Stonebridge Nursing Home

We found the following examples of good practice.

¿ Staff had access to and wore full personal protective equipment (PPE) at all times. This ensured people were protected as much as possible from the risk of infection.

¿ Additional domestic staff had been employed to enhance cleaning schedules to help control the spread of the Covid 19 virus.

¿ The home had taken steps to limit the spread of COVID 19 by effective zoning and using separate staffing groups to support people who had tested positive.

¿ Regular Covid 19 testing of staff and residents was taking place and staff had received appropriate infection control and prevention training.

¿ There were procedures, policies and risk assessments in place. The management team worked closely with a range of external health and social care professionals to minimise the risks Covid 19.

¿ People were supported to maintain contact with their friends and relatives through video calls, increased phone calls. The provider had maintained contact through frequent newsletters, sending videos and photographs to families.

Stonebridge Nursing Home is a residential care home providing personal and nursing care for up to 52 people aged 18 and over. At the time of the inspection 47 people were using the service. The home has four wings, each with its own lounge and outside gardens, with bedrooms on two floors. Three wings provide care for people living with advanced dementia and one wings specialises in providing care to people living with long term mental health conditions. There is a separate building for staff training and administration.

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

People were at the heart of the service. The provider's philosophy, vision and values of person-centred care were understood and shared across the staff team. People were supported to maintain their purpose and pleasure in life.

People received care which was highly responsive to their individual needs. Staff had an excellent understanding of people and ensured this was used to provide exceptional individualised care which took account of people’s life histories

The provider and staff team were passionate about providing high quality care tailored to people's individual needs and preferences. Staff invested time to understand the experiences of people who lived at the home.

People told us they had formed excellent relationships with the provider, staff team and other people who lived at the home, built on trust and respect. People contributed to the running of the home because their ideas and choices were acted on.

People were supported to maintain relationships with people important to them. Visitors were welcomed at the home, without restriction and were encouraged to be actively involved in people's lives.

People, relatives and staff agreed the service was extremely well managed and was an exceptionally caring home. Everyone consistently praised the skills of the management team and emphasised they were motivated to provide an exceptional service.

The provider ensured care was based upon good practice guidance. Exceptionally good governance was embedded into the provider and registered manager’s processes. This ensured people received a highly effective service which put them at the heart of their care.

The home had a vibrant and welcoming atmosphere where visitors were welcomed and encouraged. There were processes to monitor the quality and safety of the service provided and actions were taken to drive continuous improvement for the benefit of the people who lived there.

The staff provided a flexible care approach and people were empowered to decide how and when their care was provided. People, relatives and health professionals told us the care provided was effective and people experienced positive outcomes. People and relatives told us staff were empathetic and gave compassionate care.

Staff understood their responsibility to safeguard people from harm and had a good understanding reporting concerns both within and outside the home. Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks.

Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence. Staff had a good knowledge of how to support people at these times.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Skilled staff were available at the times people wanted to receive support, in all aspects of their lives. Staff had received training, so people's specific care and support needs were understood and met. We saw training was put into practice. Staff told us the provider proactively ensured they had many opportunities to further develop their skills and knowledge. Staff felt supported and valued by the provider and they prided themselves on providing high quality care.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. The provider and staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was promoted and maintained.

Wherever possible staff supported people to retain responsibility for their own health. Medicines were managed so that people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (12 May 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stonebridge Nursing home is registered to provide accommodation and personal and nursing care for adults who have a dementia and or mental health related illness for a maximum of 52 people. There were 45 people living at home on the day of the inspection. There were four separate communal lounges, each tailored to people’s mental health and/or dementia related needs.

There was a registered manager in place. 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 supported by care and nursing staff to be safe and protected from the risk of abuse. All staff knew each person which helped them to understand and reduced their risk of harm or abuse. Staff consistently helped people with any anxiety or distress immediately and provided reassurance and guidance to support until settled. Staff told us that helping people to live in a calm and relaxed environment reduced the risk of abuse to people living at the home. All staff felt confident in recognised the potential signs of abuse and would report these through the senior staff or management at the home. Where needed the team took steps to prevent further harm and make referral to external agencies as required .

People had care staff that were available on a one to one basis where required and there were sufficient numbers of staff to provide care to all people living at the home without the use of agency staff. Where people had risks identified as part of their daily living staff supported them to reduce those risks. People told us they received their medicines as prescribed and at the correct time. All relatives we spoke with told us there were enough staff to support their relative and did not have to wait for care to be provided.

People were cared for by staff the who told us their training reflected the needs of people who lived at the home. We saw that all staff provided care and support to people in a confident and caring way. Nursing staff had recently discussed how they were recording and evidencing their clinical supervision to maintain their professional registrations, which help to ensure people were receiving the most appropriate care. They told us they wanted to show how their professional discussion prompted a high standard of care and supported to people who lived at the home.

Where people had not been able to consent to certain aspects or decisions about their care records of decisions had been completed. The provider was currently reviewing all care and support records to ensure any changes in people’s capacity and consent to ensure that they made decisions in the person’s best interests.

People had access to snacks and meals throughout the day and night. Where people required support to eat and drink care staff helped them. People had accessed other healthcare professionals to support them and had regular visits from their GP.

Staff developed positive, respectful relationships with people and were very kind and caring in their approach. People’s privacy and dignity was respected and they were supported and empowered to be as independent as possible in all aspects of their lives. Staff anticipated people’s care needs and attended to people quickly in a gentle and unhurried way.

People were involved in the planning of their care and the registered manager ensured that all people were able to be involved. All relatives we spoke with felt they were involved in their family members care and their view and opinions mattered. People’s care plans recorded their care needs in an individual way that reflected their preferences and life histories.

People were happy to raise any concerns or worries directly with the staff who were able to provide solutions or answers at that time. All relatives we spoke with knew how to make a complaint if needed. The provider had a complaints process which had been followed when a complaint was received. The registered manger was keen to answer people’s concerns as they happened and the provider had reviewed and responded to all concerns raised.

The service acted on people’s views and regularly consulted with them about how to improve. People experiences of living at the home were important and valued by a

caring leadership team which promoted an open culture. People were seen to approach and make requests through the day with all staff, including the registered manager and provider. The management team felt it was important that they were approachable and visible within the home which helped them monitor and maintain a home which people and relatives liked. The management supported and listened to staff at all levels to improve the quality of service and acted on them about how to improve.

During the day we were able to speak with two people who lived at the home and six family members. We also received seven comment cards where people gave their views about the care and treatment that people received. One person commented: 'I feel this home offers good quality care and residents are respected and I feel that their needs are met.'

We also spent time observing the care and treatment people received. We looked at six people's care records, and spoke with three members of staff which included the director of nursing and the registered manager.

Before people came to live at the home their needs were assessed in their own homes, hospitals and other community services. This meant that people only came to live at the home if all their needs could be effectively and safely met.

People and their family members told us that they were happy living at the home and they felt staff understood their needs. One person described life at the home: 'Everything is very nice' and a family member said that they were: 'Very impressed with staff, they are kind and caring.'

People were involved as much as possible in decisions about their care and treatment. Staff made appropriate referrals to other professionals and services in the community. We saw that staff understood people's care and support needs were kind and caring and thoughtful towards them and treated people with respect. One staff member told us: 'It is all about the residents.'

We saw that the provider had effective systems in place that made sure staff training was planned and delivered. This included person centred dementia care training.

The provider had responsive systems in place to monitor and review people's experiences and complaints to ensure improvements were made where necessary. The director of nursing commented: 'While our home is far from perfect, it is honest in its self-assessments and utterly committed to providing meaningful, loving care.'

We observed that staff treated people as individuals. There were positive interactions between staff and people with lots of laughter and smiling and clear friendships were established. It was clear from what we saw that staff knew people's needs and provided care and support in a gentle way when people's behaviour needed to be supported.

People's representatives told us positive things about the care and support people received whilst living at the home. They told us that they felt involved in any decisions that needed to be made and these were done with their relation's best interests at heart. One representative told us, 'They (staff) are always there for you' and involved them in the planning and delivery of care to meet the person's needs.

Staff had been recruited in an appropriate way and checks had been undertaken to ensure that they were suitable to care for vulnerable people. Staff understood the needs of people living with dementia and mental health needs.

We saw that people and their representatives had access to a complaints procedure and their concerns had been listened to. People's representatives told us that they would feel comfortable raising any concerns.