We undertook an inspection of Three Bridges on 13th and 14th May 2014. During our two day inspection we spoke with the regional manager, acting manager, deputy manager, seven staff, four relatives, two social workers and eight people who used the service. We also encouraged other people using the service to participate in our visit using their preferred methods of communication.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
Policies and procedures had been developed by the registered provider (Warrington Community Living) to provide guidance for staff on how to safeguard the care and welfare of the people using the service.
The acting manager and staff spoken with demonstrated awareness of the Mental Capacity Act and the circumstances when it was necessary to apply for authorisation to deprive a person of their liberty and to ensure the correct safeguards were in place.
Likewise, staff spoken with also demonstrated a sound awareness of the different types of abuse and the action that should be taken in response to suspicion or evidence of abuse.
A safeguarding log was in place. This highlighted that there had been seven safeguarding referrals since January 2014. Safeguarding records prior to January 2014 could not be located to provide an overview of incidents and action taken. A compliance action has been set against Regulation 20 of the Health and Social Care Act 2008 in regard to missing records and the provider must tell us how they plan to improve.
Examination of the training matrix for the service together with the training statistics summary record highlighted a number of gaps in training across a range of subject areas for newly appointed and some existing staff.
We noted that a new e-learning system was being set up for mandatory training. Likewise, a range of training courses had been booked by the provider for staff to nominate themselves to attend. Systems were also in place to monitor the outstanding learning needs of staff and when refresher training was due.
Staff spoken with confirmed they had attended team meetings periodically and received supervision and appraisal sessions. Staff reported that the quality and frequency of supervisions had improved since the new management team had started working at Three Bridges and clinical supervision had been introduced to support nursing staff.
Upon reviewing records we noted that the provider had not always notified CQC of notifiable incidents and copies of some notifications were not available for reference. This is a requirement of the Care Quality Commission (Registration) Regulations 2009. A compliance action has been set in regard to this matter and the provider must tell us how they plan to improve.
Is the service effective?
We spoke to eight people who lived at Three Bridges Residential and Nursing Home during our inspection. Comments received from people using the service included: 'This place is like my Tina Turner record 'Simply the best better than all the rest'. The standard of care is superb'; 'Everything is fine. I'm very satisfied and the staff are so kind and friendly'; 'I'm getting fed and I'm well cared for. What more could I ask for' and 'The standard of care and meals are good. I have no reason to complain.'
Records highlighted that there had been three complaints since March 2014 and that the complaints had been listened to and acted upon. Complaint records prior to this date could not be located. A compliance action has been set in regard to records and the provider must tell us how they plan to improve.
No complaints or allegations were received from people using the service during our visit however some people expressed concern regarding the limited range of activities. We discussed these concerns with the acting manager who reported that the service was in the process of recruiting an activities coordinator to cover the absence of the post holder.
Is the service caring?
People living at Three Bridges Residential and Nursing Home who were spoken with were complimentary of the staff team. Comments received from people living at Three Bridges Nursing and Residential Home included: 'All the carers are very kind'; 'The staff are so kind and friendly' and 'The new management team and staff are approachable and friendly people.'
We also spoke with the relatives of four people who were supported by the service. All feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.
Is the service responsive?
Files viewed contained a range of assessment and care planning information which included a plan of care that outlined individual needs and risks; aims and objectives; and details of the level of support / intervention required by staff. Monthly evaluation records had also been completed which provided evidence that care plans had been kept under regular review.
We observed staff carrying out their duties and responsibilities with confidence and skill, in good humour and in a relaxed and positive manner.
People spoken with were complimentary of the staff team. Comments received from people living at Three Bridges Nursing and Residential Home included: 'All the carers are very kind'; 'The staff are so kind and friendly' and 'The new management team and staff are approachable and friendly people.'
We noted that some parts of the home remained in need of redecoration and refurbishment. We were informed by the regional manager that a rolling maintenance and refurbishment programme for Three Bridges Residential and Nursing Home had been agreed to enhance the internal and external environment.
For example, we received confirmation that dementia care unit would have all community areas redecorated and refurbished over the next three months to include improved signage; new floor coverings; themed colour schemes, dementia specific wall art, reminiscence items and tactile materials.
A programme of redecoration is also planned for the rest of the home over the coming twelve months.
Is the service well- led?
Since our last inspection, a number of concerns were identified by the local authority's contracts monitoring team following an unscheduled review during December 2013. Concerns regarding: the management and leadership of the home; care standards and culture; communication and record keeping and training and staffing were identified.
The home was issued with an action plan by the local authority to ensure on-going improvements were made and significant progress has been noted across all areas requiring improvement. This had included the appointment of a new regional director and a home manager to provide leadership and direction. We received assurance from the regional director that the acting manager would apply for registration with the Care Quality Commission upon satisfactory completion of the organisation's probationary period.
The provider has established a comprehensive internal quality assurance system and had developed systems to involve and obtain feedback from people using the service and / or their representatives.