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

People who were admitted into contract beds did not always have clear goals to achieve recorded within their care plans. However, people’s needs were appropriately assessed before they moved into the service. The service worked closely with health professionals to monitor people’s health and care needs. Peoples rights were protected as staff were knowledgeable around the Mental Capacity Act 2005. Best interest decisions were made in conjunction with people who knew the person well to ensure their wishes were considered. People were encouraged to make decisions around their care where possible.

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’s needs were assessed before the moved into the service. One relative told us, “We went all through his life history at the beginning.” Another relative said, “Before [person] moved in, they asked me questions about his needs.” Relatives confirmed that this was also an ongoing process with regular care plan reviews. One relative told us, “They have a resident of the day, so they call us every few weeks to check we’re happy with the care.”

Staff spoke to people about their life histories to understand any needs that may be particular to them. One staff member said, "I enjoy talking to [people]; I like to find out what sort of past life they have had." However, this was not always documented in people’s care plans. When we advised the registered manager of this she assured us this would be addressed in a timely manner.

A ‘Resident of the Day’ system allowed for staff to conduct and in-depth review a person’s care plan and environment on a regular rolling basis. When a person was the ‘resident of the day’, staff called their family members to gain feedback and to gather additional information on their past to help deliver personalised care, as well reviewing all aspects of the person’s care plan.

People’s lunch time experience was made comfortable by staff sitting next to them and engaging in friendly and humorous conversation while supporting them.

Kitchen staff ensured they were knowledgeable in people’s dietary needs. One staff member told us, "We have a list of what is required for each person, and we have boards on the walls, so we know who needs what. We have it all labelled and colour-coded, and we know all the different levels [consistencies of food]; we have all that on a board."

People’s needs were met through evidence-based treatment. For example, those who required modified texture diets received them, as well as staff supporting those who required assistance with eating.

Staff worked together to improve people’s wellbeing. For example, whilst some staff were engaging a group of people in various activities such as ball games and bingo, other staff were supporting people to have their nails painted. Relatives commented on the range of activities available to people. This was due to staff working alongside external providers to provide entertainment to people. One relative said, “There’s been animals here, there’s always something on in the garden in the summer like singers.”

Staff told us by working well as a team they were able to ensure people received good care. One staff member told us, “We work well as a team. Everybody is willing to teach you the right way of doing things." Another staff member told us staff meetings were used useful as, “We need to know if the staff are having any concerns, or anything new we need to tell them - we need to make sure they are all on the same page if we are doing something in a new way." Staff working well together extended to supporting each other to get to work. One staff member told us they used the transport provided by the service. They said this was very useful to them and not having access to this may mean they could not work at the home. A member of staff who was able to drive the service’s transport was available 7 days a week. This meant people were able to access the community throughout the week.

The nurse practitioner said a lot of people were admitted to the home from hospital with poor mobility or poor mental health as this had declined during their time in hospital. The nurse practitioner said the home worked with her to provide the individual care people needed to improve their overall health and wellbeing. They said, "We come up with a plan, and we discuss it with the patient and the family. The family and the patient will tell me what they want, and we go from there, and I work with the staff here to help them achieve that."

People’s needs were met through evidence-based treatment. For example, those who required modified texture diets received them, as well as staff supporting those who required assistance with eating.

People felt supported to live healthy lives. The main way people and their relatives felt this was encouraged was through people’s nutrition. One person told us, “The food is very good, I don’t look thin do I, so it must be good!” A relative said, “The food looks very good, I get very jealous when I see it!”

An activities coordinator was in place to help boost the mental wellbeing of people at the service. A staff member told us, “[Activities coordinator] does the weekly [activities] planner. We have pets as therapy (said this included goats, rabbits and donkeys). We have events for families like barbecues. We have a singer every week. Music works very well for people with dementia. It is the favourite thing for a lot of people." Another staff member told us, “There are trips out now and then. They have been to the garden centre nearby for coffee and cake. The Museum of Rural Life is nearby and there was a trip to see that." The registered manager told us, “It’s important staff spend time with people in their rooms if they did not enjoy participating in the group activities or rarely left their rooms.”

There were links with external professionals such as a nurse practitioner who visited the service for a whole day each week. This allowed opportunities for pathways to additional professionals such as the speech and language team to be referred to without delay.

Relatives did not always feel people’s outcomes were monitored appropriately. This was especially evident in those who were in temporary beds contracted by the local authority and Integrated Care Board (ICB) as a step to that person returning home from hospital. One relative told us, “Theres no mention of what her goals are or when to aim for to get her home. “ However, the nurse practitioner from the local GP surgery visited the home on Thursdays. This allowed for people to receive regular checks on their health and rehabilitation in order to ascertain when they would be able to return home if in a temporary step down bed.

Staff were able to confirm and describe the use of the block contract beds, and the types of goals people who used them would like to achieve.

Care plans of those who were in contracted beds did not always include goals or outcomes they needed to achieve to live independently again. We raised this with the registered manager who told us they would resolve this immediately.

People were supported to make decisions around their care wherever possible. One relative told us, “Mum can’t think for herself but still knows us. She probably chooses her own clothes as she’s in the colours I know she likes.” Another relative said, “[Staff] give them a choice of food by using pictures. They let them choose the day before. Staff give him choices of if he’d like to join in with activities too.”

Staff had a good knowledge of the Mental Capacity Act 2005 and its application in their day to day work. One staff member told us the importance of gaining consent, adding “Thats the first thing you have to do before anything." Another staff member told us of the importance of giving people choices in the day. They said, “When I am supporting them to get dressed, I show them a variety [of clothes] to make a choice from - which one would they prefer? We ask where they would prefer to sit, we ask them what they would like to eat. It is all about giving them choices."

Decision specific mental capacity assessments were in place where people lacked capacity to make certain decisions, such as where they live or receiving personal care. Where the person lacked capacity to make these decisions, best interest meetings had been documented. These included information such as who had attended the meeting and how it had been decided that the decision taken was the least restrictive option. Where people required to be deprived of their liberties independence, Deprivation of Liberty Safeguards (DoLS) had been applied for by the service.