Swimbridge House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Swimbridge House Nursing Home accommodates a maximum of 30 people in one adapted building. An extension to the building was under construction. There were 29 people resident at the time of the inspection.

The inspection took place on 2 and 3 January 2019. It was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People felt safe. They knew staff were available to meet their needs and respond in a timely manner. Recruitment arrangements ensured only staff suitable to work with older people, and meeting the service’s standards, were recruited.

Staff had a good understanding of how to protect people from abuse and discrimination. They were aware that any concerns could be taken to the registered manager and the local authority safeguarding adults’ team.

The premises were clean, hygienic and maintained to a safe standard.

Medicines were managed in people’s best interest.

Risk was understood and managed in a least restrictive way. The overview of accidents and incidents helped to reduce any risk.

People enjoyed the food and their nutritional needs were met.

People’s health care needs were fully understood and met. External health care expertise was sought appropriately.

Staff received training, supervision and support to help them in their role. They were encouraged to progress if this was what they wanted.

People’s legal rights were understood and protected. Where people lacked capacity to make informed decisions these were made in their best interest.

Policies, procedures, staff training and delivery of care promoted people’s wellbeing regardless of disability, age and other factors which might put them at a disadvantage to others.

Staff were caring, kind and compassionate. They treated people with respect and upheld their dignity. People’s views were always sought.

People had an in-depth assessment of their needs and wishes. Care plans were detailed, complete and enabled staff to understand important aspects of the person they were caring for.

Shared activities were enjoyed and staff looked for ways to provide meaningful activities to people.

Complaints were considered a way to continually improve the service.

The registered manager and provider were committed to people’s care and welfare. The quality of the service was closely monitored. Staff said they were proud to work at Swimbridge House Nursing Home.

This inspection took place on 18 and 19 April 2016 and was unannounced. The previous comprehensive inspection was completed in October 2014 where we found there were a number of requirements in four out of the five key areas. A focussed inspection was completed in June 2015 where we found some improvements had been made.

The service is registered to provide nursing care and support for up to 30 people. Most people living at the home are older and some are living with dementia. At the time of this inspection there were 27 people living at Swimbridge.

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.

The registered manager had been at the service for just under 12 months and during this time, she and the senior management team, which included a clinical lead, registered provider and nurses have achieved a great deal to improve the service. This included improving the morale of the team, improving standards of care and using an approach which showed the person at the heart of the service. The leadership team have provided exceptional support to the staff team, people living at the home and to relatives. The registered manager had worked hard to forge great community links and ensure Swimbridge House had a good reputation locally and with commissioners.

People and the relatives were very complimentary about the care and support they received and about the leadership of the home. Comments included ‘‘The staff are very kind and very patient.’’ and ‘‘Staff are brilliant. They are always so kind to me.’’ One relative said ‘‘The manager has gone a long way in making this home welcoming and inviting. It really does feel like home from home.’’ Another said “This is a five star service; you don’t get better than this. Every member of staff welcomes you and makes you feel at home.’’

Care and support was being well planned by a staff team who understood people’s needs and were supported and trained to do their job effectively. Staff said they had effective and inspiring leadership which helped them to implement the ethos and values of the service.

People were kept safe because staff understood what may place people at risk and what types of abuse to watch for. Staff were confident about how to report abuse and that the senior team took all concerns seriously and acted on issues quickly and appropriately. Recruitment was robust which ensured only staff who were suitable to work with vulnerable people were recruited.

Medicines were being appropriately managed and monitored. Where minor errors had been made, these had been picked up quickly through medicine audits.

There were enough staff with the right skills to meet people’s needs in a timely way. Staff showed a caring attitude and approach to people. For example being alert and responsive to people’s changing moods and ensuring they provided comfort and support when people needed to feel safe. The ethos promoted by the registered manager and provider had impacted positively on staff, enabling them to be responsive. Staff ensured people were given personalised care in an environment which was homely and welcoming.

People were offered a wide variety of meals and snack and drinks throughout the day. Where people had been identified as being at risk of losing weight, additional monitoring measures were in place to ensure they were offered extra snacks and support to eat sufficient amounts to stay healthy. People were complimentary about the food.

Well managed systems were in place to ensure the quality of care and support were continually reviewed and monitored. Where improvements were needed, prompt action was taken to drive up the quality of care and support. T

This focussed inspection took place on 11 June 2015 to follow up on requirements issued during the previous inspection completed on 18 and 19 October where we found a number of areas for improvement. These included staffing levels, staff training and support, medicines management and quality assurance. The provider had sent us an action plan showing how they intended to improve on these identified areas and this included the timescales by which they would be met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Swimbridge House on our website at www.cqc.org.uk

At the time of this inspection the service was registered for 31 and there were 21 people living at the service.

The registered manager had resigned and left in April 2015, and a new manager was in place who was about to complete the process for registering with the Care Quality Commission. 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.’

We found that staffing levels had increased and were being sustained by either new staff who had been recruited and also by the use of some agency staff. Additional ancillary staff had been employed to ensure care staff had sufficient time to spend with people. The provider had employed an activities coordinator who worked four hours per day and was having a positive impact on people being meaningfully engaged in activities of their interest. For example several people had been keen gardeners and there had been projects set up to enable them to continue to pursue their interests with raised flower and vegetable beds.

Medicines were being administered in a timely way and audits were in place to ensure there was a robust recording and administration process.

A dependency tool was being used to help the manager and provider ensure they had the right levels of staff for the number and needs of people in the service. There were also clear audits in place to review any accidents of falls, learn from these ensure risks were minimised. One example was ensuring there was always a staff presence in the lounge areas.

We were able to conclude that the three requirements set from the previous inspection had been met.

This inspection was unannounced and took place on 18 and 19 October 2014. There were 20 people living at the service. The inspection was brought forward in response to some information of concern CQC received about the management culture and low staffing numbers for the number and needs of people living at the service. This is the first inspection completed since the providers registered with CQC.

Swimbridge House is registered to provide accommodation for up to 24 people requiring personal and nursing care. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they were well cared for by a staff group who understood their needs, but could not always meet them in a timely way. Care and support was well planned but there were not enough staff to meet people’s needs. People’s safety was being compromised in a number of areas. This included how well people were being monitored through busy periods of the day to ensure their safety and wellbeing and how well medicines were being administered.

Staff provided care and support in a kind and respectful way. They showed they understood the needs and wishes of the people they cared for and worked in a way which promoted their independence where possible.

There had been improvements to the way staff received information, including handover time to discuss each person at the start of each shift, monthly team meetings and opportunities for one to one meeting with a senior member of staff. The feedback we received from staff was that the culture of the management team was not always open and inclusive and staff morale was described as low.

The registered manager and provider had needed to discipline a number of staff in order to drive up improvement in practice. People’s rights were protected via the Mental Capacity Act 2005. The registered manager had made sure people’s capacity to make decisions was assessed for all aspects of their lives.

Staff had received training in understanding the safeguarding processes and were able to describe types of abuse and when they should report their concerns and who to. The registered manager had been proactive in ensuring any concerns about vulnerable adults were detailed to the local safeguarding team and CQC.

There had been a significant investment in training and staff had been asked to complete a training audit so further training could be planned. Steps had been taken to ensure the right equipment was in place to assist staff to meet people’s needs, but quality assurance audits were not always in place to monitor that all equipment remained fit for purpose.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

You can see what action we told the provider to take at the back of the full version of the report.