Tilford Care & Nursing Home

“We identified concerns in relation to people’s care records. Records were not always contemporaneous or sufficiently detailed, and to support staff to deliver person-centred care. Monitoring records for people at risk of constipation or weight loss were not consistently completed, which meant there was a risk that changes in people’s health needs may not be identified or responded to in a timely way.”

“We observed poor moving and handling practices which placed people at risk of harm. Staff did not always demonstrate a dignified approach when supporting people and did not consistently treat people as individuals or support them to make choices about their care”

“At lunch time people did not always get the support they needed in a timely way due to ineffective staff deployment. We also found concerns in relation to the safety of the environment and infection prevention and control. Staff did not always follow safe practices, increasing the risk of harm to people. Medicines were not always managed safely, and associated records were inconsistent.”

“The provider’s governance systems were not effective in identifying and addressing these issues. The shortfalls we identified had not been recognised by the management team, indicating a lack of robust oversight.”

“We found the service in breach of regulations related to safe care and treatment, dignity and respect and good governance.”

“There were some positive aspects of the service. Staff understood how to recognise and report safeguarding concerns and told us they felt confident to do so. Accidents and incidents were reviewed to support learning. Staff worked collaboratively with external health and social care professionals to help ensure people received appropriate care and support.”

“Staff spoke positively about working at the service and told us they felt supported by their colleagues and managers. They had opportunities for supervision and felt there was good teamwork. The management team demonstrated a willingness to learn from the concerns identified and had begun to develop an action plan to address the issues highlighted during the assessment.”