Threeways Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Work was ongoing to improve the newly implemented electronic care system. We found some gaps in recording, however, this had already been identified by the provider and steps were underway to improve and add additional information. The management team had good oversight of this work and areas for development were included within the monthly improvement plan. Managers and RN’s were responsible for updating care plans. RN’s told us they spoke to the care staff throughout the day to ensure they were aware of any changes and to ensure their input in any care plan reviews.

Monthly review provided a RAG rating of people’s needs to highlight which areas of care and support people may need. This included people’s specific communication needs, for example, whether a person could communicate verbally or may require the use of communication aids.

People’s wellbeing and social support needs were reviewed to identify those at risk of depression, anxiety or social isolation.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Care plans were written and reviewed to ensure they reflected any information from other health professionals involved in the persons care. This included the implementation of acute care plans for short term issues, for example, for chest infections. Evidence based monitoring tools were used in the care and support of people. This included the Waterlow pressure area risk assessment used to assess and monitor the risk of skin breakdown and the Abbey pain scale used to assist in the assessment of pain for people who may not be able to verbalise their needs.

People were supported to maintain a healthy weight through the provision of balanced and nutritious meals. We received positive feedback regarding the meals provided and people told us there was plenty of choice. One person told us, “I am pretty fussy, but if there is nothing I like that day, they will always cook me a bit of fish or something I like.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff attended regular handovers and there was good communication between care and nursing staff, which supported continuity and consistency of care. Referrals to specialist teams had taken place when required and appropriate information was available and shared with professionals when needed.

Staff worked well together and enjoyed working at Threeways Nursing Home. Everyone we spoke with told us they felt supported by the management team.

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were empowered and supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. One told us, “I do most of my care myself, but for the bits I do need help with staff are there.” Staff understood the importance of supporting people to remain independent whenever possible. We saw lovely examples where people had been supported remain independent. One person went out on their own most days, others went out with staff, popping to the shops or out for a coffee in a local cafe.

Staff worked with GPs and health specialists to source and access new treatments and medications for people to help manage long term conditions. Staff told us, “This is not just a nursing home, the most important thing is how the person is feeling, it's a holistic approach.”

Alongside training provided by the provider, staff kept their knowledge and skills up to date by attending further training and conferences. One RN had recently attended a respiratory conference where they were told about a new inhaler that would replace the need for people using 2 inhalers. Following this they identified a person living at Threeways Nursing Home who had respiratory issues and was unwell. The RN discussed this with the GP and spoke about the new inhaler, as a result this new inhaler was prescribed and the person's health had improved. Another person had a patch used to monitor blood sugar levels in diabetes. The patch had somehow broken, and it was proving difficult to source a replacement via the GP. Whilst attending a previous seminar the RN had met someone from the local hospital diabetes clinic. They contacted this person and they were able to obtain a replacement patch. They had developed a working relationship with the clinic which meant they were able to contact them for advice and supplies.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had effective processes in place to continually monitor and improve people’s outcomes. This meant that care and support provided for people was amended and adapted in the event of a changing health or wellbeing need or when outcomes were not met.

Relatives told us this had a positive impact on people’s care. One said, “My [relatives name] is unfortunately entering an end of life care framework and the team have been very supportive, helpful and proactive in the provision of help and guidance, particularly with the liaison with the GP Surgery over medication and care related needs. This has been much appreciated.”

To ensure information was shared with staff effectively, daily flash meeting reports and staff handover took place. These included relevant information relating to wounds, medication, weights and daily charts being completed for individuals. Memos were shared with staff to inform them of improvements to care documentation to ensure all care needs were effectively documented. For example, the introduction of clearer recording relating to oral healthcare, pressure mattress checks and changes following an accident or incident.

A resident of the day had been reintroduced for a few months previously. This had been enhanced to incorporate further areas. With the aim to improve consistency, a care plan review was completed alongside this.

People’s weights were regularly monitored and actions taken if needed. However, we did find some improvement was needed regarding recording for nutrition. For example, if a person declined a meal, it was not always clear what action staff had taken, or whether an alternative had been offered. This was particularly important for people who were at risk of weight loss due to reduced appetite. One person had been offered water several times by staff despite relatives informing staff the person did not like plain water but preferred squash. This information had been documented on their likes and dislikes sheet on display by the kitchen but had not been communicated to all staff effectively. This was responded to promptly by management and discussed with the family.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA), the legal framework to support people who may lack the mental capacity to make decisions for themselves. MCA and best interest meetings had been completed when appropriate. Care records demonstrated any decision made on behalf of a person was in their best interests and involved relevant persons, there was no evidence of any blanket restrictions or overly restrictive practices. Relatives confirmed they had been involved in decision making for people that could not make decisions for themselves.

People told us they were involved in decisions and felt their needs and wishes were listened to and considered. We saw staff asking appropriately for consent during the inspection, this included when people needed support with their personal care and with medicines.