Tilford Care & Nursing 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 71 (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 ensured people’s care and treatment was effectively planned and delivered in line with legislation and evidence-based guidance.

The registered manager made sure, prior to someone moving into the service, that they were satisfied they could meet their needs. This was determined through their pre-admission assessment processes, phone assessment and face to face meeting. They told us, “A couple of weeks ago, we were asked about someone moving in and although we could have met their needs because our corridors are quite narrow, I knew that the environment would not suit the person, so we declined the request for them to move in.”

People’s care plans included detailed information which helped staff to understand people’s preferences and support them in a personalised way.

There was some work history and details on their families. One person’s recorded they liked to wear hats and we saw them with one on during our visit. A staff member said, “If there’s a new resident we are given all the information and we have handover for any changes.”

The provider 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 and current evidence-based good practice and standards.

Staff undertook training to help ensure they kept up with the latest and best practices in areas around people’s medical and health needs. This included how to prepare foods to a suitable consistency, how to monitor a person’s weight when they were unable to weigh them or how to recognise when a person may be at risk of choking and requiring a modified diet. This supported staff to meet people’s health and nutritional needs safely and effectively.

The registered manager demonstrated a clear understanding of effective care planning and told us, , “When someone moves in we register them with the GP on the same day. We complete MUST (malnutrition), Waterlow (skin integrity) and dependency assessments immediately and we also look at falls, incidents and accidents. In addition to that, we do a deep dive into people’s nutrition, checking their BMI (body mass index) as even though a person may not gain weight, their BMI may be fine.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. This supported continuity of care and reduced the need for people to repeat their information. The service worked effectively with local agencies and healthcare professionals. The GP came to the service weekly to review anyone staff were concerned about and in addition, staff could refer people to other services such as the physiotherapy team when needed. The registered manager told us, “The TVNs (tissue viability nurses) don’t tend to come in, but we will raise things with them to seek their advice, and they really support us.” They went on to say, “If we can’t get the GP, then the paramedic is good at responding to emails and we can request a visit from them.” A professional told us, “The service has played an important role in supporting timely hospital discharges, showing flexibility in accepting individuals with varying levels.” A relative told the service, “All her medical requirements are being met by you guys when we visit.”

Staff met throughout the day to share up to date information about people. A staff member said, “Every 4pm we have a meeting here and can say what happened during the day and anything we need. Handover is every morning before starting everything. In (the computer system) we have messages that we need to read before we can start using it.” Another told us, “The carers are fantastic at letting us know about bruising and skin tears. We have handover every evening.”

The provider supported people to manage their health and wellbeing, promoting their independence, choice and control. This supported people to maintain and improve their health and wellbeing. People were provided with food and fluid in line with their needs. This helped to ensure that people received their nutrition in a way that met their individual preferences and was in line with their medical conditions. The registered manager told us, “We don’t have too many IDDSI (food modification) levels. We have a check board in the kitchen, which is reviewed monthly (or more often if people’s needs change). We review this in line with a person’s care plan and profile to check they all match. The chef knows how to fortify people’s food, and we use shakes and puddings to increase a person’s calorie intake. Clinical staff had a good knowledge of when to escalate concerns with people’s healthcare needs. A relative told the service, “We have also noticed that [person’s name] is now eating a balanced diet and appears to have lost a bit of excess weights – she now looks a picture of health.”

The provider routinely monitored and reviewed people’s care and treatment to drive improvements in outcomes. This demonstrated how staff adapted care to support people to improve their independence and wellbeing.

People’s wellbeing improved after moving into the service. This included where 1 person started to eat better, became more confident and was able to move around the service more freely. Staff supported this person by including them in daily tasks such as giving them a duster so they could do some cleaning and tasking them with shredding paperwork in the office or collecting up people’s cups. One person had commented, “I can finally sleep” and another, who had initially thought of a care home as a prison had requested a permanent room in the service. A relative told us, “My dad kept suffering from UTIs (urine infections). He was in hospital for 6 weeks where they were finally treated and came here. So far he’s been all good and in the clear.” Another relative told us, “They have resident of the month and they always ring up and ask if there is anything they are not doing and should be doing.”

The provider did not always ensure people’s rights were upheld in line with the Mental Capacity Act.

Staff did not always understand the need to assess a person’s capacity when considering restrictive practices, despite the registered manager telling us, “I’ve applied for a Deprivation of Liberty Safeguard (DoLS) for practically everybody unless they’ve had capacity.”

Mental capacity assessments and best interest decisions were carried out. However we found this was inconsistent, and some were not always decision specific. The information lacked sufficient detail, and did not clearly document the questions asked or any consideration of less restrictive options. One person did not have an assessment for them living at the service with locked doors and another person did not have any for the one-to-one staffing they had or the sensor mat which was in their room. This meant decisions about people’s care and restrictions were not always made in line with legal requirements

However, assessments had been completed for some people in relation to living in an environment with locked doors and the use of bed rails or sensor mats.. Those involved in a person’s care, outside of the service were included in the final decision to ensure that any restrictions were made with the person in mind. This included where people were on covert medicines (medicines given to them without their knowledge). Decisions around this involved the GP and pharmacy to help ensure the medicines were prepared in a safe and suitable way for the person.

Staff did understand the need to gain a person’s consent, however. A staff member told us, “We need to give them choices and what things they want such as lunch. And make it easy for people to answer by offering only a few choices at a time. If people are not able to communicate, we still tell them what is happening and explain it.”