Swallownest Nursing Home

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 safeguarded from abuse and avoidable harm. People said they felt safe living at Swallownest Nursing Home and were involved in making decisions about their safety. Overall, risks to people were managed well. The provider learned lessons when things had gone wrong and took immediate action to manage risks. We saw evidence of thorough investigations being carried out and of lessons learned and embedded into practice. The provider followed safe recruitment processes and made sure there were enough suitable staff. People were supported to receive their medicines safely. People were protected from the risk of infection, as staff followed safe infection prevention and control practices. The home environment and equipment was kept clean and safe. The provider was working in line with the Mental Capacity Act. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS).

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 their relatives told us they felt incidents and complaints were managed well; investigated, responded to and lessons were learned. One person said, “It is well managed, yes. [Registered manager] is really good.” Relatives said there was a culture of openness. A relative said, “I do think it is well manged now, yes. Communication is great. They had to call an ambulance for [my family member] a while ago and they were straight on the phone to us.”

The registered manager was passionate about promoting a culture of honesty, openness and learning. Staff confirmed this. They told us they were encouraged to raise concerns and were confident they would be listened to and supported. Staff told us meetings and handovers kept them up to date on changes made to the service, such as any lessons learned from incidents, accidents and concerns.

The provider had effective systems and processes to investigate and learn from incidents and concerns. Records showed the registered manager and wider management team analysed incidents, accidents and complaints thoroughly. This helped to identify common themes, patterns and lessons to be learned. Action was taken to address shortfalls and changes made in people’s care, how the service was run or training needs for staff. The registered manager used handovers, meetings, 1 to 1 supervision sessions, and team meetings to share learning with staff. This enabled the team to reflect and share ideas on how to improve the service.

We received positive feedback from people about their experience moving into the home. Relatives confirmed they were involved in this process and felt assured staff gathered relevant information about people prior to them moving in. One relative told us, “We had concerns about putting [my family member] in a care home, but she’s happy here. We can sit back knowing she’s safe.” Another relative said, “[My family member] has a pressure mat by his bed, so staff know when he gets up in the night. As he has limited eyesight, they are quickly there to help him.”

Staff told us that before each person moved into the home, a trained member of the management team undertook an assessment of the person's needs to make sure their needs could be met and they experienced a safe transition into the service. This assessment involved the person and those close to them.

Feedback indicated the service worked well, in partnership with other professionals to assess and address people’s individual needs.

Records showed staff communicated with other professionals and services to make sure people experienced smooth transitions when using or moving between healthcare and other care services. Care was well-organised and monitored daily. When needed, staff referred people to other services, such as GP, community mental health teams, speech and language therapy or social services for additional help. People could use short term care when they needed to. Changes in people’s needs and any new admissions were discussed within the staff team at handovers and meetings to make sure the service kept pace with people’s needs.

Everyone we spoke with told us they felt safe at the service. One person added, “There is a nice atmosphere here. Staff are wonderful”. People knew who to talk to if they did not feel safe. One person said, “The staff are very good, so I know I could talk to them. They are always available to listen.” Most people we spoke with knew the registered manager by name, said they knew her well, and would speak to her if they had any issues. They had confidence in the way the registered manager would respond. For instance, one person said, “I know she would sort it for me.”

Staff received safeguarding training and were familiar with the provider’s policy on safeguarding people. They told us they looked out for signs of possible abuse and neglect and knew how to report this. Staff said if they raised concerns, they were confident the management team would take appropriate action. The staff we spoke with did not share any concerns with us. The registered manager was aware of their responsibilities in safeguarding people and committed to making sure people were protected from abuse. The provider had a clear and effective investigation process along with clear processes for discovering the root causes of problems to identify appropriate solutions. Concerns were reported appropriately, and action taken to protect people from the risk of harm. The management team made sure staff were aware of lessons learned and action taken to reduce the risk of recurrence.

Information about safeguarding people was available in an accessible format and displayed around the home. This helped people and their visitors to know how to report concerns. We saw people were relaxed with staff and felt able to ask for support. There was a calm and pleasant atmosphere and staff treated people with kindness and respect. We saw several positive interactions between people and staff. There was a culture of openness and communication and we saw no evidence that people were fearful.

There were clear and comprehensive policies and procedures in place regarding safeguarding and whistleblowing, to provide staff with guidance. Records showed incidents were investigated and referred to the local authority safeguarding team appropriately and in a timely way. When necessary, the registered manager investigated safeguarding concerns, worked with the local authority and took action to protect people from harm. Some people would be at risk if they did not have continuous supervision. Where this was the case, the provider applied the suitable Deprivation of Liberty Safeguards. These safeguards make sure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. Deprivation of liberty safeguards applications were submitted to the local authority when people’s liberties were restricted to receive necessary care and treatment. This was monitored by the registered manager and reflected in people’s care records.

People told us staff understood their needs, respected their wishes and supported them to keep safe. A person said, “Yes I have a care plan. I also have a personal monthly review, to check my health. I have been here for several years, so [staff] all know me well.”

The members of the management team we spoke with understood the importance of involving people and their families in the risk assessment process. Care and nursing staff were familiar with people’s needs, identified risks and understood how to support people safely.

Staff supported people in line with the guidance in their care plans. For instance, we saw staff monitoring and reminding people to use their walking aids and helping to adjust their footwear to help minimise the risk of falls. Staff supported people with mobility needs to transfer from wheelchairs to comfortable seating in a safe and sensitive way.

Staff assessed all relevant risks to help make sure people were safe and took action to mitigate any risks identified. People had detailed person-centred care plans and risk assessments in place.The service was in the process of moving from paper files to an electronic system. New assessments and plans were being completed by staff who knew people well. The service used monitoring systems, such as sensor alarms. This helped to minimise nighttime disturbance for people, while reducing the risk of accidents and falls.

People and their relatives felt the environment was pleasant and safe. One person said, “My bedroom is safe and homely. I have a call bell that’s nearby.” Another person said, “My room is OK. It is comfortable and I can have my pictures up. I do use a walker and a chair, which staff look after for me.”

Staff told us they received training in all areas of health and safety relevant to their work. They demonstrated awareness of safety procedures and of their responsibilities around maintenance and health and safety in the home.

The environment was safe and well cared for. Care equipment we saw was in good working order. The building was accessible for people with mobility needs and free from clutter. People’s names or items of reference were on people’s doors, which helped people with finding their way around the home. One relative felt there were areas where the decor was becoming a little, "tired." We saw there were plans to address this.

There were systems for monitoring all aspects of maintenance and health and safety, and records were well organised. People had individual personal emergency evacuation plans and fire safety measures were in place. Fire alarm testing was carried out regularly and fire drills recorded appropriately. The provider made sure health and safety and maintenance checks were completed and appropriate monitoring records and safety certificates were available.

Overall, people and their relatives told us there were sufficient staff to keep people safe and they felt staff were competent. Although, One relative said, “I don’t think that there are enough staff here, especially when people phone in ill. I guess that is to be understood though. The staff though, are amazing. They go above and beyond.” One person said, “I do need some help and sometimes I have to wait for staff." They went on to say that this wait wasn't usually for long.

Members of the management team explained staffing levels were based on the dependency levels of people using the service. They felt supported by the provider in ensuring staffing levels were safe. Staff told us they felt there were enough of them to offer appropriate care to people.

We saw staff worked well as a team to make sure tasks were completed, and they interacted with people well. On the day of our visit there were enough staff to safely meet people’s needs and respond to people's requests. Staff were available in communal areas and people did not wait long for their support. Staff did not appear rushed and there was a pleasant, calm atmosphere.

The provider followed safe recruitment practices. This included requesting references from previous employers and checks with the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. The provider had processes to make sure there were enough staff. Staffing levels were monitored by managers and people’s needs were reviewed to establish if staffing levels were sufficient. This helped make sure people's changing needs were considered in deciding the appropriate staff ratio, and there would be safe staffing in the event of an emergency. There were processes in place to make sure staff received the support they needed to deliver safe care, including training, supervision and appraisal. Core training was provided, related to staffs' roles, along with specific training related to the individual needs of people using the service.

People and their relatives told us the home was always clean and staff followed good infection prevention and control practice. One person said, “I love it here. I have no worries anymore. My room is cleaned. They never stop cleaning, so I feel safe and well looked after.” Another person was happy to show us their room, which was clean and homely. They said, “Staff are smashing, they help me with cleaning and keeping it tidy.”

Staff knew how to protect people from the risk of infection. They told us they had training in hand hygiene and the use of personal protective equipment such as gloves and aprons.

The home was clean, and the laundry was managed safely. We saw staff washed their hands and used personal protective equipment when required, and hand sanitiser was available.

The provider had up to date infection prevention and control (IPC) policies and procedures in place. The registered manager completed regular IPC audits and where the need for improvement was identified, there was evidence of prompt action taken.

We received positive feedback regarding medicines management from people and their relatives. People told us they received their medicines safely and at the correct times. For instance, a person told us, “I do take medication, but staff deal with all that. It is all kept electronically on a tablet. I do know what I take and why though.”

Staff told us they received training to manage medicines safely. Training records confirmed this. Staff understood and followed procedures to make sure people’s medicines were correct when changes were made by the GP or hospital and when people moved between services

There were safe arrangements in place for managing people's medicines. Records were in good order, clearly recording when medicines had been administered, or the reason they were not administered. Guidance was available for staff and regular medicine audits were completed by senior staff. We saw medicines were kept safely and were well organised. ‘When required’ and high-risk medicines were managed in a safe way. Staff we saw supporting people with their medicines were aware of and followed safe practice. While we were talking with one person, a staff member came to administer their medicine. This was done politely and with dignity.