We carried out a comprehensive, unannounced inspection of this service on 08 June 2017. It was rated as ‘Good’ in all the areas we inspected. Since our last inspection we received a concern about the management of people’s wounds following an injury a person sustained while living at the home. At the time of this inspection the specific incident was being investigated by partner agencies.

We undertook this unannounced focussed inspection on 09 August 2018. We inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. No risks, concerns or significant improvement were identified in the remaining key questions of is the service: effective, caring or responsive. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Swan House on our website at www.cqc.org.uk

Swan House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Swan House accommodates 45 people in one adapted building. At the time of our inspection 39 people were living at the home.

The home had 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 told us they felt safe. Risks to people had been assessed and monitored to protect people from the risk of avoidable harm. Staff were aware how to protect people from the risk of abuse and effective reporting systems were in place. Adequate numbers of staff were available to meet people’s needs. People received their medicines safely and there were effective systems in place to monitor medicine administration. The home environment was clean and well maintained and there were systems in place to monitor and audit infection control practices.

People and staff were complimentary about the leadership and management of the home and said the registered manager was friendly and approachable. People and staff felt supported to share their views and concerns. There were systems in place to monitor the quality of service provided to people.

This unannounced inspection took place on 8 June 2017. Swan House is a nursing home which provides accommodation and personal care for up to 45 older people. At the time of our inspection 36 people lived at the home.

The home had 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 told us they felt safe living at the home and were supported by staff who received training in how to recognise signs or harm or abuse. People’s risks had been assessed and staff knew what action to take to keep people safe. People received their medicines as prescribed.

People were supported by sufficient numbers of staff who had been safely recruited. Staff received induction, training and support from the management team. People were asked for their consent before staff provided care. Staff understood people’s rights and choices when supporting them. People told us they had a choice of meals and had sufficient to eat and drink. People had access to healthcare professionals when needed.

People were supported by staff who were kind and caring and who treated them with dignity and respect. Staff knew people well and supported people to maintain their independence. People felt listened to and able to raise concerns they may have.

Staff understood their roles and responsibilities and felt supported by the registered manager. Processes were in place to listen to and respond to people’s experiences of the service and audit systems were in place to monitor the quality of care being provided.

We completed this inspection because we received information of concern about how people were supported and that there were insufficient staff working with people who used the service.

At the time of our inspection, 31 people were using the service.

We spoke with six people who used the service, the registered manager and five members of staff. 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. Prior to our inspection, we spoke with two social care professionals and reviewed information we held about the service.

We observed how people were supported and how staff spoke with people.

We looked at five people’s care records to see if they were accurate and up to date.

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

Based on the information we received we asked if this service was safe and effective?

Is the service safe?

People were not always supported to move in a safe way. Risk assessments were in place which recorded how people should be supported to move, although we saw people being supported without moving equipment and in a manner which could cause them harm.

We saw systems were in place to manage and monitor how the staffing was provided to ensure people received the agreed level of support. The staff we spoke with told us there was generally enough staff on duty to meet people’s needs. We saw that staff were available and people never had to wait long if they needed any support.

Is the service effective?

People made decisions about their daily care including what they wanted to eat and their daily routine. People’s capacity to consent was not assessed and relatives were asked to consent for major decisions. There was no evidence that decisions were made in peoples best interests in accordance with legal guidelines.

We carried out this inspection to check on the care and welfare of people who used this service, and to ensure that compliance actions we made in June 2013 had been addressed. The visit was unannounced, meaning the service did not know we were going. We spoke with two people who used the service, three relatives and three staff about how the service was delivered, what improvements they had noticed and the quality of service provided.

During our unannounced inspection in June 2013, we made a compliance action in one area. This meant the provider had to make improvements. We said that people were not involved in discussions about their care and treatment or able to influence how the service was run. We said improvements were needed to ensure that people had their dignity respected. We also found people needed more personalised activities to support their well-being. Our visit was to establish that these improvements had been made.

We found that all necessary actions required had been taken. One person who used the service said: “I’m alright here – I don’t want to go anywhere else”. One relative we spoke with told us: “I am really happy with the care they give to my relative”.

We carried out this visit to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff did not know we were coming.

29 people were in residence when we visited. We spoke with eleven people living in the home, seven visitors and eight staff.

Some people were unable to speak with us either because of frailty or personal preference. However, when care and support was provided, we observed good interaction between staff and people who used the service.

We saw three people who looked unkempt. One person we spoke with told us: “I do like to be dressed properly. Sometimes it’s only half done; I do not like looking like this”. This meant that people who used the service did not always have their views listened to.

We saw that care records provided clear information to staff about how to meet the needs of the individuals who used the service.

Two people we spoke with told us the care they received was good. One visitor told us: "The care is marvellous".

We saw that people had a choice of food each day. We saw staff supporting people who needed help to eat their meals.

We found effective systems were in place for storing, recording and handling medicines.

We found staff received sufficient training to meet the needs of the people who used the service.

We checked how the home assessed its own quality and safety and saw effective monitoring systems were well recorded.

We spoke with five people living at Swan House and three relatives. People told us that they were happy with the care that they received. They told us that staff consulted them about the care they needed and provided them with care in a way that met their needs and capabilities.

People told us, "Staff here are lovely and very supportive". They told us that staff were respectful and provided assistance when they needed it. People told us that they had no complaints, and that their relatives were always well dressed, and well cared for.

We found that care plans and risk assessments were kept under review. This meant that people received the care they needed.

We saw that the management and administration of people's medicines was undertaken safely which meant that people received their medicines as prescribed.

We saw that the service had a robust safeguarding system in place, including regular training for staff. The system used for holding people's personal monies ensured that it was safely and securely held. This meant that people living at the service were

appropriately protected, and people's money and property were safe.

We saw that the service had a quality assurance system in place ensuring that people received safe and appropriate care that met their needs.

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This unannounced inspection took place on 6 and 7 August 2015. At our last inspection on 23 September 2014, we asked the provider to take action to make improvements to ensure people received safe care and there were suitable arrangements in place to obtain or act in accordance with the consent of people who live at the home. During this inspection we found the provider was meeting the regulations.

Swan House is a nursing home providing accommodation and personal care for up to 45 older people, including people who have dementia. At the time of our inspection 43 people were living at the home. The home had 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, relatives and staff told us that there were not always enough staff available to support people with their needs in a timely manner. The registered manager agreed to review the deployment of staff particularly during busy times to ensure people’s needs were met.

Staff kept people safe from the risk of abuse. We saw that the provider had systems in place to protect people from potential harm or abuse. These included thorough staff recruitment checks, staff training and procedures to report allegations of harm or abuse.

Risks to people’s health and care needs had been assessed. Personalised care plans had been developed and were reviewed to ensure people’s needs were being met.

People received their medicines as prescribed and they were stored and disposed of safely.

Appropriate action was taken to protect the rights of people and people were asked for their consent by staff to provide care.

People were supported to eat and drink sufficient to keep them healthy. People’s health and care needs were assessed and care was planned and delivered to meet those needs. People were supported to access a variety of healthcare professionals to ensure their health needs were met.

Staff understood people’s choices and preferences and respected their dignity and privacy when providing care. People were encouraged to be as independent as possible. People were supported to maintain their interests and a range of activities were available.

People and their relatives told us they were aware of how and who to raise any complaints or concerns with. They were confident that they would be listened to and responded to appropriately. The provider had an effective process in place to respond to people’s concerns or complaints.

People, relatives and health care professionals told us the registered manager and staff were knowledgeable and approachable. Relatives and visitors said they were always welcomed by staff which enabled them to maintain relationships with family members.

The provider had systems in place to monitor the quality of the home. This included gathering feedback from people who use the service and monthly audits to check the quality of care people received.