Tilford Care & Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people’s needs were met through good organisation and delivery.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

did not consistently ensure people were at the centre of their care and treatment choices or work in partnership with them to respond to changes in their needs.

Staff may not be able to provide person-centred care due to a lack of information. Staff had not been provided with personal, social life histories about people which limited staff’s ability to understand people as individuals and deliver personalised care

One person who experienced distressed behaviour, could be rude, shout and may kick out if people got too close to them, was not consistently monitored or supported by staff. This increased the risk of the person becoming distressed and posed a risk to others.”

During the morning, they were sitting close to a person and at times were shouting and speaking loudly, but staff were not always in the lounge to help ensure this person did not reach a state of agitation, increasing the risk of them potentially hurting someone else. Although there was a risk assessment in place, which stated staff should monitor them during the day there was no information about potential triggers. This person was also recorded as going into other people’s rooms at night and taking their belongings, yet there was no risk management measure listed in relation to this, which meant staff did not have clear guidance on how to respond or reduce this risk. Another person could be physically aggressive and although they had consistent staff support during certain times of the day there was no information regarding what staff should do if they became aggressive. This person regularly attempted to leave the service, however, there was no information or wording for staff to use in response to their requests, which would enable a consistent approach from the staff team, as 1 staff member responding in one way while another responding differently could cause confusion or escalation.

This meant care plans and risk assessments did not contain enough practical, person-specific information to help staff understand individuals, anticipate problems, and respond consistently and safely to people’s needs in a person-centred way.

Despite our findings 1 person told us, “The staff are super” and that they felt staff knew them and how they liked their care.

The provider understood people’s diverse needs and worked with partners to support joined-up flexible care,

Staff supported people through their links with the local area. This included links with the local Muslim community, the local parish church, taking people to the nearby ponds and involving professionals when running in-house competitions. One person attends the local church group, and previously another person used to go to a nearby day centre.

The registered manager told us that, as far as possible, they did not use agency staff, but when this was needed, they used regular agency staff who knew the service.

Staff worked alongside a range of professionals to co-ordinate people’s care. A professional told us, “I have and continue to work closely with both the manager and deputy in relation to support and sharing of information. I find both extremely responsive and knowledgeable about those individuals living in the home and clear in relation to legislation and regulations in place to support the individuals living in the service.”

The provider provided people with appropriate, accurate and up-to-date information tailored to their individual needs. People received information to enable them to make choices during the day. This included a pictorial menu and pictorial activity sheets. This supported people to understand their options and make informed choices.

The registered manager shared information with relatives through emails and newsletters, and invited them to be involved in reviewing people’s care plans through the ‘resident of the day’ process.. This was confirmed by 1 relative who told us they were consulted on their family member’s care plan and, “I have a good dialogue with staff.”

People were provided with information on how to raise a concern of a complaint about the service or the care their family member was receiving. One relative told us, “We have no concerns so far.” Another said, “Communication is prompt.”

The service worked with professionals by providing information to support collaborative working. One professional told us, “I have and continue to work closely with both the manager and deputy in relation to support and sharing of information. I find both extremely responsive and clear in relation to legislation and regulations in place to support the individuals living at the service.”

The provider provided accessible ways for people to share feedback, raise concerns and be involved in decisions about their care. This demonstrated that feedback was valued and acted upon in a timely way.

Although meetings were held for people and relatives, attendance was not always high.

One person said, “We don’t have meetings. Would be nice if we did.”

Despite this, people and relatives had other ways of giving feedback or being involved. There was a suggestion box, and the registered manager’s door was always open. A relative told us, “There was a suggestion box and they took a suggestion I made and ran with it. If I had a problem, I would speak to the nurse or admin.” Another relative said, “We regularly receive a call to confirm that we are happy with mum’s care and if we have any concerns it’s an opportunity to discuss or be referred to someone who can answer any questions we may have.”

Staff listened to people’s feedback. One relative mentioned their family member’s air mattress had deflated resulting in their relative having an uncomfortable night's sleep. This was resolved for them the following day. We also heard another relative tell a member of staff that their family member had no clean nightwear. The staff member offered to go to the laundry immediately to see if there were some freshly washed ones available that they could bring back to the room.

The provider ensured people could access the care, support and treatment they needed in a timely way.

Staff worked effectively with the GP and other services to support access to healthcare when needed.

Staff used the service minibus to support people to attend external healthcare appointments, with a member of staff accompanying them where required. For example, where a family member had planned to take their relative to a dental appointment, staff undertook this to reduce potential anxiety for the person.

One person’s daily notes evidenced staff making sustained efforts to access a range of healthcare professionals to support the person when they experienced health concerns. Staff demonstrated persistence by making repeated phone calls and following up as needed, even when they encountered difficulties in contacting the appropriate services and professionals.

Professionals told us staff supported people appropriately. One professional told us, “The manager and deputy are both fantastic advocates, as are the staff for the people they support. I find that collaborating with the service to try to get the best support for individuals is always the best possible outcome.” This demonstrated strong advocacy on behalf of people to ensure their health needs were met.

Staff and leaders did not consistently listen to or act on information about people who were most at risk of experiencing inequality in their care and engagement. This meant people who were less mobile or who remained in their rooms experienced reduced opportunities for engagement and stimulation.

Although people were supported to attend external appointments, we found activities and engagement within the service was lacking. There was also little engagement for people who spent all of their time in their rooms. People told us, “There is nothing to do and I don’t know what would happen without family visits”, “There is nothing much to do all day. I get bored, we are watching too much TV and the light reflects off of it (which affects being able to watch it properly)” and “I get sores on my bottom from just sitting here all day. I am bored.”

Staff said that although there were activities, they also felt more could be done. One told us, “We did a lot before, but they are looking for a new staff member.”

At 11:40 we asked staff what activity was taking place today and were told they would find out at the 11:00 meeting, despite it being past this time already. Staff later said they would lead activities, and although there was an attempt at a bingo game in the afternoon, we did not observe any other activities taking place, or staff spending time with people in their rooms. Despite this, external entertainers did come into the service, however, and 1 relative told us, “She is into everything. She is always involved in the activities. She is able to move around.”

The registered manager was aware of the need to develop activities within the service, as they told us they were currently looking for an additional member of staff.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People had care plans in place to record their wishes for when they were approaching the end of their life. However, some plans would have benefitted from further detail, as they focused primarily on people’s medicines rather than their wider preferences and wishes. Other people had ReSPECT forms in place, which provided clearer guidance regarding their care and treatment in the event of an emergency.

Staff worked with local services, including the hospice and clinical professionals, to support people at the end of their lives, helping to ensure care was coordinated and aligned with people’s needs.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People had care plans in place to record their wishes for when they were approaching the end of their life. However, some plans would have benefitted from further detail, as they focused primarily on people’s medicines rather than their wider preferences and wishes. Other people had ReSPECT forms in place, which provided clearer guidance regarding their care and treatment in the event of an emergency.

Staff worked with local services, including the hospice and clinical professionals, to support people at the end of their lives, helping to ensure care was coordinated and aligned with people’s needs.