Swanholme Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and residential care for up to 25 people, including older people and people living with dementia.

We carried out this inspection on 14 December 2017. The inspection was unannounced and there were 22 people living in the home at the time of our inspection.

The home was run by a company who was the registered provider. A registered manager was in post who was available at the time of this inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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. In this report when we speak both about the company the area manager and the registered manager we sometimes refer to them as being, ‘The registered persons’.

At our last inspection on 5 October 2016 we found that there was a breach of the regulations that had reduced the registered persons' ability to consistently provide people with care that was being well-led. We also said that other improvements needed to be made to ensure that the service was always safe and responsive. We rated each of these parts of the service as ‘requires improvement’. Overall, our assessment of the service was ‘requires improvement’.

Shortly after our inspection visit the registered persons told us that they had made the improvements that were necessary to address each of our concerns. The registered persons told us they had also reviewed the arrangements in place for the way the home was set out and that they had changed the name of the home from Eccleshare Court 40-64 to Swanholme Court. They said these changes were made to help more clearly distinguish the home from another home the registered persons owned which was located next to Swanholme Court. The registered persons also provided us with subsequent monthly updates about how they were addressing and making further improvements to the concerns we had raised at our last inspection.

At the present inspection we found that suitable arrangements had been introduced to ensure that the service was being well-led. The breach of the regulations for well-led had been addressed and resolved and other improvements we had highlighted were needed had been made. As a result people were receiving safe and responsive care which was well-led. Given the progress made we revised our assessment of each of these aspects of the service to ‘good’ and also changed the overall assessment of the service to ‘good’.

Our other findings at the present inspection were as follows:

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place which were used to ensure effective infection prevention and control.

We found there were sufficient care staff available to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively, internally and externally.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

Training and support systems were in place to provide staff with the knowledge and skills they needed in order to care for people in the right way. Staff worked well together and were kind and attentive in their approach.

People were invited to comment on the quality of the services provided and the arrangements for receivi

We carried out an unannounced inspection of Eccleshare Court 40-64 on 5 October 2016.

The home is located near to the centre of the city of Lincoln. It provides personal and nursing care for up to 25 people, some of whom live with dementia. It is a purpose built building containing 25 en-suite rooms. There is a wheelchair accessible lift to use between floors and communal areas so people can easily access all areas of the home. As well as each room having an en-suite bathroom there are also 3 communal bathrooms with bathing facilities. There is also a garden area at the front of the building for people and their families to use. There were 22 people living at the home at the time of our inspection.

There was an established registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

We found there was a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014.This was because registered provider had not ensured that quality assurance and audit systems were reliably managed so as to enable them to identify and resolve shortfalls in the services provided for people. This breach had reduced the registered provider's ability to ensure people were kept safe. You can see what action we told the registered provider to take at the back of the full version of this report.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for eight people living in the home and was waiting for these to be assessed by the local authority.

During our inspection visit we found some areas in which improvement was needed to ensure people were provided with safe, effective care and that the provider’s regulatory responsibilities were met in full.

There were not always enough suitably deployed staff at the home to ensure people’s needs were always being met.

We found that the management of people's medicines was not always conducted safely in line with good practice and national guidance.

People had access to a range of healthcare services and were supported to enjoy a varied diet in order to help them stay healthy. There was also a range of equipment available to meet their needs and encourage independence. However, care records did not always reflect up to date information about people’s needs.

People and their relatives were involved in planning their care and had been consulted about their individual preferences, interests and hobbies. Activities were available for people to take part in, however, the activities available did not always enable people living with dementia to be stimulated or maintain and further develop their interests and hobbies.

People living at the home were invited to comment on the quality of the services provided. However, the arrangements for receiving feedback about the way the home was run were not always effective.

Staff were recruited appropriately in order to ensure they were suitable to work within the home and were provided with training to develop their knowledge and skills.

There were systems in place for handling and resolving formal complaints and the provider and registered manager took action to address concerns when they were raised with them.