This inspection took place on 23 and 25 February 2016 and was unannounced. The Swallows is a residential care home for older people which provides accommodation and support for up to 19 people, some of whom have dementia. At the time of the inspection there were 19 people living at The Swallows. There was 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 were placed at significant risk of harm as the provider did not take reasonable steps in relation to fire safety management. The service did not have fire risk assessments, Personal Emergency Evacuation Plans (PEEPs), fire safety audits or functioning fire escapes in place. The service did not have enough staff to meet people’s needs at night. The service did not have sufficient staffing at night to ensure people could be evacuated from the building safely in the event of an emergency. People were at risk of harm as the provider did not have adequate audit systems in place to monitor the safety of the premises and equipment. Records showed electrical hardwiring checks, portable appliance testing [PAT] and legionella water tests were out of date.
People had their liberty restricted without authorisation. Staff had inadequate knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These aim to make sure that people in care homes, hospitals, and supported living services, are looked after in a way that does not deprive them of their liberty and ensures that people are supported to make decisions relating to the care they receive.
People were not always protected against the risk of harm and abuse. Staff were not always clear on the correct procedure in reporting alleged abuse. Staff were unclear of the provider’s whistleblowing procedure. The service did not have an ‘easy read’ complaints procedure in place to support people who found written documentation difficult to understand. People received their medicines in line with their prescriptions. However, the service demonstrated unsafe medicine management in relation to the storage and disposal of medicines.
People were protected against known risks, such as the risk of falling. The service had in place risk assessments which identified known risks and provided staff with guidance on how to mitigate these risks.
People’s consent to care and treatment was sought before care was delivered. Staff were aware of the importance of ensuring consent was obtained prior to giving care. Staff were respectful when consent was not given. Care plans were person centred and detailed people’s likes, dislikes, preferences, history and health care needs. People had access to health care professionals to maintain their health and wellbeing. Records showed people received support and guidance from staff that followed health care professionals’ advice. People’s privacy and dignity was promoted. Staff were aware of the importance of maintaining people’s privacy and dignity at all times.
People were given sufficient amounts to eat and drink throughout the day. The chef provided people with nutritious food that met their nutritional needs. People were able to request additional food that was not available on the menu.
We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.