19 July 2023
During an inspection looking at part of 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.