We inspected Swanborough House on the 6 June 2017. We previously carried out a comprehensive inspection at Swanborough House on 11 April 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to people’s choices, dignity and independence being promoted. We also found further areas of practice that needed improvement. This was because we identified issues in respect to the management of medicines, assessments of capacity and the provider acting on feedback received. The service received and overall rating of ‘requires improvement’ from the comprehensive inspection on 11 April 2016. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found that improvements had been made. The overall rating for Swanborough House has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been sustained.

Swanborough House provides accommodation, care and rehabilitation for up to 31 people aged over 18 with acquired brain injury. On the day of our inspection there were 29 people living at Swanborough House. Some people stay for a structured time specific period of rehabilitation, but others are living more permanently at the service due to their specific needs in relation to their acquired brain injury. The service follows the Rudolph Steiner philosophy of holistic living. All catering, furnishings, decor and therapies offered follow this philosophy.

People told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People felt staff were skilled to meet their needs and provide effective care. One person told us, “I have lots of seizures. I used to be at home with my Mum, but it wasn’t fair on her, so I came here. I like it, they look after me and know what to do for me”.

People were encouraged to express their views and feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us, “It’s all organic, so it’s better for you”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. One member of staff told us, “[Registered manager] is strict with supervisions. The team will ask her if they have a concern. She tells staff not to wait for supervision. She uses the Skills for Care as a guide when carrying out supervisions”.

Everyone we spoke with spoke highly of the caring and respectful attitude of the staff team which we observed throughout the inspection. On

We carried out an unannounced comprehensive inspection at Swanborough House on 11 April 2016. Swanborough House provides accommodation, care and rehabilitation for up to 31 people aged over 18 with acquired brain injury. On the day of our inspection there were 31 people living at Swanborough House. Some people stay for a structured time specific period of rehabilitation, but others are living more permanently at the service due to their specific needs in relation to their acquired brain injury. The service follows the Rudolph Steiner philosophy of holistic living. All catering, furnishings, decor and therapies offered follow this philosophy. The home is located in Brighton with access to local amenities, which include the local community centre. Public transport routes serve the area.

There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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.

During the inspection we saw that people were not routinely offered day to day choices around their care. They did not always have their independence promoted, and some had their dignity and privacy compromised. The manager told us, “I am aware there are some restrictions around choice. This is something I am looking at”. We have identified this as an area of practice that needs improvement.

Medicines were managed and administered safely. People’s medicines were stored safely and in line with legal regulations. People received their medicines on time. However, adequate guidance was not in place for the use of ‘as required’ medicines and care plans failed to demonstrate the steps required before administering the medicine. This therefore placed people at risk of receiving medicine that they did not require. We have identified this as an area of practice that needs improvement.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards. People’s consent to their care and treatment was assessed and staff had a good understanding of the Mental Capacity Act 2005 (MCA). However, we could not always see evidence of involvement with the individual or their representatives in how their decisions had been made. We have identified this as an area of practice that needs improvement.

We saw that regular staff meeting took place. Staff were encouraged to ask questions, discuss suggestions and address problems or concerns with management. However, we identified concerns in relation to feedback from staff being acted upon by the provider. We have identified this as an area of practice that needs improvement.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I really do feel safe, yes”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Risks were thoroughly assessed and planned for. Accidents and incidents had been recorded and appropriate action had been taken. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did

During our inspection we spoke with five people who used the service and a visiting relative. We also spoke with five staff members; these were the registered manager, a team co-ordinator and three support workers.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us “Yes I like it here and I would give it 8 out of 10”.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service.

The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

The service also had a system in place to effectively deal with comments and complaints.

There were 29 people who used the service at the time of our inspection. We used a number of different methods to help us understand the views and experiences of these people, as not all of the people who used the service were able to tell of their experiences. We observed the care provided and looked at supporting documentation. We spoke with three members of staff and the manager. We talked briefly with three people who used the service.

We saw that people had been involved in making decisions about their care and treatment. We found staff to be knowledgeable, well trained and supported in order to meet people's needs. People had not always been assessed before they moved in and this put them at risk of not having their needs met.

People's care needs had been planned, reviewed and delivered in line with their individual care plan. People who use the service were protected from the risk of abuse and told us that they felt safe at the service. People were protected by the service’s recruitment procedures. There were systems in place to identify, assess and manage risks to people who used the service.