Tilford Care & Nursing Home

Tilford Care & Nursing Home is a care home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 50 people and is set across two floors.

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

We were not assured that staff were always following national guidelines on the use of personal protective equipment (PPE). We observed staff did not consistently wear face masks in accordance with national guidelines. There was a lack of oversight from the provider prior to our inspection to ensure staff were consistently following the UK Health Security Agency Guidance on the use of PPE: ‘Personal protective equipment: resource for care workers working in care homes during sustained COVID-19 transmission in England’. The provider took action to address this following our findings.

We received mixed feedback about the support available for staff. Whilst some staff commented on the positive culture in the service, others told us they did not always feel they had the support to read care plans and risk assessments and did not feel they could always approach management about this as they felt they did not have the time.

We reviewed minutes of staff meetings and staff told us they were able to feedback using surveys, however we saw that action was not always taken in response to surveys. Staff told us they were aware of risks associated with people’s care.

People and their relatives told us they felt safe and that staff were kind towards them. People’s medicines were stored and administered safely. There were sufficient staff at the service to support people with their care needs. Care plans including the management of risks were in place. There were plans in place to evacuate people in the event of a fire.

People and relatives told us they felt management would address concerns and that they felt able to feed back if they had ideas to improve the care provided.

There were some systems in place to monitor the quality of care provided. Accidents and incidents had been reviewed to see if the risk of them happening again could be reduced.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 August 2020).

Why we inspected

We received concerns from the local authority and healthcare organisations in relation to staffing levels and competence, lack of management oversight and poor infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led detailed findings sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tilford Care & Nursing Home is a nursing home that provides care to older people, people with physical disabilities and complex health needs. A number of people in the home lived with dementia. The home is registered to support up to 50 people and there were 41 people living at the service at the time of our inspection.

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

People were protected from the risk of abuse. Previous concerns had been fully investigated by the registered manager and improvements were made to keep people safe. The registered manager communicated with the safeguarding team well and had been open and honest when investigating any concerns.

People were observed to have positive and supportive interactions with staff. There was a happy atmosphere within the home with people smiling and laughing with staff. People seemed to have developed good relationships with staff and did not appear to be cautious or uneasy in the presence of staff including managers. People who were able to speak with us said they were happy at the home and did not shy away from speaking to inspectors.

People could access healthcare professionals when needed. When accidents and incidents happened, staff responded to these effectively which protected people from risk of harm. The registered manager reviewed all incidents to identify any triggers or underlying causes which helped to reduce the risk of reoccurrence.

We found that the home was clean and tidy in all areas which included communal areas and people’s bedrooms. The provider had a Covid-19 policy in place and had increased cleaning schedules in the home to ensure the risk of any contamination was minimised. The registered manager has agreed to seek some additional support from the local authority to ensure staff are supported and updated around the use of personal protective equipment (PPE) as guidance changes.

Staff said they were happy working at Tilford Care & Nursing Home. Staff displayed a caring attitude towards the people they were supporting. Staff had developed close bonds with people and were able to describe people’s individual needs, likes and dislikes in detail.

The registered manager was fully aware of their responsibilities and kept staff motivated to ensure good retention of staff. The registered manager had made improvements in the home culture and staff reported a change in atmosphere since the registered manager had been in place. The registered manager was open and honest about improvements required in relation to recording of daily notes and was implementing support and training to develop this area with staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 01 December 2019).

Why we inspected

We undertook a focused inspection due to concerns we received relating to incidents of alleged abuse, lack of effective infection control and unsatisfactory overall cleanliness of the communal areas and people’s rooms. This report only covers findings in relation to care which people received, safe care and treatment, safeguarding people from abuse, treating people with dignity and respect and management of the service.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Caring and Well-Led sections of this full report.

The overall rating for the service has now changed following this focused inspection to good.

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.

Tilford Care & Nursing Home (Tilford) is a nursing home that provides care to older people, people with physical disabilities and complex medical needs. Some of the people who lived at the service were also living with dementia. The home is registered to provide support to up to 42 people and there were 29 people living at the service at the time of our inspection. The service was in the process of a major refurbishment project when we visited and therefore the provider had temporarily stopped accepting new admissions during this period.

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

Since the last inspection, AginCare, a large national provider has taken over the ownership of Tilford. Upon acquiring the service, the new providers devised development plan to improve the service. A large-scale renovation project, along with personnel changes had resulted in a period of challenge and disruption to those living at the service.

The provider focus over recent months had been on maintaining a safe service. The risk assessments and increase in staffing levels reflected our findings that appropriate consideration had been given to keeping people safe. Transition plans however, had not fully assessed the effect on the quality of care during this period. As this work had spanned many months, people had experienced variable standards of care and their enjoyment of life at the service had been disrupted by excessive noise, dust and restrictions to parts of the building.

Staff morale had also been affected by the challenges of working at Tilford during the building work; which in turn had created an increased use of temporary staff. Day to day leadership of the service had not always been effective and some staff required skill development in respect of supporting people living with dementia. The management team were open about the quality improvements which now needed to be addressed. They shared their action plan with us which highlighted how the improvements to areas such as staff training, communication and record keeping were being addressed.

People received care that was safe, and staff understood their roles in managing risk and safeguarding people from harm. There were sufficient staff to support people safely and appropriate recruitment processes were followed to ensure new staff were suitably employed. People received their medicines as prescribed. Systems were in place to manage infection control and prevention. Accidents and incidents were monitored, and lessons learned when things went wrong.

People’s needs were appropriately assessed, and nursing staff ensured their medical needs were regularly reviewed. People were supported to have 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. People were supported with their food and drink. Staff worked in partnership with other healthcare professionals to deliver holistic support.

People had positive relationships with the staff who supported them. Staff knew people well and delivered care in a kind and compassionate way. People’s friends and relatives were welcomed in to the service and staff encouraged people to engage in activities and conversation that enabled them to remain connected with others and the local community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 January 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about how people were being supported during the building works. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Effective, Responsive and Well Led sections of this full report. Prior to our visit, the provider had already taken action to mitigate the risks and had a clear improvement plan in place.

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.

Tilford Care & Nursing Home is a nursing home providing care to people older people, people with physical disabilities and complex medical conditions. Some of the people who lived at the service were also living with dementia. The home is registered to provide support to up to 42 people and there were 38 people using at the service on the day of our visit.

There was a registered manager in post. 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 received appropriate support to meet their clinical needs. Staff worked alongside healthcare professionals to meet people’s needs. Risks relating to people’s medical conditions were routinely assessed and appropriate plans were implemented to keep people safe. People received their medicines safely from trained staff. Nursing staff had access to appropriate training and clinical supervision to keep them up to date with current practice. The provider had systems in place to reduce the risk of cross contamination and responded robustly when we identified an infection control concern.

People were supported by staff that understood their roles in safeguarding them from abuse. Staff had been trained to carry out their roles and had regular meetings with their line managers. Where any incidents had occurred, staff responded to these appropriately. The provider monitored accidents, incidents and complaints. People and their relatives were aware of how to raise a complaint and the provider responded to any concerns appropriately. There were sufficient numbers of staff to keep people safe and the provider carried out the appropriate checks on all new staff to ensure that they were suitable for their roles.

People received person centred care from kind and compassionate staff. Care plans contained important information about people’s needs as well as their routines and what was important to them. A thorough assessment was carried out before people came to live at the service. People told us that the staff that provided care to them were kind and caring. Care was provided in a way that involved people and helped them to maintain their independence. Staff were respectful of people’s privacy and dignity when providing care. The provider prepared appropriate plans where people received care at the end of their lives and staff were trained in this area.

The provider regularly sought feedback from people and relatives about the quality of the care that they received. People gave feedback about food and activities that was responded to by the provider. People’s dietary needs were met and people were prepared food in line with their preferences. People gave us positive feedback about the food that they received. There were regular activities taking place at the home and these reflected people’s interests.

There was clear leadership at the service and the provider had systems in place to enable effective communication between staff. People, relatives and staff had regular meetings where they could have their say about how the service was run. The provider carried out regular audits in areas such as documentation, dignity and infection control. Where improvements were identified, these were added to the provider’s ongoing plan to improve the service and were actioned by staff. The provider kept accurate and up to date records to ensure people received the right care.