requirements.

Appropriate measures were in place that ensured the physical environment and equipment within the service was suitable for its purpose. Risks associated with the environment were assessed and managed and safety checks were carried out routinely.

People’s medicines were stored and administered safely and managed appropriately.

Is the service effective?

People were involved in decisions about the environment in the home and consideration was being given in the refurbishment and redecoration schedules to provide an environment that met people’s diverse needs.

Staff received appropriate professional development and support to enable them to carry out their role effectively and safely. Records showed that staff received regular training relevant to their role and the needs of people using the service.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. They showed patience when communicating with people and interacted with them in a caring, respectful and professional manner, giving them time to respond. The people we spoke with said that they were looked after well and the care staff were nice.

We saw that relatives and friends were welcomed into the home. We were told by visiting family members that there was an open visiting policy and that they were always welcomed, at any time. They were all satisfied with the standard of care delivered to their relatives and they all found the staff to be approachable, helpful and informative.

The manager demonstrated compassionate care. We found that the manager had worked tirelessly to facilitate, at the end stage of life, a last reunion of two people with their spouses, who were at the time, patients in hospital. One visiting family member told us that they did not think this would have been possible but the manager sorted everything out, “she was wonderful.”

Whilst people had detailed and personalised care plans in place that guided staff as to the type and level of support they needed, improvement was needed to ensure care plans incorporated people’s existing healthcare needs. Records showed that the staff acted promptly when any healthcare concerns were identified.

Is the service responsive?

During our inspection we saw people were engaged and interacted well with staff. They received care and support in accordance with their preferences, choices and diverse needs.

Visiting relatives told us that they were confident that their comments were listened to and dealt with effectively. Although nobody spoken with had had any cause for complaint, there was an effective system in place for handling and responding appropriately to any complaints that may be made by people using the service or their representatives.

Is the service well-led?

The service had a registered manager in post. They provided strong leadership and demonstrated a good role model to staff. Staff told us that the manager was approachable and they felt well supported.

People and/or their representative’s were provided with the opportunity to feed back their experiences to inform the provider about the quality of service provided. There were quality assurance systems in place to assess and monitor the quality and safety of the service provided. Further improvement is needed in order to complete the quality monitoring cycle and provide an overview of the information gathered to identify the weaknesses and strengths of the service delivered. This would demonstrate the quality of the service was continuingly improving and developing to provide good outcomes for people.

As part of this inspection process we spoke with the manager, manager of one of the provider's 'sister' homes, three members of staff, three people who used the service and one visitor.

Our observations suggested that people living at the service liked living at Swan Care Residential Home, that they felt safe and were well cared for. It was evident that people who used the service had a good relationship and rapport with the staff who supported them. We spoke with three people who used the service. People told us that they liked living at Swan Care Residential Home and found the staff to be kind and caring. Comments included, "Well it's not like your own home. The staff are nice and they do their best" and, "The staff are very pleasant. They are kind."

People's health and personal care needs were assessed and there were care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Improvements were required so as to ensure that these were robust and recorded each person's care needs and included associated risk assessments.

Areas for further improvement related to the management of medicines, consent to care and treatment, ensuring that staff received appropriate refresher mandatory training and specialist training for the needs of older people. In addition we found that improvements were required for the recording of complaints.

People who lived at the Swan had a range of care needs and dementia. People who were able told us that they liked the home and were cared for by kind and patient staff. Staff members listened to what people had to say and responded in a warm and caring way.

A number of people were not able to tell us directly about their experiences. However, we observed that they were relaxed and they interacted positively in different ways with the staff. This showed us that people experienced care and support that met their needs in a timely and individualised way. One relative said “The staff don’t just care for my [relative], they also care for me. That makes me feel important too.”

There were a range of daily activities on offer and people could get involved as much as they wanted. People liked the food and the choices available and attended meetings every three months to share their views and experiences. Some people attended a weekly club in the village. One person said “I like the games we do and I like the food, and I like the carers and I like everything here.”

The Swan had all the necessary policies and procedures, quality assurance and monitoring systems in place for the safeguarding and protection of people who lived at the home. Staff carried out their caring responsibilities well and people and their families were involved in their care arrangements.

People told us that they were satisfied with the care and support provided at the home, and that the staff were helpful and considerate towards their needs. People also told us that they were satisfied with the food provided and the daily menu choices. They said that their rooms were comfortable and that staff kept rooms clean and tidy.

One person told us that the staff were very good and they could not ask for more with regard to their support needs being met by the staff. Another told us that the staff were always friendly and that they had no complaints about the home.