Tilford Care & Nursing Home

Updated 19 January 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

Tilford Care & Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. On the day of the inspection, the registered manager was on a period of leave.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The local authority and local hospital made us aware of concerns they had in relation to the quality of care provided to people. We attended local authority provider support meetings with representatives from the service and healthcare professionals. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experience of the care provided. We spoke with nine members of staff including the deputy manager, an operations consultant, nurses, care workers and the chef. We observed interactions between staff and people who used the service.

We reviewed a range of records. We looked at three staff files in relation to recruitment and staff supervision. We reviewed people’s medication administration records (MARs). A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We spoke with six relatives about their experience of the care provided to their loved ones. We spoke with three members of staff. We continued to seek clarification from the provider to validate evidence found. This included five people’s care records and multiple medication records. We looked at training data and quality assurance records. We received feedback from a healthcare professional and the local authority. We continued to attend the provider support meetings arranged by the local authority.

Updated 19 January 2022

About the service

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.