Tilford Care & Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff were aware of their responsibility to safeguard people from abuse and harm. Care plans and risk assessments were in place to guide staff on how to deliver safe care. There were sufficient numbers of appropriately trained staff, who had gone through a robust recruitment process. Medicines were managed safely, and the environment was clean and tidy. Lessons were learnt from accidents and incident to prevent reoccurrence.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives felt confident in the quality of the service and had no concerns. One person told us, “I haven’t got any worries here.” Another person told us, "I am very safe here." A relative said, “I was asked for feedback a few months ago by email. Management team are all very polite and friendly.”

The management team were able to confirm steps they took to ensure lessons were learnt following incidents. For example, following a recent incident the registered manager confirmed they were more proactive in assessing people’s pain levels and that this had been recorded on the lessons learned log. The registered manager told us, “We have reminded [staff] on so many occasions since through messaging, meetings, handovers how important the learning is from this incident.”

Lessons were learnt from accidents and incidents to prevent reoccurrence. These included incidents such as falls and medical emergencies. Any accident or incidents recorded on the provider’s internal system were reviewed by the management team so any trends in occurrences could be identified.

People and their relatives told us referrals to healthcare professionals were actioned when needed. One relative told us, “The GP has been called when he needs it. We’ve been asked if he wants a ‘flu jab. The GP visited the day after he returned from hospital to check how he was doing.”

The operations manager told us the provider has aimed to create a "positive and learning culture; we want the staff to report anything to us." This demonstrated systems being promoted to keep people safe in the service.

Partners told us the service was communicative and responsive when it came to supporting people. One partner told us, “They kept me informed of any issues and concerns they had, we worked well together.” Another partner told us, “They notice every bruise every mark. It could be a small blister or a skin abrasion. They will put a safeguarding referral in if they do not know how they have got it. They are very good at communicating with the families."

The service had a contract with the local authority to provide short term beds for people requiring discharge from hospital but were not yet ready physically to go home. These people were reviewed regularly to monitor their progress and assess their needs going forward. Additional training was also provided by external professionals, such as syringe driver training from the local hospice.

People and their relatives felt safe at the service. One person told us, “I’m very happy here.” Another person said, “Oh you won’t find much better than here, we’re very well looked after.” A relative told us, “I find it wonderful. We’ve had no safeguarding concerns at all since he’s been here.” Furthermore, a visiting professional confirmed “The people here always seem happy when I speak to them and never raise any concerns.”

Both had completed safeguarding training and knew how to report any concerns they had, including escalating these outside the home if necessary. What would you do if you were concerned about how a resident was being treated? "First I would report to my senior, the nurse in charge, or the management. If it was the management involved, I would have to go external." Said she would always report any concerns about a resident as, "We are here to protect them, to keep them safe."

We observed people receiving kind and compassionate care from staff. People who were feeling anxious were given appropriate support.

Safeguarding incidents were reported appropriately to the local authority. The management team were responsive in providing any follow up information required by the local authority in order for them to complete any necessary investigations.

On the whole, relatives told us people were supported to remain safe due to staff managing individual risks appropriately. One relative told us, “They found [person] sitting on the floor by the lift, but she hadn’t hurt herself. They did the right thing and told me and checked her over.” Another relative said, “People look safe when walking with staff.” However, one relative told us, “I asked to see [person’s] care plan and found it was very flimsy.” Despite this, we found no evidence that the person had come to harm due to this.

Staff were knowledgeable on people’s individual risks and how best to manage these. Staff were able to describe how the needed to support people with elements of their care such as their mobility and nutrition.

We observed people being supported safely according to their individual needs. For example, those who required support with their mobility received it. People who required modified diets received these in line with their risk assessments.

Care plans were detailed on individual care needs and provided advice and guidance for staff. These included areas such as communication, continence, tissue viability, personal care, and oral care.

People were receiving care with equipment that was clean and appropriately serviced.

Staff confirmed that replacement equipment was sought when required in order to keep the environment safe for people. For example, two of the service’s tumble dryers were out of order during our assessment. However, a staff member told us, “An engineer has visited and has had to order a part.”

We observed the environment was adapted to meet the needs of people to keep them safe. Corridors had automatic sensor lighting to support people to walk around the premises safely at night. Window latches were in place to provide security and safety. Some people’s rooms had gates across the entrance to manage the risks of people wandering in to other’s rooms.

Various processes were in place to ensure people could live in a safe environment. Fire safety checks such as emergency lighting and fire alarm tests were completed regularly. Hoists and other mobility equipment had been serviced as per manufacturer’s guidance. If any equipment such as wheelchairs were found with any defects, they were retired from service and new equipment purchased. Other health and safety checks such as legionella testing and water temperatures were completed in line with the provider’s policy.

People and their relatives told us there were enough staff to keep people safe. One person said, “The staff are very lovely, there’s always someone around.” Another person said, “If you have a problem at night, you have a bell to ring and they will come and sort you out; you are not left on your own." A relative told us, “The staff 100% are kind and caring. I can’t fault any of them.” Another relative echoed this, saying, “Staff seem to be attentive. There seems to be enough staff. Management team have been approachable.” Furthermore, a visiting wellbeing partner told us, “Theres always enough staff.”

Staff felt there were enough of them to deliver safe care. One staff member said, “If we are short-staffed, they ask the others [permanent staff] to step in. If no one steps in, they will call agency to come and support." Another staff member told us they had enough time to sit and chat with residents as well as providing their care. Staff also told us they had received the training they required for their role. These included training modules such as safeguarding, fire safety and infection prevention and control. For example, one staff member told us they had to keep up to date with their refreshers in mandatory training and specialist training was made available by the provider when needed. Emails were sent to staff to remind them when a training module was going out of date so they could complete the refresher module.

There were suitable numbers of staff to be able to deliver safe care. We observed various staffing roles taking time to engage with people, such as carers, the administrator and the regional manager.

Robust recruitment processes ensured staff were suitable to work with vulnerable people. This included conducting recruitment checks such as a disclosure and barring service (DBS) check and obtaining references from staff member’s previous employment. Staffing rotas demonstrated staffing levels were in line with the provider’s dependency tool. The provider’s training matrix confirmed staff were up to date with their training requirements.

People and relatives told us the home was always in a clean and orderly state. One relative told us, “The home is always clean and tidy.”

The registered manager was able to confirm the action they had taken to improve infection prevention and control since our last inspection. They told us, “It has changed our approach to infection control and we have constantly been working towards being compliant. We always have it as an item on our improvement plan to remind us and work towards.” Staff confirmed there was a housekeeping team on duty every day who completed cleaning checklists each day. This included deep cleaning of two people's bedroom each day.

We observed the service was clean and tidy with no malodours. Staff were observed cleaning people’s hands with wipes before lunch.

There was a cleaning schedule in place to maintain the hygiene of the service. Staff logged any concerns identified whilst cleaning the premises on a record which was then resolved in a timely manner. For example, when it was identified the carpet in a person’s room was in need of a deep clean, this was actioned within two days.

Relatives felt assured that medicines were managed safely. One relative told us, “I have no meds concerns; they seem efficient with that.” Another relative said, “We’ve discussed what medications [person’s] on and we’re happy.”

Staff confirmed that in order to ensure medicines were administered safely, only trained staff were signed off to do this. They told us, “I do not administer medications. Only the nurses and trained people are allowed to administer medication.”

Competency checks were completed annually to ensure staff members trained in medicines continued to be appropriately skilled in the task. Competency checks included confirming the staff member’s knowledge and understanding of person-centred care, preparation of medicines, completing medicine administration records (MARs). Storage of medicines were safe. Stock counts of medicines were correct, and controlled drugs were stored in a locked cabinet.