CQC report explained · a nursing home
What the CQC found at Tithe Farm Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Risks, staffing, recruitment, medicines, infection control and accidents were managed more safely than at the previous inspection, although nurses' medicines competency assessments had not yet been completed.
- Effective?
- Good
- Staff received more regular training and supervision, and people received suitable support with food, drink and healthcare. Inspectors noted that specialist training for complex needs, including choking risks, was not yet in place for staff.
- Caring?
- Good
- People and relatives gave consistently positive feedback. Inspectors saw kind, respectful care, including staff explaining care, protecting privacy and encouraging people's independence.
- Responsive?
- Good
- Care was personalised and activities were provided in groups or one to one. Complaints systems had improved, but end-of-life plans did not always record people's wishes and some information was not available in accessible formats.
- Well-led?
- Good
- Management oversight and audits had improved, with a new compliance audit and service improvement plan. The report also notes recent management changes and says staff and relatives gave positive feedback.
What inspectors found, January 2019
Tithe Farm Nursing Home is rated Good; inspectors found safe, kind and personalised care, with some improvements still needed in dementia-friendly surroundings and end-of-life planning.
Inspectors visited without notice on 8 and 9 January 2019. They spoke with people living there, relatives and staff. They observed care and reviewed care records, staff files, audits and other management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. People were protected from avoidable harm, received kind care and were supported to maintain their independence. Staff worked with health professionals when people needed further support.
The home had improved since the previous inspection, when it was rated Requires Improvement. Inspectors found better safety checks, staff training, complaints handling and management oversight. They made recommendations about the environment, specialist training, medicines competency and accessible information. End-of-life plans were also not always detailed enough.
Kind and respectful care
Inspectors saw compassionate support and found that staff respected people's privacy, dignity and choices.
“We observed people continued to receive kind and compassionate support from staff.” from the report
Improved safety
The home had acted on earlier concerns about risks, staffing, recruitment and premises. Call bells were answered promptly and no falls had been reported since September 2018.
“At this inspection, we found the service had taken some steps to improve the safety of people's care.” from the report
Personalised support
Care plans included people's interests, communication, emotions, health and social needs. People who did not want group activities could receive one-to-one support in their rooms.
“People continued to receive personalised care.” from the report
Food and clinical support
Nutrition and choking risks were assessed. The home used modified diets and thickened drinks where needed, and worked with outside health professionals.
“People had correctly modified texture diets where there were risks of choking.” from the report
Stronger management systems
New audits and a service improvement plan gave managers more information about safety and quality, and helped them track actions over time.
“The results from the management team's new governance checks ensured that the provider received more detailed information about the safety, governance and performance of the service.” from the report
End-of-life plans
needs fixingSome plans did not contain person-centred details, and people's preferences or wishes were not always recorded. The home manager said this would be improved.
“The service had not always recorded end of life preferences or wishes.” from the report
Dementia-friendly environment
needs fixingThere was limited signage for bedrooms, bathrooms and communal areas. Inspectors recommended reviewing guidance for dementia-friendly environments and continuing investment in some areas.
“There was a lack of appropriate signage in all areas of the service.” from the report
Specialist staff training
needs fixingStaff had general training, but inspectors found no focused training for some complex needs, including diabetes, epilepsy, mental health conditions and choking risks.
“There was no focused training in these areas to support staff.” from the report
Medicines competency checks
needs fixingNurses had medicines training, but the home had not yet completed competency assessments for registered nurses. Inspectors recommended that this should be done.
“At the time of our inspection, the service had not completed any staff medicines competency assessments for registered nurses.” from the report
Accessible information
minorThe home had taken some steps to support communication needs, but accessible information was not fully embedded. Complaints information was not in pictorial or large-print form.
“The use of pictures was not widely adopted throughout the building.” from the report
- 01What changes have been made to signs and other parts of the building to make them more suitable for people with dementia?
- 02How do you now record and review each person's end-of-life wishes and preferences?
- 03What specialist training do staff receive for choking risks, diabetes, epilepsy and mental health conditions?
- 04How are registered nurses' medicines skills checked and recorded?
- 05How can people with hearing, sight or cognitive difficulties access the complaints process and other important information?
This was an unannounced inspection covering all five key questions, so all five ratings were assessed and updated from Requires Improvement at the previous inspection. This explanation was written from the published report of 26 January 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2017
Rated Requires Improvement; inspectors found kind care and safe medicines, but staffing, risk management and leadership needed urgent improvement.
Inspectors visited without notice on 24 and 25 October 2017. This was a comprehensive inspection, brought forward partly because of complaints from members of the public. They spoke with people, relatives and staff, observed care, checked medicines, care records, staff files and management systems.
The home was caring in its approach. People were treated with respect and dignity. Food, drink and access to health professionals were appropriate. Medicines were managed safely. However, inspectors found risks were not always assessed or reviewed properly. Staffing levels were not always enough, some call bells were not answered promptly, and staff training and supervision were incomplete.
The home also needed to improve how it handled complaints, accidents and incidents, and how its managers checked that improvements lasted. The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. Caring was rated Good.
Kind and respectful care
Inspectors saw staff being kind and respectful. People’s privacy and dignity were protected during personal care and conversations.
“People received care from kind staff who treated them with respect.” from the report
Food and healthcare
People had suitable food and drink, with choices and alternatives. Records showed access to professionals such as GPs, opticians, audiologists and podiatrists.
“People and relatives we spoke with felt the food and drink provided by the service was good.” from the report
Medicines management
Medicines records were correctly completed. Controlled medicines, storage temperatures and nurses’ competence checks were also reviewed.
“People's medicines were safely managed at the service.” from the report
Incomplete risk assessments
seriousSome risks were not recorded or reviewed often enough. This included falls, pressure sores, challenging behaviour and other high-risk areas.
“We found the completion of people's risk assessments required improvement.” from the report
Staffing and call bells
seriousInspectors found times when there were not enough staff to keep people safe or respond promptly. Some call bells were out of reach and some calls were not answered for considerable periods.
“This meant people's calls for help were not always responded to in a reasonable timeframe.” from the report
Training and supervision
needs fixingSome staff had not completed required training. Supervision was irregular, and some staff had not received any supervision during 2017.
“This meant staff did not always receive appropriate support from their managers and were unable to discuss their aims, objectives and performance.” from the report
Complaints were not fully investigated
needs fixingThe home had a complaints process, but verbal concerns were not recorded and complaints reviewed by inspectors did not have proper investigation notes or outcomes.
“The service had not completed notes, investigation reports or reached outcomes with regards to the complaints we reviewed.” from the report
Weak management checks
seriousManagers had introduced more audits, but accident and incident records did not match the care records. The home could not reliably use its systems to prevent problems happening again.
“This showed that the incidents and accidents were not correctly calculated by the management team.” from the report
- 01What has changed to make sure every resident's falls, pressure sore and behaviour risks are assessed and reviewed on time?
- 02How many staff are now deployed during the evening, night and lunchtime periods, and how do you monitor call-bell response times?
- 03How do you check that all staff have completed required training and receive regular supervision?
- 04How are complaints, including verbal concerns, recorded, investigated and followed through to an outcome?
- 05How do managers now reconcile accident and incident records and make sure actions from audits are completed?
This was an unannounced responsive comprehensive inspection of the home and its care, covering all five CQC questions and prompted partly by public complaints. This explanation was written from the published report of 28 December 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Tithe Farm Nursing Home
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- January 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2016Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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