The inspection took place on 12 January, 2017 and was unannounced. The home was previously inspected in August 2015 when two breeches of legal requirement were identified. The provider sent us an action plan outlining how they would meet this breech. You can read the report from our last inspection, by selecting the 'all reports' link for ‘Swinton Grange’ on our website at www.cqc.org.uk.

Swinton Grange is situated in Swinton, South Yorkshire. The home provides accommodation for people who require nursing or personal care. The service is provided by Hermes Care Ltd. It can accommodate up to 27 people who were living with dementia. The home has bedrooms on three floors of the building. At the time of our inspection there were 26 people using the service.

The service had a registered manager in post at the time of 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.

Throughout our inspection we observed staff interacting with people who used the service and found there were enough staff on duty to meet people’s needs. Staff responded to people in a calm, unhurried manner and kept people safe.

The provider had a policy and procedure in place to ensure that people received their medicines in a safe way. We saw risks associated with people’s care had been identified and risk assessments had been put in place to help reduce the risk from occurring. However we raised one issue with the registered manager and this was resolved without delay.

We looked at four recruitment files and found the provider had a safe and effective system in place for employing new staff. The four files we looked at contained pre-employment checks and they were obtained prior to new staff commencing employment.

Staff were knowledgeable about protecting people from the risk of harm and knew what action to take if someone was at risk of abuse.

We looked at records in relation to training and found appropriate training was provided to maintain the skills of the staff team. Staff found the training provided was interesting and informative. The staff we spoke with confirmed that they received training on a regular basis.

People received a balanced diet based on their individual needs and choice. Drinks and snacks were offered throughout the day.

The provider was meeting the requirements of the Mental Capacity Act. Best interest decision meetings were held and were appropriate.

People had access to healthcare professionals as required and staff took advice from them. Care plan documentation was amended so that the correct care was given to people. This showed that guidance from professionals had been sort and acted upon.

We observed staff interacting with people and we found they were kind and caring in their approach. Interactions were person centred and focused on individual people. Staff ensured that people’s privacy and dignity were maintained.

We looked at records belonging to people and found they were detailed and explained how people needed supporting. We saw an assessment of needs had been completed prior to people moving in to the home.

We saw activities took place and people joined in and enjoyed them. The service employed two activity co-ordinators to ensure social stimulation was provided over seven days a week.

The service had a complaints procedure and people felt able to raise concerns with the registered manager.

We spoke with relatives of people who used the service, and they felt the registered manager was approachable, friendly and would address any concerns without delay.

We saw that audits had been completed to ensure the service was providing appropriate care and support. We also saw that actions were addressed and resolved.

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Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations, speaking with people who used the service, speaking with staff supporting them and looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People were cared for in a clean and hygienic environment. We carried out a visual inspection of the premises and found that the service was clean.

We spoke with some relatives of people who used the service and they felt able to raise any concerns with the staff or the manager. They were confident that they would resolve any issues.

We observed staff and saw they respected people and offered choices suitable to their needs.

The provider had systems in place to ensure the service was safely run. Audits were carried out by the registered manager.

Is the service effective?

People’s health and care needs were assessed and care plans were designed to meet the needs of people who used the service. Relatives of people who used the service told us that they felt involved in their relatives care, and were able to contribute to their care plan.

Each person had a named nurse who was responsible for their care. They ensured the care plans were still relevant to meet people’s needs.

Is the service caring?

We observed staff interacting with people who used the service and saw that they were patient and gave time for people to respond. Care plans included people’s interests, likes and dislikes. This ensured that people’s preferences were considered as part of their care.

We spoke with relatives of people who used the service who told us that they felt their relative was cared for appropriately. One relative said, “The staff are very caring and considerate, I know my relative is well cared for.” Another person said, “It’s great here, staff are caring, I can’t fault it.”

Is the service responsive?

The service had an activity co-ordinator who planned social events and daily activities for people who used the service. Activities were based on people’s likes and interests. We saw that families had been involved in creating a ‘My life story’ document. Staff found this document useful when caring for the person.

We spoke with relatives of people who used the service who were able to discuss anything with the manager or the staff. One relative said, “The managers door is always open and she always makes time for me.”

Is the service well-led?

We spoke with staff who were clear about their roles and responsibilities. They felt able to speak with the nurses or the manager if they needed to. Staff saw the importance of involving people and their relatives to improve the service.

There was a quality assurance system in place which was completed on an annual basis. The registered manager acted on suggestions made and discussed the outcome of the survey with people who used the service and their relatives.

We were unable to ask the views of people resident in the home because of the level of their dementia. However, we did speak with five relatives of people who used the services. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed the dining room when people were having their lunch. We saw staff including people in their conversations even if they were not able to respond fully. We saw that people were given choices and that their choice was respected.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent. We spoke with five relatives and they told us that people were always given a choice.

People who used the service had a care plan which was relevant to their individual needs. We spoke with five relatives who spoke positively about the care their relative received. One relative said, “I have confidence that the staff meet my relative’s needs.” Another relative said, “I can’t fault the care here it is marvellous.”

People were supported to be able to eat and drink sufficient amounts to meet their needs.

We found that the provider had appropriate arrangements in place to manage medicines. Staff were knowledgeable about the system. We found that medication was administered by a qualified nurse.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.

We found there was an effective complaints system in place. People knew how to complain and felt their concern would be resolved.

We spoke to a relative of one of the people who used the service.

They said that people were treated with dignity and respect. They also said they were satisfied with the care people received and felt they were safe from abuse.

They said that staff were well trained and knew what they were doing.

They also said that when they bring issues to the attention of the home they are dealt with quickly and appropriately.

The inspection took place on 11 and 17 August 2015 and was unannounced on the first day. Our last scheduled inspection at this service took place in April 2014 when no breaches of legal requirements were identified.

Swinton Grange is situated in Swinton, South Yorkshire. The home provides accommodation for people who require nursing or personal care. The service is provided by Hermes Care Ltd. It can accommodate up to 27 people who are living with dementia. The home has bedrooms on three floors of the building.

The service had a registered manager in post at the time of 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.

We looked at the storage of medicines and found some items were not stored correctly. Temperatures were not taken of the room which stored the medicine trolley. This was a breach of regulation. You can see what action we told the provider to take at the back of the full version of this report.

We saw a protocol was in place for medicines which were prescribed on an ‘as required’ basis. We saw that people who required this type of medication had a care plan explaining why this had been prescribed and when to administer it.

The service had procedures in place to safeguard people from abuse. Staff were knowledgeable about how to recognise and report abuse.

Care and support was planned and delivered in a way that ensured people were safe. We saw support plans included areas of risk. However one person’s care plan did not contain relevant information. This meant their safety could be compromised.

We saw there were enough staff with the right skills, knowledge and experience to meet people’s needs.

The service had robust arrangements in place for recruiting staff. Pre-employment checks were carried out prior to a person starting work with the company.

We looked at files belonging to three staff and found training certificates were in place. The registered manager showed us a training matrix which indicated what training had been completed and what was required.

Staff had an awareness of the Mental Capacity Act 2005 and had received training in this area. Staff were clear that when people had the mental capacity to make their own decisions, this would be respected.

People who used the service were supported to have sufficient to eat and drink and to maintain a balanced diet.

We observed staff interacting with people. It was clear that staff knew people well and they offered and respected people’s choices and preferences. The home had a very homely atmosphere and people appeared comfortable with staff.

Care plans included areas of support such as personal care, communication, eating and drinking, and consent. Care plans were regularly reviewed to ensure they were applicable to the person’s needs.

The service had a complaints procedure and people knew how to raise concerns.

The registered manager was supported by a team of nurses, one being the deputy manager. One nurse was on duty at all times, they managed the shift and supported the staff group and people who used the service.

We saw various audits had taken place to make sure policies and procedures were being followed. However, actions were not always clearly identified and recorded. The audit only gave space for yes or no answers.

There was evidence that people were consulted about the service provided.