Swansea Terrace

Updated 6 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by an inspector, a pharmacy inspector, a nurse specialist advisor and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One Expert spoke with people on site and their visitors and another made calls to relatives.

Swansea Terrace is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Swansea Terrace is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. There was a manager in post who had applied to register. However they were off at the time of inspection and therefore, there was an interim manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We received feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed the the care records of 14 people and multiple medicine records. We spoke with 14 people who lived in the home and the relatives of 12 people. We spoke with three senior managers, the interim manager and 12 staff including; nurses, care staff, housekeeping staff and the office administrator. We looked at a range of maintenance and premises safety records including fire risk assessments and safety equipment checks. We observed lunch on 2 days and looked around the building including some bedrooms.

Updated 6 March 2024

About the service

Swansea Terrace provides accommodation and personal care, including nursing care for up to 44 people in single bedrooms with partial ensuite facilities. Rooms are on the ground and first floor. There are two lifts and stairs for access. Communal areas are on the ground floor. There was a paved area at the rear with some seating for people to access. At the time of inspection there were 36 people in the home,

People's experience of using this service and what we found

People had not always received safe care because assessed risks had not been consistently managed. Alerts on the care records system which indicated people had missed support with repositioning or had not had enough to drink, had not been responded to in all of the cases we reviewed.

People had not received their medicines safely. Diabetes care was inconsistent and not enough information was available to guide staff to recognise increased risks related to blood sugar levels. Medicine stocks were not properly monitored which meant some people did not always have enough. Oversight of medicine records had not been safely maintained by managers.

People had not been supported to drink enough. Everyone assessed as needing support to drink had missed their fluid targets. Some people felt they did not get enough of the right foods in relation to their dietary wishes. We observed people enjoyed the food they were served at lunch times.

People were supported by staff who had been safely recruited. The provider followed a system to assess how many staff were needed to maintain people's care safely, however, we found staff were not able to meet all of people's needs.

People's needs had been assessed using an electronic system. Staff accessed care records on handsets. Some assessments and care plans did not contain enough information to guide staff.

People's health needs had been assessed, however we found some records had not always been updated. People had access to health screening, including a visiting optician.

People did not receive consistent high-quality person-centred care because managers had not ensured there was enough oversight of the quality of care and care records. Recent changes to the management structure in the home had impacted on this. The provider and interim manager were committed to working with partners and following their own action plan to achieve the necessary improvements.

People and their relatives had mixed views about how well the home was managed. The home's regular staff were praised as being knowledgeable and caring. People's relatives did not feel they had been asked for their feedback recently however, this was an area the provider had already identified as needing to be addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

The inspection was prompted in part due to concerns received about the availability of registered nurses on each shift, the quality of clinical care in relation to; safe medicine administration, wound care and access to community health services. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The provider had already begun responding to some of these concerns and had developed their own action plan.

The overall rating for the service has changed from good to requires improvement, based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to; the management of risks, safe management of medicines, supporting people to eat and drink enough, management oversight and governance. We have made a recommendation about care assessments and planning.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.