What life is like for people using this service:

People told us that they felt safe living at Swan Hill House. People were cared for by enough staff who understood how to keep people safe from harm and abuse. People told us that they received their medicines on time however medicines were not always managed safely and some improvements were needed to the current system for medicine management.

Staff were kind and treated people with dignity and respect. People were supported to make their own choices and were encouraged to be as independent as possible. Staff understood people’s preferences and care was delivered in line with people’s wishes and needs.

People told us that the management team were approachable and people knew how to make a complaint. The registered manager carried out health and safety checks of the premises and equipment. Accidents and incidents were recorded and action taken where necessary to keep people safe.

More information is in the full report

Rating at last inspection:

At our last inspection (report published 28 September 2016) all of the key questions were rated Good and the service was rated as Good overall. At this inspection, the key question Safe has changed to Requires Improvement however this has not changed the overall rating and this remains Good.

About the service:

Swan Hill House is a residential home that provides accommodation with personal care for up to 28 older people. At the time of our inspection, there were 27 people using the service. Swan Hill House is a Georgian town house situated in Shrewsbury town and people have easy access to the town centre.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

The inspection was carried out on 25 August 2016 and was unannounced.

Swan Hill House is registered to provide accommodation with personal care for up to a maximum of 28 people. There were 28 people living at the home on the day of our inspection. The home is situated close to Shrewsbury town centre and offers easy accessibility into the town.

There was a registered manager in post who was present during our inspection. 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 felt safe living at the home as staff were always available to support them when needed. The registered manager monitored staffing levels and adapted these in line with changes in people’s needs. People were supported in a calm and unrushed manner.

Staff had received training on how to keep people safe and knew how to recognise the different signs of abuse. They knew how to protect people from further harm and who to report concerns to. The registered manager followed safe recruitment procedures to ensure staff were suitable to work with people living at the home.

Staff were aware of the risks associated with people’s needs and took action to minimise these without restricting them from doing things they enjoyed doing.

People received support to take their medicine when needed and accurate records were maintained. Staff monitored people’s health and arranged health care appointments as and when required.

People were confident that staff had the skills and knowledge to meet their individual needs. Staff felt well supported and received training that was relevant to their role and to further their development.

Staff sought people’s consent before supporting them. Staff provided information to people in a way they could understand to enable to make informed decisions about their care and treatment. Where people were unable to make certain decisions for themselves these had been made in their best interest by people who knew them well.

People were impressed by the choice and quality of food provided. Where required people received support to eat their meals independently.

Staff treated people with kindness and compassion. People were offered choice and felt listened to. Staff promoted people’s dignity and independence. Staff spoke with and about people with respect.

People’s needs were assessed prior to moving into the home and reviewed at regular intervals to ensure they reflected their needs and preferences. People were encouraged to follow their interests and could spend their time as they liked.

People felt able to talk to staff or management if they had any concerns or complaints and were confident that these would be dealt with promptly.

There was an open and honest culture at the home where people and staff were encouraged, and felt comfortable, to express their views. The registered manager promoted excellent care standards and led by example. Staff were proud to work at the home and felt valued. The registered manager carried out a range of checks to monitor the quality and safety of the service and used their findings to make necessary improvements.

We carried out this inspection in response to concerns we had received about Swan Hill House.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with eight people who used the service, two relatives, two staff and the registered manager. We also reviewed records relating to the management of the home which included four care records.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Risks to people had been identified and managed in a way that ensured people’s safety. These were regularly reviewed and care records updated.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had been submitted by the provider.

People’s capacity to make their own decisions had been assessed. Where people could not make a specific decision without support we saw appropriate professionals had been involved in making that decision on their behalf.

Is the service effective?

People told us their needs were met by staff and they were involved in discussions and decisions made about their own care and support.

We saw evidence that the provider worked closely with other health professionals to ensure there was a joined up approach to meeting people’s current care needs.

Is the service caring?

People told us staff respected their privacy and dignity and were caring towards them. We saw that people who used the service were comfortable talking with staff.

When we observed staff supporting people we saw they treated them with respect and kindness.

Is the service responsive?

People’s individual needs had been assessed before care was provided and these were updated regularly. Where people’s health needs changed the provider contacted the appropriate health professionals to meet these needs.

A variety of activities were provided for people to attend. People we spoke with told us they enjoyed these activities and were able to choose which ones they took part in.

Is the service well led?

People and relatives told us the provider listened to them and did what they said they would do. They told us they were able to freely talk about any issues or concerns they had and these were dealt with quickly.

The provider told us they were present at the home most days. They were able to demonstrate they were fully involved in the care and welfare of people and the day to day running of the service.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “They are marvellous” and another said, “I’m very happy here”.

There were 25 people living at the home when we went to check the provider had taken the actions required by us to meet essential standards of quality and safety.

We spoke with 14 people who used the service, and seven members of staff. Some people were not able to share their views with us. We spent time with them in communal areas, as well having lunch with them or meeting them in their bedrooms. We also spoke with a local authority professional who had arranged to visit the home on the day we inspected it.

We saw how care and support plans had improved. People who received a service had been involved and consulted so they could agree to the detail and contents of this paperwork.

People said they were very happy with the choice and quality of food. We saw they received appropriate support at meal times to make this a dignified experience.

People told us they were happy and felt safe. Relatives agreed. One person commented, “It’s excellent here."

Staff said they were confident to recognise and report abuse. They told us their training made sure they knew what to do if they ever had concerns about a person's welfare. Staff agreed that regular support and monitoring of their performance made sure people were cared for properly.

When people made complaints they were fully acted upon. Prompt remedial action was taken when concerns were raised.

We saw that records lacked detailed information about the good care people said they had received.

We carried out this review to check on the care and welfare of people using this service and to check on improvements we asked them to make following our inspection visit in November 2011.

There were 27 people living in the home on the day we visited. We met and spoke with over half of the people who lived at the home, three relatives who were visiting, and six members of staff. We looked at selected care records, staff files and other records relating to the running of a care home. As some people were not able to share their views with us we spent time with them in the communal areas in the home to observe them and the support they received.

All the people who were able to talk with us spoke positively about their life at Swan Hill House and the care they received from the staff. People we spoke with told us they were happy living at home. Relatives we spoke with were equally pleased. One person commented that the care offered to their family member since they moved into the home had improved their well being.

We found that some people who lived at Swan Hill House, particularly those who had difficulty in making decision for themselves were not always supported to make choices and have as much control as possible over their daily lives, whilst keeping them safe. We saw this had an impact on care needs for themselves, and others in the home.

We saw that some people lived active lives with varying levels of support suited to their needs and choices. People took part in a range of leisure and social activities, both at home and in the local community. Relatives said they felt included and welcomed to join in the day-to-day goings-on and special parties and functions with their family member when they visited the home.

Everyone we spoke with said they were happy with the quality of food provided. One relative who had regularly dined at the home commented that the food was very good and there was always plenty of choice.

When people’s needs increased or changed there was evidence that the home worked with health and social care professionals to keep them comfortable and well. We saw that most people's needs were assessed and care and treatment was planned but not all of their needs were accounted for. This meant staff did not have all the guidance to carry out all of the support people required.

We saw that the home did not always seek or follow good practice and specialist advice to fully promote people's health and well-being. We saw that for two people this had led to an increased risk of harm due to lack of bedrail safety systems in the home. The home management also had to take urgent action to improve their infection control systems during our inspection visit.

Relatives we spoke said they felt people were safe and well looked after at Swan Hill House Residential Home. Staff told us they were confident to recognise and report abuse. Staff we spoke with confirmed they received training to keep vulnerable people safe on a regular basis.

People told us they were pleased with the cleanliness of Swan Hill House. One regular visitor to the home commented “it is always spotlessly clean”. People appreciated their recent involvement in choosing the colour schemes for parts of the home which had been decorated recently.

We saw the home had improved their recruitment practices to make sure new staff were suitable to work with vulnerable people before they started working at the home. We saw this process would benefit further development to make sure the working and education background of applicants had been fully looked into.

The home staff told us they sought people's views about their care and listened to them on a day to day basis. We were told that that as the home was so small a lot of this practice was carried out verbally and had not been recorded.

We saw the home quality assurance systems would from benefit further development, as some management systems had not been maintained to ensure people received good quality and safe care for some time. We noted lack of audits which meant that issues including accident management were not addressed to make sure people living at the home well kept safe and well.

We conducted this responsive review following concerns we received about how staff were employed to work with vulnerable adults.

We visited the service and looked at the employment records held for five staff.

Staff told us that there was a recruitment and selection process in place. Staff stated managers carried out relevant checks when they employed new staff.

Staff files reviewed did not show that all outcomes of these processes were kept or documented. People living at the home cannot be assured that only applicants who are suitable to work with them are employed or suitable for their role. This practice potentially places people who use the service at risk of harm.