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Ticehurst Care Home With Nursing Good


Inspection carried out on 22 August 2019

During a routine inspection

About the service

Ticehurst is a residential care home providing nursing and personal care for 81 people at the time of inspection who may be living with dementia.

Ticehurst accommodates up to 86 people in one purpose built building that is divided into two wings, one for nursing care and one for residential care.

People’s experience of using this service and what we found

The provider had systems and processes in place to manage medicines safely and protect people from the risk of abuse. Infection control measures were in place to minimise the risk of infection. The provider acted on or learnt from incidents, such as an incident highlighting the need for pre- admission assessments to be more detailed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care workers had developed caring relationships with people they supported. Staff respected people's dignity and privacy and promoted their independence.

People's care and support met their needs and reflected their preferences.

Management processes were in place to monitor and improve the quality of the service. There was a positive and open culture. The management team sought feedback from people, relatives and staff. Feedback was positive across all areas.

Rating at last inspection

The last rating for this service was good (published 17 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 11 January 2017

During a routine inspection

‘Ticehurst Care Home With Nursing’ is a nursing home operated by Hampshire County Council. It is registered to provide accommodation for up to 86 people, including people living with a cognitive impairment. The home is split into two interconnected parts; a nursing unit and a residential unit each spread over two floors. At the time of the inspection 36 people were being accommodated in the residential unit and 41 people in the nursing unit. Six of the people in the nursing unit were using ‘discharge to assess’ beds funded by the Clinical Commissioning Group (CCG) to support their rehabilitation following discharge from hospital.

The inspection was conducted on 11 and 12 January 2016 and was unannounced. 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.

People felt safe and felt able to raise concerns. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. People were protected from individual risks in a way that supported their independence and environmental risks were managed effectively.

People were supported to take their medicines safely. Suitable arrangements were in place for ordering, storing, administering and disposing of medicines, including topical creams.

There were enough nursing and care staff to support people on a timely way. Staff recruitment practices were appropriate and helped ensure only suitable staff were employed.

Plans were in place to deal with foreseeable emergencies. Fire safety equipment and procedures were tested regularly; staff were trained to administer first aid and a defibrillator was available in the event of a cardiac arrest.

Staff underwent a comprehensive induction and training programme. They were knowledgeable and skilled at meeting people’s needs. They were suitably supported in their role by managers through the use of supervision and appraisal processes.

Staff acted in the best interests of people and followed legislation designed to protect people’s rights. They also involved people or their relatives, where appropriate, in discussing and planning the care and support they received.

People were offered a choice of meals and their dietary needs were met. They received appropriate support to eat, when needed, and were encouraged to drink often.

People were supported to access other healthcare services and staff worked well with external professionals. At the end of their lives, people received appropriate care and support to have a comfortable, dignified and pain free death.

Staff had created a positive, relaxed environment that suited the people living at the home. They maintained a calm atmosphere by supporting people in a patient, unhurried way. They cared for people with kindness and compassion, respected people’s privacy and treated them in a dignified way.

Staff put people at the heart of the service and were committed to meeting people’s needs in a personalised way according to their individual needs. Care plans contained comprehensive information to enable staff to support people in a consistent way and were reviewed regularly.

People were encouraged to make choices about every aspect of their lives and to remain as independent as possible. They had access to a range of suitable activities either in a group setting or on a one-to-one basis.

The provider sought and acted on feedback from people. There was a suitable complaints procedure in place and people were confident any concerns would be addressed.

People and their families felt the service was run well. They had confidence in the management, as did the staff. There was a clear management structure in place. Staff understood their ro

Inspection carried out on 17 and 19 February 2015

During a routine inspection

This inspection visit took place on 17 and 19 February 2015 and was unannounced.

Ticehurst provides accommodation, nursing and personal care for up to 86 older people, some of who are living with dementia. The home is comprised of a residential unit and a nursing unit. There were 64 people using the service at the time of this inspection.

The service has 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 last inspection on 7 and 8 August 2014, we asked the provider to take action to make improvements. This was because people were not being protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. At this inspection we found that improvements had been made.

Some areas required improvement. Good practice was not always followed for the recording of medicines or the assessment and administration of ‘variable dose’ or ‘as required medicines’, particularly around pain relief. The system for monitoring people’s food and fluid intake was not always implemented effectively.

People told us they felt safe and there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff deployed to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was a comprehensive induction, training and development programme, which supported staff to gain relevant knowledge and skills.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration.

People told us they were happy with the care they received and said they had good relationships with staff. One person told us “The staff understand me, they are very kind”. Another person said “The staff really look after me. It is amazing here nothing is too much trouble”.

People told us the service was responsive to their needs and staff listened to what they said. People were confident they could raise concerns or complaints and that these would be dealt with.

People spoke positively about the service and the registered manager and said they would recommend the home to their friends. There was an open and transparent culture within the service, which encouraged people’s involvement and their feedback was used to drive improvements. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.

Inspection carried out on 7, 8 August 2014

During a routine inspection

During this inspection we spoke with nine people who use the service, two visiting relatives, 14 members of staff, the manager and a senior manager. We observed support being given and looked at care and treatment records for 14 people who use the service.

We considered our inspection findings to answer questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

This is a summary of what we found �

Is the service safe?

We found that care and support records were not all up to date, accurate and fit for purpose. There were some inconsistencies in the way that care and treatment was recorded, which meant that people were at risk of receiving unsafe or inappropriate care and treatment. Senior staff had started to audit the care plans on both the residential and nursing units and had identified areas which required improvement.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Risks associated with the provision of care and support had been assessed, such as in relation to mobility and falls, nutrition and weight. Any concerns were followed up and appropriate action was taken. This meant that care was planned and delivered in a way that was intended to ensure people's safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw records demonstrating that proper policies and procedures were in place and these were adhered to. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

The service was effective in supporting people to be able to eat and drink sufficient amounts to meet their needs. We saw kitchen and care staff had a list of people who required special diets, such as vegetarian, diabetic, soft, pureed or fortified meals. There was no choice of food on the menu. However, when the food arrived if the person did not want it then alternatives were offered, such as toast, sandwiches or fruit.

A training programme was in place, which showed staff were provided with training and relevant qualifications to support them in meeting people�s needs. The staff we spoke with said they felt the training was relevant to their work and helped them to meet the current needs of people using the service. Staff confirmed that they had supervision meetings in which they could discuss any matters relating to their work.

Is the service caring?

We observed that staff interacted with people who use the service and knew their likes and dislikes. This helped to create a friendly, caring and supportive atmosphere in the home. A relative told us �My Mum is so happy here, she has been happy from the moment she walked through the door. The staff are marvellous and look after her really well�.

All of the people we spoke with in the residential unit told us they felt safe and happy living in the home. One person said �This is a lovely to place to live, I am happy here�. Another person commented �The staff are really, really wonderful, they look after us well and I feel safe living here�. Another person told us �I sleep like a log here, I feel so safe�. People we spoke with in the nursing unit also commented positively about the care they received. One person said �It�s a wonderful home. They are so kind. They can�t do enough for you�.

Staff demonstrated positive attitudes to their work. For example, one care worker said �This is a lovely home, we work as a team and all help each other. The resident is the most important�. An agency member of staff we spoke with told us �This is a very happy home. I love it here. I feel part of the team�.

Is the service responsive?

People�s health needs were monitored and referred to health professionals appropriately. We observed that staff assisted people in a way that was sensitive and responsive to their changing needs. One person told us �They are so good here. I had a hospital appointment today. The staff got me up early and got my breakfast for 7 am. We don�t usually get it until 9 am but they did that just for me�.

Another person who uses the service told us staff �See the need before you ask�. A relative told us �There has never been any problem. They would phone me if need be�.

A system was in place to monitor and respond to any concerns or complaints about the service. We saw a copy of a letter written in response to a person�s complaint, which showed the management had taken the complaint seriously and taken appropriate action.

Is the service well led?

The service was well led. We saw that regular audits of the quality and safety of the service took place and were recorded. In addition to these, a services manager for the organisation carried out regular checks that were also recorded. There was an on-going improvement log completed by the manager, which was a record of actions taken in relation to audits, incidents, and feedback from people using the service or others acting on their behalf.

A person who uses the service said �We have no complaints. If I did I would talk to the boss. You could talk to her about anything; she is so calm and lovely�. Another person also told us �You can talk to the manager about anything�. We observed that the manager knew the names of people who use the service and had a good rapport with them.

Inspection carried out on 19 April 2013

During an inspection looking at part of the service

We found that people expressed their views and were involved in making decisions about their care and treatment.

We reviewed two care plans and noted that both were in a new format introduced by the provider. From the level of detail on views and preferences that had been recorded it was apparent that people and relatives had engaged in the process. In addition we saw that both plans had been reviewed in the last two months and had been signed by relatives.

This meant that opportunities were provided for people, relatives and representatives to discuss people�s care and support preferences.

In the Ticehurst service user guide, we noted that that the section relating to complaints and comments had been updated. The manager told us that people using the service and relatives were spoken with about the complaints procedure during reviews of their care plan and that a large print version of the document was now available.

We reviewed the service complaints folder and noted that three formal complaints had been made recently. We saw that each had been investigated thoroughly and that the outcome had been notified to each complainant. This meant that people�s complaints had been listened to and acted on.

Inspection carried out on 11 December 2012

During a routine inspection

We were unable to speak with people using the service during this inspection because all were suffering from dementia. We observed the interactions between staff and residents to gain an understanding of people�s experiences at this service. A relative told us that Ticehurst has a friendly family atmosphere and that the staff were very caring and always treated their relative with affection and respect.

We saw that people using the service had their individual needs assessed before admission. However, we saw no evidence that people or their relatives had been involved in planning their care and support.

A relative told us, �I�m happy with the care they provide. They are busy but there is always someone on hand to help them or talk to them�.

We observed that people looked well cared for and that those who wished to be were engaged in activities.

We noted that current guidance regarding safeguarding people from abuse was available to staff and that they had received training in how to deal with reports or suspicions of abuse.

All of the managers and staff that we spoke with said they were able to meet people's care needs safely. We found that there were enough qualified, skilled and experienced staff to meet people�s needs.

We reviewed the procedure for handling, storage and administration of medicines and found this to be compliant.

We noted that there was a complaints system in place but it was not readily accessible to people using the service.

Inspection carried out on 27 September 2011

During a routine inspection

People using the service that we spoke with said they felt well treated by staff. People gave examples of staff having the right skills and of offering choices about the way care was provided.

People said they received the care they needed. One person said they had been consulted about their needs when their care plan was being developed.

People reported that although staff were busy, they were able to meet their needs.

Reports under our old system of regulation (including those from before CQC was created)