Saintbridge House Nursing and Residential 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 75 (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 support was effective by assessing and reviewing their health, care, wellbeing and communication needs with them

People’s needs were comprehensively assessed and regularly reviewed to ensure care plans remained person-centred and responsive. Care plans reflected people’s physical health, wellbeing, communication and nutritional needs, and were reviewed on a monthly basis or sooner if changes occurred.

The provider had a holistic approach to assessing people’s needs, seeking specialist input sought where required, including dieticians and speech and language therapists. The service showed strong and innovative practice in identifying and managing risks early. For example, staff used structured health monitoring tools to identify early signs of deterioration. People had regular blood pressure checks to ensure regular monitoring and staff worked closely with the GP to review any concerns promptly.

Some people required support with a Percutaneous Endoscopic Gastronomy (PEG). A PEG is a feeding tube that goes directly into a person’s stomach to provide nutrition and fluids when they cannot safely swallow food. Staff received additional training to safely manage PEG feeding, monitor for complications and respond to concerns quickly.

People and their families were involved in care planning and reviews where appropriate. The service respected individual preferences, for example, supporting people to retain their own GP when moving into the service, where this was their wish.

The provider always 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. They worked to develop evidence-based good practice and standards.

The service demonstrated innovative and proactive practice through the use of Gold Standard Framework (GSF) frailty coding. GSF is a nationally recognised programme that helps services identify people who may be nearing the end of life or becoming increasingly frail. It supports earlier planning, better coordination of care and improved quality of life. At the service, GSF coding was effectively used to identify people at risk of deterioration at an earlier stage, ensure regular multidisciplinary (MDT) reviews were held, plan ahead with people and their relatives about future wishes and reduce unnecessary hospital admissions.

People received care and treatment in line with current legislation, national guidance and best practice. Nationally recognised clinical tools, including Malnutrition Universal Screening Tool (MUST) and Waterlow were used appropriately to assess, monitor risks, and these were reviewed regularly. Records showed people’s nutrition and hydration needs were clearly identified and monitored, with monthly weights completed and acted upon where concerns were identified.

People consistently described staff as knowledge and understanding their individual needs. A person living at the service said, “They know I can’t stand so they hoist me into my chair. The staff take me around in my wheelchair. They [staff] are really good, they know what they are doing.”

People had clear advance care planning discussions, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), where appropriate. DNACPR forms were clearly recorded and supported by discreet visual prompts to ensure staff and visiting professionals were immediately aware of people’s wishes. This reduced delays and ensured people received care in line with their preferences.

Staff demonstrated a strong clinical awareness and responded quickly to changes in people’s health. For example, where a person was admitted with an area of skin breakdown, staff sought timely advice from external professionals and implanted appropriate care, which led to improvement and prevented further deterioration.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The provider demonstrated exceptionally strong and proactive partnership working across teams and external services, resulting in measurably improved outcomes for people. An example of this, was people’s weights being recorded on a monthly basis on their system. If any weight loss was identified, it was escalated to the nursing staff, who then liaised with the GP to consider interventions such as fortified meals or nutritional supplements. Comprehensive assessments were consistently shared when people moved between services, ensuring seamless transitions and preventing people from having to repeat their experiences. This approach promoted dignity, continuity and person centred care.

Staff described positive partnership working and openness when people moved into the service. One staff member told us, “We work well with people coming into the home. We are open and transparent with people coming into the home.”

The service maintained exemplary communication processes, including handovers and communication records, which supported continuity of care. We observed daily huddles being held, which went beyond task allocation and were used as a risk management forum. During these huddles, staff reviewed falls and discussed falls prevention strategies. This proactive, joined up approach led to improved oversight of risk.

Professionals consistently described the service as organised and responsive. Professionals stated that the home has strong processes and documentation in place. Communication with GPs was structured, timely and preventative, supporting early intervention and reducing health deterioration. The provider worked in strong partnership with GPs, dieticians and other healthcare professions to ensure people received coordinated, holistic care. Families were meaningfully involved in planning and spoke positively about the collaborative approach. A professional working with the home told us, “The staff are approachable and take time to give updates onpatients when I visit each time. Recommendations are actioned to patient's benefit and where there is need for clarity, the managers communicate via email.”

The provider supported people to manage their health and wellbeing to 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 supported to maintain and improve their health and wellbeing. Care plans included detailed information about people’s healthcare needs, preferences and risks. This assisted staff to monitor changes in people’s well-being and respond appropriately to any deterioration. Records showed people’s weights, nutrition and hydration were routinely monitored, and action was taken when concerns were identified.

Staff worked proactively with healthcare professions, including, GPs, dietitians, and district nurses to ensure people received appropriate treatment and specialist input when required. Concerns such as skin integrity and nutritional risks were escalated appropriately and monitored closely.

People were supported to access healthcare services and make healthier lifestyle choices where possible. The service took a proactive approach to supporting people to live healthier lives.

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.

Care plans demonstrated that key areas such as people’s nutrition, hydration and weight were reviewed regularly, with appropriate action taken where risks were identified. Staff worked closely with people to understand their preferences and confirmed they checked regularly that care continued to meet individual needs.

Staff told us they knew people well and routinely checked in with them about their preferences and needs. One member of staff told us, “We know what people like and need and we check in with people about preferences regularly”. This demonstrated a person-centred approach to monitoring outcomes.

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

Care plans included clear information about people’s capacity, decision making needs and any support required. Where people lacked capacity, appropriate mental capacity assessments and best interest decisions were completed and documented in line with legislation.

Staff demonstrated a good understanding of consent and told us they routinely checked with people before providing care. One member of staff said, “Consent is important to us. We always check with people that they are consenting to what we are about to do”. This reflected the respectful culture observed within the home

Systems were in place to ensure people were supported to make decisions wherever possible and that their rights were upheld in practice.