The last inspection to this service was on the 7 and 9 August 2017 where we found wide spread failings and seven regulatory breaches. We rated the service inadequate in two key questions we inspect against, Safe and well led. The breaches included a breach for Regulation 12: Safe care and treatment, Regulation 13: Safeguarding, Regulation 18: Staffing, Regulation 11: Consent, Regulation 12: Safe Care and treatment and Regulation 17: Good Governance. Regulation 18 (registration)

At the last inspection, the provider agreed not to take any new admissions until they had made the improvements we had identified as part of our inspection. We also put a condition on their registration in respect to staff training as we found a high percentage of staff had inadequate or no training in some key areas of practice. We found their knowledge poor and we were not confident that they would be able to carry out their job safely.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the overall service with particular emphasis on key questions relating to safe and well led and how they were going to meet the regulatory breaches and conditions on their registration. The action plan was submitted to us in a timely way, and updated at regular intervals. We noted over the last three years this service has not achieved an overall good rating.

Because the service was rated inadequate, it was placed in special measures. Services in special measure will be kept under review and if we have not taken immediate action to propose to cancel the provider’s registration of the service, we undertake to inspect within six months of the last inspection. The expectation is that the provider should have made significant improvement within this period.

We re-inspected this service over a number of different dates due to its complexity and size. The first date was 14 March 2018 and was unannounced. A pharmacy inspector visited on the 19 March 2018 and the lead inspector returned on the 20 March to follow up on some concerns and provide feedback. The service had nine vacancies so had 40 people living on site at the time of the inspection.

Swanton House care centre is a care home. 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. The care home accommodates up to 49 people in three separate houses. Some of the accommodation is self-contained. The three houses are referred to as Holly Court and Bluebell, which are single storey and purpose built. The third house is Birch, which is a converted period building. The service accommodates people who require residential in Bluebell and in Birch and Holly Court for those requiring nursing care. People may have a mental health need, a learning disability, a physical disability or a dual diagnosis. Some people are over 65 others under 65 and some living with dementia.

At the time of the last inspection, there was no registered manager, an acting manager left shortly after the last announced inspection. According to our information, the service has not had a registered manager since 30th November 2016. Just prior to the departure of the last manager, the service employed a management consultancy team to help improve the service and achieve compliance. One member of the team agreed to stay on as manager and has submitted an application to the CQC to become the registered manager. However two fit persons interviews had to be cancelled which has resulted in the manager resubmitting their application to register. In this report, we refer to them as the general manager as they are not yet registered.

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

The inspection took place on 7 and 9 August 2017 and was unannounced.

Swanton House Care Centre provides residential and nursing care for up to 49 people. It is divided into three units. Holly Court and Bluebell are single story and purpose built. Birch is a converted period building. Some people who used the service needed support with their mental health needs. For other people their needs were age related or they were living with dementia.

Both Birch and Holly Court provided nursing care whilst Bluebell provided residential care only. Those people requiring care for their age related conditions or support whilst living with dementia, lived in Birch. At the time of our inspection there were 46 people living in the home.

At the time of our inspection, there was no 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. However, in order to manage the service, the provider had employed a consultancy agency six weeks prior to this inspection. This consisted of a full time manager and part time clinical lead.

We last inspected this service in April 2017 where we found widespread concerns and failure to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the April 2017 inspection, we found six breaches to the regulations. These breaches related to safe care and treatment, safeguarding people from abuse and improper treatment, the need for consent, person centred care, staffing and good governance. The provider sent us a plan to tell us about the actions they were going to take to rectify the breach of the regulations. They told us these would be completed by July 2017.

At this inspection, carried out in August 2017, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be in breach of the above six regulations. In addition, the service had failed to treat people with dignity and respect.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider had been aware of failures within the service for a number of months. The action plan, quality monitoring system and management resources they had in place to address these failures had not been sufficient. We found continued and widespread issues across the service and we had serious concerns about the health, safety and welfare of people who used it.

The risks around people’s mental health and associated behaviours had not been mitigated and managed. This put them, and others, at risk of harm or abuse. Clear strategies for supporting people living with behaviour that may challenge them and others were not consistently in place. Where they were, they were not consistently being followed by staff. In addition, the procedures in place to safeguard people were not fully effective. Staff were stretched to support people in a safe manner.

People’s basic needs were met but they did not receive person centred care that was tailored to their individual needs. Care and support was delivered in a task orientated manner. People had not been included in the planning of their care and we saw that consent was not consistently sought prior to support being provided. The social and leisure needs of all those that used the service were not being met with little in place to stimulate or interest them.

Care and support was not consistently provided in a way that maintained people’s dignity or in a manner that demonstrated respect. Staff interventions were not consistently empathetic, warm or discreet. Whilst we saw that some staff displayed kin

The inspection took place on 19 and 20 April 2017 and was unannounced.

Swanton House Care Centre provides residential and nursing care for up to 49 people. It is divided into three units. Holly Court and Bluebell are single story and purpose built. Birch is a converted period building. Some people who used the service needed support with their mental health needs. For other people their needs were age related or they were living with dementia.

Both Birch and Holly Court provided nursing care whilst Bluebell provided residential care only. Those people requiring care for their age related conditions or support whilst living with dementia, lived in Birch. At the time of our inspection there were 48 people living in the home.

At the time of our inspection, there was no 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.

An application to register one of the service managers had been received by CQC and, at the time of this inspection, was being processed. However, shortly after the inspection, we received confirmation that this service manager intended to withdraw their application. They were present at this inspection.

We last inspected this service over March and April 2016 where we found that the service was not meeting one requirement of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to meeting people’s nutritional and hydration needs. The provider sent us a plan to tell us about the actions they were going to take to rectify the breach of the regulations. They told us these would be completed by June 2016. At this inspection, carried out in April 2017, we found that the service had made some improvements in regards to meeting people’s nutritional needs and were no longer in breach of this regulation.

Six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified at this inspection carried out in April 2017. These breaches related to safe care and treatment, safeguarding people from abuse and improper treatment, the need for consent, staffing, person centred care and good governance.

The provider was already aware of the issues we identified at this inspection and action plans were in place to address them. However, the concerns had been evident for some time and insufficient action had been taken to rectify them in a timely manner.

A reduced management team had had an adverse impact on the service and there were not enough resources in place to ensure a consistently good quality service was being delivered. The processes for assessing, monitoring and improving the service had not been effective.

People did not consistently receive care and support that was tailored to their individual needs. Care plans lacked accurate, up to date and person centred information that reflected people’s needs. The social and leisure needs of all those that used the service were not being met.

Risks were not always fully mitigated and managed. Clear strategies for supporting people living with behaviour that may challenge them and others were not consistently in place. The procedures in place to safeguard people were not fully effective. Staff were stretched to support people in a safe and dedicated manner.

Medicines management arrangements had not been regularly reviewed and audited and some people had not received their medicines as the prescriber had intended. This put people at risk of a decline in their mental and physical wellbeing.

Records contained gaps in regards to managing people’s nutritional needs and there was confusion over how this was managed. There was no clear process in place to effectively monitor, assess a

The inspection took place on 31 March and 5 April 2016 and was unannounced.

The service provides accommodation and support with personal care or nursing needs to a maximum of 49 people. It is divided into three different units, two of which are purpose built. Some people using the service needed support with their mental health needs. For other people their needs were age related or they were living with dementia. The provider set out on the home’s website and to the Care Quality Commission (CQC) that they can also provide support to people with a learning disability or autism. At the time of our inspection there were 46 people using the service.

There was a registered manager in place. A registered manager is a person who has registered with CQC 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. The current manager had completed registration with CQC in February 2016.

At our last inspection on 24 April 2014, concerns were identified that care plans did not all contain relevant information about people's needs and were not updated regularly. At this inspection we found that action had been taken so that staff had access to information about the care people required.

People experienced a service that was safe. Staffing levels had improved and people received support from staff in a timely and safe way. Staff understood their obligations to report any concerns that people may be at risk of abuse or harm. The risks to which people were exposed were assessed with guidance for staff about how to minimise these.

Medicines were managed in a safe way.

The service people received was not consistently effective. Mealtime routines did not always provide an experience conducive to encouraging people to enjoy their meals. There were shortfalls in the way that people's intake of food and drink was monitored and encouraged to ensure this was sufficient for their wellbeing and health. We have told the provider they need to make improvements in this area.

Although underpinning written assessments of people's capacity to make informed decisions were not always properly completed, staff understood their responsibilities under the Mental Capacity Act 2005 for supporting people to make decisions. Action had been taken to ensure people's rights and freedoms were protected and that any restrictions were considered to see if these were appropriate.

Staff ensured that prompt action was taken to seek advice about people's health when they became unwell.

People received support from staff who were kind and compassionate. Staff took action to intervene promptly when people became distressed and needed reassurance. They respected people's privacy and dignity.

The service was responsive to people's needs and preferences. Staff were flexible in the way they delivered care to people. They took into account individual preferences and day-to-day changes in their wellbeing before tailoring how they offered support that people needed.

Although people were not all aware of the formal process for making complaints, they were confident that any concerns they needed to raise would be dealt with properly.

People experienced a service that had not been consistently well-led. Changes in management arrangements, both within the provider's management team and within the service, compromised the ability of the service to demonstrate consistent, stable and appropriate leadership. The new arrangements needed time to consolidate to ensure identified improvements were made and sustained, taking into account the views of people using and working in the service.

You can see what action we told the provider to take at the back of the full version of the report.

We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

People living in the home told us that they felt safe. The environment was safe, clean and hygienic. Equipment used at the home was well maintained and had been regularly serviced. There were enough nursing and care staff on duty to meet the needs of the people living at the home.

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living in the service.

There was a proper process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Records, policies and procedures were held and relevant staff had been trained and knew how to submit a DoLS application.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, mobility and equipment needs had been identified in care plans when required. People told us they received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that staff understood the care and support needs of each person. One person told us. “This is a lovely, comfortable home and the staff will do anything to help you. You only have to ask.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that care workers were patient and encouraged people to be as independent as possible. People told us that the staff were often very busy but did not rush them. Our observations confirmed this. A visitor told us. “I am so happy with the care given to my family member. The members of staff are so polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed before people moved into the home and when their needs had changed. A record was held of their preferences, interests and diverse needs. People told us that staff members consulted them and encouraged them to make their own decisions. People had access to a range of planned activities and outings.

Is the service well led?

All of the staff spoken with had a good understanding of the whistleblowing policy. A variety of quality assurance processes were in place to ensure that the standard of care provided to people was monitored and improvements were made. Visitors and staff said they had felt listened to when they had made a suggestion or raised their concerns. People living in the home told us that their views were listened to and they were included in discussions about any planned changes within the home.

We found that care was provided according to people's assessed needs. The provider may wish to note that people’s wishes and preferences were not always recorded. People's nutritional needs were being met, people told us the food was very good and that there was plenty of choice.

During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences. They were knowledgeable about people’s needs and promoted their independence.

Staff were provided with training and support to enable them to care for people living at Swanton House Care Centre.

We spoke with six people using this service who all confirmed they were happy with the level of care and support provided. One person commented: “Staff are very good to us – they help with my medicines and all my personal care”.

During our inspection we were approached by the relatives of a person using the service. They told us that they thought their relative was “…safe…” and that the staff were “…extremely good”. They further commented that whilst their relative had been living at Swanton House Care Centre, they had “…never had a moment of doubt or concern…” about the level of care provided to them.

Our observations of the home demonstrated to us that it was clean, free from any unpleasant odours and that infection control practices were in place. For example, we observed staff wearing disposable gloves and aprons and saw cleaners undertaking their duties.

Staff were provided with training and support to enable them to care for the people living at Swanton House Care Centre appropriately.

People were given support by the provider to make a comment or complaint.

People we spoke with told us that they were happy living in Swanton House Care Centre and that they had lots of things to do.

We saw that people looked content and that the staff treated them with dignity and respect.

Staff with whom we spoke told us that they knew the people living in Swanton House Care Centre well and how to support them.