Archived: Swiss Cottage

Swiss Cottage is a residential care home without nursing situated within a detached residential property on the outskirts of Basingstoke town centre. Swiss Cottage specialises in providing short to mid-term support to enable people to regain and maintain their independence before moving to more independent living accommodation.

Swiss Cottage is comprised of two floors containing individual bedrooms with communal areas including bath and shower rooms, toilets, two kitchens, a dining room and two living room areas. Outside is a large fully enclosed garden with fish pond and greenhouse as well as a large car parking area to the front of the service.

People who receive this care service live with long term enduring mental health conditions including paranoid schizophrenia and psychosis.

At the time of the inspection the service was providing personal care to six people. Care was available and provided by rehabilitation recovery workers who will be referred to as staff throughout this report.

Swiss Cottage has a 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.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people.

People's safety was promoted because risks that may cause them harm had been identified and managed safely. Appropriate behaviour and medical condition related risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely. There were sufficient numbers of staff employed to ensure that people's individual needs were met.

Contingency plans were in place, known by staff and evidenced in their practice to ensure the safe delivery of care in the event of adverse situations such as a fire, flood or power loss at the home. The registered manager was also qualified to be deployed to deliver care if staff were ill and unable to work.

People were protected from unsafe administration of their medicines because staff were trained effectively and had the competency to do so regularly assessed.

Staff had completed mandatory training to ensure they could prompt people to take their medicines where required and where they administered people's medicines this was carried out safely. People were encouraged to take steps to eventually enable them to self-medicate and become more independent. Where people did self-medicate processes were in place to ensure this was risk assessed appropriately. Staff skills in medicines administration were reviewed on a regular basis by the registered manager to ensure they remained competent.

People were supported by staff to make their own decisions. Staff were knowledgeable about the actions to take to ensure they met the requirements of the Mental Capacity Act (MCA) 2005. The registered manager and staff identified and evidenced they would work with health care professionals when required to assess people's capacity to make specific decisions for themselves.

Staff sought people's consent before delivering their care and support.

People were supported to eat and drink enough to maintain a balanced diet. People were encouraged to participate in identifying their menu choices, purchase the appropriate items and then prepare with support. A cooking club was created in the home to support people in preparing and cooking healthy and nutritious meals.

People's health needs were met to maintain their safety and welfare. Staff and the registered manager promptly engaged with other healthcare agencies and professionals to ensure people's identified health care needs were met.

Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the support provided. The registered manager and staff were able to identify and discuss the importance of maintaining people's respect and privacy at all times. People were encouraged and supported by staff to make choices about their care including how and what care they required.

People had support plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide support in a manner that respected each person's individual requirements and promoted treating people with dignity. People were encouraged to be involved in preparing their support plan and these were subject to regular reviews and when people’s support needs changed.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People and staff were encouraged to provide feedback on the quality of the service during regular support plan reviews and quality assurance questionnaires.

The provider's values included the right for people to: experience individual-centred care; be treated compassionately; work together with staff to ensure their wellbeing and; be supported with the planning of their future. Staff were knowledgeable about how they were expected to deliver care and staff demonstrated these principles. People told us these standards were evidenced in the way that care was delivered.

The registered manager and staff promoted a positive culture which focused on providing individual person centred care. People were encouraged to raise concerns with staff and the registered manager if required.

The registered manager provided positive leadership which instilled confidence in staff and people using the service. The registered manager had informed the CQC of notifiable incidents which occurred at the service, allowing the CQC to monitor that appropriate action was taken to keep people safe.

People and staff told us the service had a confident registered manager. Staff told us they felt supported by their colleagues, senior staff and the registered manager.

The provider carried out regular quality monitoring to assess the quality of the service being delivered.

On the day of the inspection three people were living in Swiss Cottage. One of the people who use the service was in hospital recovering from a recent operation. We spoke with three people and were also able to find out about people's experience of the service by observing care and talking with relatives and staff. On the day of our inspection the registered manager was temporarily unavailable so we spoke with the person managing the service in their absence, three care workers and a relative. We also spoke with people's care managers and a community project manager on the phone.

This is a summary of what we found;

Is the service safe?

People told us they felt safe because the staff treated them as individuals and respected Swiss Cottage was their home. One person said, 'I know sometimes I can be grumpy and a real pain but the staff always know how to calm me down and keep me safe.'

We found the service was safe because people's needs had been assessed and these were constantly reviewed. This meant people experienced effective, safe and appropriate care that met their needs.

The service had reduced the risk of people receiving unsafe or inappropriate care by ensuring care was planned and delivered to keep people safe in line with professional guidelines. For example, one person had been identified to be at risk of falling. We found the person had received additional support to prevent or reduce the risk of falls, which had been reviewed and assessed by local health professionals.

People were safe because the provider responded appropriately to any allegation of abuse. During 2014 two safeguarding issues had been reported to the Care Quality Commission and local authority, using the correct notification process. We looked at these and found that they had been recorded and investigated appropriately in accordance with best practice.

The provider ensured people had safe and personalised care, with staff who quickly recognised when people became seriously ill and required treatment. For example, staff realised a person was unwell and in pain due to their behaviour. We found they immediately arranged for the person to be examined by relevant health professionals.

The provider had an effective process to manage medicines safely. During our inspection we observed two care workers administer medicines appropriately, in the way people preferred, in accordance with their medication plan.

People were protected from the risk of inappropriate or unsafe care because the provider had an effective system to identify, assess and manage risks to their health, safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the service had been meeting the requirements of the DoLS and that relevant staff had been trained to understand when an application should be made, and how to submit one. Whilst no applications had been submitted, the manager was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.

Is the service effective?

Where people needed support with more complex health needs we saw there were specific health care plans which detailed the care people needed and how staff should provide this. We found that staff had received appropriate training in relation to meeting people's mental health and complex needs, which had ensured that people's needs had been met effectively.

We found that staff clearly understood people's mental health needs and positive behaviour support plans, which allowed them to effectively support people with behaviour which may challenge.

Is the service caring?

People were supported by kind and compassionate staff, who spoke with people in a caring manner. We saw that care workers gave encouragement to support people who were able to do things at their own pace.

We found that staff had visited one person who had been admitted to hospital for urgent surgery. We noted that other people who use the service had also visited 'their friend' in hospital and taken them some gifts.

Is the service responsive?

Staff knew people's needs and behaviour. This allowed them to respond quickly during a hospital visit when they identified concerns that a person from the service had developed an infection. Immediate intervention by hospital staff based on the concerns raised by the service ensured the infection was identified and treated appropriately.

The service had a complaints system which was readily accessible to people. This ensured staff listened to people's concerns and responded to them.

Is the service well-led?

The service had a registered manager, although they were temporarily absent. However, the provider had sent the appropriate notification identifying the person managing the service in their absence.

The service was well-led. We found that the service communicated effectively and worked in cooperation with other agencies. This was demonstrated when the provider worked with a GP, the ambulance and police service and local hospital admissions team to ensure a person was transferred between services quickly and safely to receive urgent treatment.

The provider had made plans in advance for foreseeable emergencies. During a recent power failure the person managing the service organised a night time evacuation of people to another home in the provider's care group. We noted how they also arranged a return to normality at the earliest opportunity and secured the necessary learning points from the incident.

We spoke with three people who lived in the home. They were all complimentary about the staff and service provided. One person said 'Living here is great. I couldn't have found a better place'.

People were protected from the risk of abuse because the staff were aware of the different types of abuse and how to report a concern. People we spoke with told us that they felt safe living in the home.

Staff recruitment followed appropriate processes. We looked at two staff records and found appropriate checks were undertaken before they started work.

The provider had an effective system to assess and monitor the quality of service. People were asked for their views and the provider acted upon these, where appropriate.

People were involved in the planning of their support and their consent was obtained before support began. Care plans were detailed and staff knew what support each person required. Staff addressed the people by their preferred name and treated them with dignity and respect. One person we spoke with said 'I have been in and out of these places for 42 years and this is the best place I have lived'. They told us that they got the support they required and could talk to staff about changing things. They also said 'we get consulted quite a bit about what goes on'.

The people living in Swiss Cottage were responsible for the cleaning of the house and cooking of the evening meal. They were supported by staff to do this. The house was clean and tidy and the menu varied with options provided.

Staff received appropriate training and support. They told us that they felt that the team was good and worked well together.

The complaints procedure had been explained to everyone living at Swiss Cottage. No complaints had been made but the person we spoke with said they knew how to complain and was confident it would get sorted out. Their comments on the service had been listened to and changes had been made.