Tithe Farm Nursing Home

Updated 26 January 2019

The inspection:

• We carried out our inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. Our inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

• Our inspection was completed by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert by experience had knowledge about the support of older adults within residential care settings.

Service and service type:

• Tithe Farm 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.

• The service is required to have a registered manager. 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. At the time of our inspection, a manager was registered with us.

Notice of inspection:

• Our inspection was unannounced.

What we did:

• Our inspection was informed by evidence we already held about the service. We also checked for feedback we received from members of the public, local authorities and clinical commissioning groups (CCGs). We checked records held by Companies House, the Food Standards Agency and the Information Commissioner’s Office.

• We asked the service to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

• We spoke with five people who used the service and seven relatives. We observed the care of six other people who were not able to speak with us.

• We spoke with the provider's nominated individual, assistant operations manager and the home manager. We also spoke with three registered nurses, five care workers, the cook, activities coordinators, two maintenance workers and the cleaning staff.

• We reviewed five people’s care records, two staff personnel files, audits and other records about the management of the service.

• We requested additional evidence to be sent to us after our inspection. This was received and the information was used as part of our inspection.

Updated 26 January 2019

About the service:

• The service is based on acreage in the Stoke Poges area; a rural setting with expansive grounds.

• The service provided accommodation and personal or nursing care to older adults with dementia. People lived in their own bedrooms. Some rooms had ensuite facilities. There were communal bathroom facilities, lounges and a dining room.

• At the time of our inspection, 24 people used the service and there were 40 staff.

People’s experience of using this service:

• The service had made improvements to the safety of people’s care.

• People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe.

• People’s risks were assessed and strategies put in place to mitigate the risks.

• Risks from the premises were satisfactorily assessed and managed. We made a recommendation about reviewing the suitability of the environment for dementia care.

• Staff received improved supervision and training since our last inspection, which provided them with the knowledge and skills to perform the roles they were employed to do.

• People and relatives provided consistently positive feedback about the care, staff and management. They said the service was safe, caring and well-led.

• People’s care was person-centred. The care was designed to ensure people’s independence was encouraged and maintained.

• People were involved in their care planning. End of life care planning and documentation required further improvement.

• There were positive changes to the management team. Improved audits and checks were put in place to ensure the service was well-governed.

• There was a happy workplace culture and staff we spoke with provided positive feedback.

• The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

• More information is in our full report.

Rating at last inspection:

• The service was rated “requires improvement”.

• Our previous inspection report was published on 27 December 2017.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

• We made recommendations in our inspection report. We will check any actions taken by the provider at our next inspection.