Archived: Tilford Park Nursing Home

This was an unannounced inspection which took place on 01 August 2016.

During our inspection the registered manager was present. 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 told us that they felt safe in the home. However, staffing levels did not ensure that people who lived with dementia received all the support they required at the times they needed. We observed that staff were rushed and had little time to spend with people outside of delivering care to them. You can see what action we told the provider to take at the back of the full version of the report.

Staff had some understanding of the Mental Capacity Act 2005 (MCA) and of the Deprivation of Liberty Safeguards (DoLS) and had received training in these areas. People’s representatives had not always been involved in decision making processes when people lacked capacity to consent to ensure their rights were upheld. You can see what action we told the provider to take at the back of the full version of the report.

People said they were happy and comfortable with their rooms and we saw that they were attractively decorated with some personal touches including photographs and memorabilia. However, some elements of the environment didn’t lend themselves to assisting the needs of people with dementia. We have made a recommendation about this in the main body of our report.

Staff said that they received sufficient support and training to fulfil their roles and responsibilities. Training was provided during induction and then on an on-going basis. A training programme was in place that included courses that were relevant to the needs of people who lived at Tilford Park Nursing Home. However, at times some staff did not demonstrate sufficient understanding when supporting people who lived with dementia. We have made a recommendation about this in the main body of our report.

Everyone that we spoke with said that the manager was a good role model. Quality monitoring systems were in place that included seeking the views of people in order to drive improvements at the home. Checks were not always completed in line with the provider's policy and action plans were not always recorded to improve identified shortfalls. We have made a recommendation about this in the main body of our report.

Potential risks to people were assessed and information was available for staff which helped keep people safe. However, at times staff restricted people’s movements without a clear rationale being in place. We have made a recommendation about this in the main body of our report.

People said that in the main they were happy with the choice of activities on offer and that they were supported to maintain links with people who were important to them. Access to further stimulation would enhance people’s wellbeing further. We have made a recommendation about this in the main body of our report.

People were treated with kindness and compassion. Although we observed that staff at times appeared busy and rushed we saw no signs of impatience with people. Staff appeared dedicated and committed. We observed that care was given with respect and kindness but it was clear that some people had to wait for too long for the help they required.

Robust recruitment checks were completed to ensure permanent staff were safe to support people.

People said that they were happy with the medical care and attention they received and we found that people’s health needs and medicines were managed effectively. People’s needs were assessed and care and treatment was planned and delivered to reflect their individual care plan.

People said that the food at the home was good and that their dietary needs were met. There were a variety of choices available to people at all mealtimes.

Equipment was available in sufficient quantities and used where needed to ensure that people were moved safely and staff were able to describe safe moving and handling techniques.

Information of what to do in the event of needing to make a complaint was displayed in the home. During our visit we observed staff assessing if people were happy as part of everyday routines that were taking place.

Below is a summary of what we found. The summary is based on our review of records, speaking with people and their relatives who used the service and speaking with staff who supported the people who used the service.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People who used the service told us they were treated with respect and dignity. For example, one person said, 'The carers informed me of what they were going to do before undertaking the task'.

We observed the service had a system in place to ensure that people's risk assessments were kept under regular review. Any trends identified were dealt with to minimise risks relating to people's health, welfare and safety.

All staff spoken to were able to describe what measures the service had in place to promote people's safety and how they would protect people if they felt their human rights were being breached.

We found that the service had systems in place to ensure that the staff they employed to support people had the required knowledge and skills to do so. The service had processes in place to ensure that there were enough staff employed to keep the service clean and hygienic.

We saw documented evidence that the service used a range of quality monitoring tools such as , yearly clients, relatives and staff satisfaction surveys to measure the quality of care and support people received from the service. People told us they felt safe with the staff.

Is the service effective?

We found that people's care plans provided detailed information on how they wished to be supported with their care needs. For example, care needs had been clearly stated. We observed that records of people's daily care were documented. Care staff spoken with told us they used the communication sheet to highlight any changes to the person's care to ensure continuity of care. These were appropriately maintained to ensure if necessary a new member of staff would be able to deliver care safely and effectively.

We found that people's health care needs were kept under regular review and they had been involved in the reviews. People had access to health care professionals such as the GP, dentist, optician and district nurse. This meant that people were supported to keep healthy and well.

Is the service caring?

People told us that care staff spoke to them in a kind and respectful manner. One person said, 'The staff all of them demonstrate a genuine affection, care and concern to me'. All members of staff spoken with were knowledgeable about people's care needs including their preferences and personal histories. It was evident that people were listened to and care staff responded to them in a positive and caring way. One person said, 'I feel I receive excellent care'.

Is the service responsive?

The people we spoke with told us they were supported to express their views and be actively involved in making decisions about their care, treatment and support. In the care plans we looked at, we saw evidence which reflected that people and their relatives were involved in making their views known about how they wished to be cared for and supported. If people were not able to sign their care plans these were signed by family members. We saw evidence that regular care plan reviews took place. This meant that people's care needs were kept current and under regular review.

We found the service had received two complaints which had been dealt with to the satisfaction of the complainants. People we spoke with all said they knew how to make a complaint, but had never done so. Relatives of people who used the service told us they discussed their relative's care needs with the manager or deputy manager and they worked well together so there was never any need to complain.

Is the service well led?

Staff spoken with said that they felt supported by the management team and were provided with regular staff meetings. At these meetings they were able to raise questions relating to the delivery and implementation of best practice. This meant that staff felt supported and well-led.

We saw records which showed that staff practices had been regularly observed. The outcomes from these observations were discussed and used to improve the care provided. Staff spoken with said that they were provided with adequate training. This enabled them to perform their roles and to be accountable for their actions.

People spoken with told us the manager and or the deputy manager was always available in the home. They said, 'Either the manager or the deputy spoke daily with the residents to check if they were happy with the care and if the care workers were performing satisfactorily'. This ensured people received agreed and effective care as documented on their care plans.

The service had arrangements in place to monitor complaints, accidents and incidents. This meant that lessons were learnt from incidents and complaints investigations to ensure improvements to the service they delivered.

The registered manager told us, 'All of the people who used the service have capacity to make decisions and to sign their care plans. If we assessed someone as lacking capacity, we would hold a best interest meeting to gain permission from the next of kin or the person who knew them best.'One person said, 'The staff consulted with me, and I signed the care plans to show I agree to the care and support in the plans.'

People told us they were very happy with the care and support they received. They told us they 'could not fault the nurses.' They said, 'The staff, every one of them including the night staff is just wonderful. They will do anything for us.' One Person said, 'The staff discusses my care with me. I know what is going on. Nothing is hidden from me.'

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care. People had their medicines at the times they needed them from staff qualified to do so. People's comments were considered and responded to appropriately. Appropriate recruitment checks were undertaken before staff began work. The service had appropriate systems in place to effectively assess and monitor the quality of the service.

People told us the staff spoke to them in a polite way, addressing them in the way they preferred. Another person said, 'I will tell them if they are doing something wrong. For example, if my clothing is not comfortable. I always thanked them after they have helped me'. Another person who used the service said, 'My right to privacy was maintained at all times and the advice and support I received from the staff were given in a way that maintained my dignity'.

We found people expressed their views and were normally involved in making decisions about their care, treatment and support. However, this has changed recently and people told us the manager had made decisions without consulting them. People experienced effective, safe and appropriate care and were provided with suitable nutrition to maintain their wellbeing. People said they felt safe in the service. Suitable precautions were in place to protect people and staff from cross infection of health care associated infections.