Swan House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were supported to receive safe care. Staff understood how to keep people safe, and where people had risks to their safety these were assessed, and plans were in place to minimise the risks. Staff were available to support people and had the skills and training to do this safely. The environment was well maintained, and staff followed procedures for minimising the risk of cross infection. People had their medicines as prescribed and where incidents happened a learning approach was taken to prevent any reoccurrence.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives confirmed they had not experienced any incidents whilst living at the home. One relative told us, they felt any incidents would be managed safely and they would be informed.

Staff described how incidents were managed, including how they were recorded and reported. Staff gave examples of learning from incidents and how this was applied to prevent them from happening again. For example, changes had been made to a medicines stock ordering system following an incident with the electronic medicines ordering and stock control system. The registered manager described the systems in place to ensure all incidents were reviewed and any learning was shared with staff. They also described the systems in place to ensure the duty of candour requirements were met.

Daily meetings with staff were used to discuss any incidents which had occurred and to ensure action was taken to make changes to peoples care plans and risk assessments. Incident analysis was completed to find the cause of incidents and make changes to prevent reoccurrence. This meant staff were continuously learning when things went wrong and adjustments were made to the service people received.

People did not share any particular views with us about how transitions were managed. One person's relative described the admission process to the home from hospital for their relative as a positive experience. The relative said, "We were fully involved from the start, it was the best decision we made, [person's name] are still here and we are still satisfied 2 years on."

The registered manager described the processes to ensure safe transitions between services. This included having an admissions policy and ensuring all care plans were updated for example when people returned from short hospital admissions. Staff described having access to all the information needed when people came into the service. One staff member told us, "We get information on discharge and cross reference this with the medicines information and with medical history from the GP. Any new information is added straight to the persons care plan."

The provider worked in partnership with other health professionals. Partners told us the provider worked with other professionals to ensure people were safe. For example, they had worked with a dietician to support people at risk of malnutrition to manage their dietary intake and ensured people with presenting health needs were reviewed by an appropriate clinician.

The provider had an admissions policy in place to ensure safe transfers into the home. The policy set out the homes referral process, preadmission assessment process, visits and trials ahead of admission. The policy was supported by an admission pathway which gave detailed instructions to staff on what needed to be in place to manage a safe admission and included an audit to conduct 72 hours after the admission to check everything was in place.

People expressed feeling safe with the staff and living at the service. One person said, "I am safe, there are people all around, you only need to ask for anything, at home I was alone." Another person told us, "‘I can talk to the staff, I trust them and they have not let me down."

Staff understood how to recognise the signs of abuse and could describe the actions they would take to report any incidents. Staff were aware of how to safeguard adults from abuse. Staff had knowledge of the whistleblowing policy at the home and were confident any concerns raised would be managed. The registered manager had systems in place to ensure any concerns were reported to the appropriate body.

We did not observe any concerns during the inspection which required safeguarding action to be taken.

All incidents were logged and investigations were carried out as required, outcomes from these investigations and any learning were shared with staff. The whistleblowing policy in place referenced links to best practice, regulations and gave staff the freedom to speak up by fostering a culture where people felt able to raise concerns and know their voice would be heard.

People and their relatives told us staff supported them to manage risks to their safety. One person said, "I have support with transferring to my chair using the hoist, the staff give me confidence that I am safe." Another person told us, "I use a walking frame, the staff always make sure I have it with me."

Staff described how they supported people to manage risks to their safety. Staff told us about risk assessments which were in place and the guidance in people's care plans which helped them support people to manage risks. One staff member told us, "[Person's name] has to be repositioned every 4 hours to manage risks to their skin integrity." Staff told us about how they monitored people to ensure they were safe. For example, using sensors to alert them when people mobilised as part of preventing people from falling.

We saw staff supported people in line with their care plans. This included support with their mobility needs and the use of equipment to help with transfers from chairs to wheelchairs.

The risk assessments and management plans were completed in an electronic system. The outcomes from the risk assessments informed peoples overall care plans and there was guidance in place for staff to understand how people should be supported. For example, where people were at high risk of falls there were plans in place which set out how staff could reduce the risks. Where people were known to have risks relating to distressed behaviours these were documented in a plan. However, there was no incident monitoring in place for these incidents and staff did not record these in separate charts. Following the site visit the provider confirmed this would be actioned.

People and their relatives were happy with the environment and felt the home was well maintained and safe. One relative told us, "The set up here is great the light and airiness of the building works well."

Staff described the checks they completed to ensure the environment and equipment were well maintained. One staff member told us, "There was a call bell not working earlier in the week. It was picked up by our checks and repaired. Sensors are all working fine." The registered manager told us about the refurbishment plans for bedrooms and the purchasing new furniture. They described the checks in place to ensure the environment and equipment were well maintained.

The home was well maintained and kept clean. We saw checks were being carried out on equipment and cleaning was undertaken. For example, we saw hoists being cleaned in between use.

The provider had a range of effective systems to ensure the home was in a good state of repair. There were regular checks on equipment and the environment which ensured any issues were identified and actioned to keep people safe.

People received support from staff when they needed it. One person told us, "There are plenty of staff around when I need them." Relatives described staffing levels as good and people had support from staff who understood their needs well and how to meet them. One relative told us, "I visit at all sorts of irregular hours and there are always enough staff on duty, I think they are well trained and knowledgeable, they know [person's name] really well."

Staff and the registered manager described safe recruitment, supervision and induction systems. Staff confirmed they had regular training updates and were supported through regular supervisions and meetings with the management team. Staff felt there were enough staff on duty to support people safely. The registered manager described using a dependency tool to ensure enough staff were on duty to support people.

We saw staff were available to support people. Staff were observed spending time reading to people, chatting and supporting them with their care needs including mobility, nutrition and hydration needs.

A dependency tool was used to identify how many hours of support people needed based on their individual needs. The registered manger was staffing the home above the tools recommended levels at the time of the assessment. A recruitment policy was in place which ensured staff were safely recruited and an induction process ensured staff understood their role and remit and regular updates to staff training were in place. Staff had access to support through supervisions and regular meetings and updates.

People and their relatives described the home as clean and well maintained and reported staff used PPE and washed their hands.

The registered manager told us they carried out visual checks daily on how staff used their PPE and washed their hands. Staff told us there access to PPE all over the building and confirmed they received training and checks on their infection prevention practice.

Our observations confirmed what people and staff told us about infection prevention and control practice.

Effective systems, such as audits and an infection prevention and control policy ensured the risk of preventable infection was reduced.

People and relatives received support to take their prescribed medicines. One person told us, "The staff give me my tablets, I have 23 a day, im diabetic and I also have tablets for high blood pressure, I trust them to give the tablets to me as I need them."

Staff described how the medicines administration system enabled them to control stock and ensure medicines were administered in line with the prescribed instructions. The registered manager told us staff administering medicines had received training and had competency assessments completed. They described how medicines checks were in place using the electronic system and medicines audits were carried out to ensure medicines were administered safely.

Effective systems were in place to ensure staff administered medicines safely. There was guidance in place for staff including how to administer medicines on an as required basis. Systems ensured stock levels were managed safely and records were completed when people received their medicines.