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Inspection on 14/12/05 for Tanglewood

Also see our care home review for Tanglewood for more information

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This inspection found that the residents at Tanglewood are treated with courtesy and respect; this helps the residents to feel secure and confidant that they will be well cared for and that their views matter. The care, care staff and food at Tanglewood were highlighted by residents as being very good; two of the residents spoken with said these were some of the things that helped them decide to choose Tanglewood as their long-term home. The atmosphere at Tanglewood continues to be warm, caring and open, which helps residents` at home. The house had been decorated for Christmas; residents spoken with appreciated the staff`s efforts. The manager has good working relationships with health care staff. Local health care services are involved in residents care and equipment to assist residents is provided as necessary, this both prevents residents developing health problems and assists in caring for residents who have or do develop health problems in the most appropriate and up to date way. This gives residents, relatives and staff confidence that residents` health and social care needs are well managed and understood by the manager and staff. The residents are well cared for by staff that are willing to go on training courses. The manager supports staff to attend training courses and makes sure that training opportunities for staff are seen as an important part of care skills development that will benefit residents.

What has improved since the last inspection?

This inspection found that since the last inspection improvements have been made in the following areas: All staff have now received some training in the protection of vulnerable adults, this will help to reduce risks and protect residents. The hot water temperature at Tanglewood is now safely controlled which reduces the serious risk of scalding to residents. Radiators at Tanglewood are now all covered which reduces the risk of scalding to residents. Regular fire drills and fire training are now in place, which will help to improve staff knowledge and confidence and help to reduce serious risk to residents and staff in the event of a fire. The assessment that the manager completes before a person moves to Tanglewood is now properly recorded and kept on record and provides a valuable record of a residents abilities before living at Tanglewood. Regularly reviewed risk assessments are now on record for each resident these will help to clearly show what risks there are for each resident and how these risks can be reduced.

What the care home could do better:

This inspection found areas for improvement, which are: The monthly review of residents care plans should be clearly recorded, this will show that care needs are regularly reviewed and where necessary updated, this gives residents and staff confidence that there is good written communication about care needs that can be followed. Health and Safety assessment for the risks of asbestos must be done to protect residents and staff.

CARE HOMES FOR OLDER PEOPLE Tanglewood Limers Lane Northam Bideford Devon EX39 2RG Lead Inspector Adele Adams Announced Inspection 14th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tanglewood Address Limers Lane Northam Bideford Devon EX39 2RG 01237 473147 01237 473147 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Andrew Philip Frederick Tucker Mrs Alison Margaret Tucker Miss Hilary Joan Seymour Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (17), Old age, not falling within any other category (17) Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. DE(E) Dementia - over 65 years OP Old Age MD(E) Mental Disorder - over 65 Date of last inspection 4th May 2005 Brief Description of the Service: Tanglewood is an older style detached property standing within its own large secluded gardens in a quiet residential area. The facilities of Northam and Bideford and the seaside villages of Westward Ho! And Appledore are nearby. Tanglewood is a care home registered to meet the needs of seventeen service users aged over 65 and those with a dementia type illness. The home can offer accommodation in a shared room if required; this occurs only when this is the stated choice of the rooms occupants and the homes criteria on shared rooms is fully met. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This inspection was announced starting at 10:10 and ending at 13:45. The inspector viewed areas of the home; this included viewing some residents rooms, a bathroom, dining room, lounge and conservatory. The inspector spoke generally with residents and one to one with two of the 14 residents and the two members of care staff on duty. The inspector observed and spoke with staff and residents and read residents care records, staff records, the home’s handbook that provides the homes policies and procedures and spoke briefly with the owners of the home. What the service does well: What has improved since the last inspection? Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 6 This inspection found that since the last inspection improvements have been made in the following areas: All staff have now received some training in the protection of vulnerable adults, this will help to reduce risks and protect residents. The hot water temperature at Tanglewood is now safely controlled which reduces the serious risk of scalding to residents. Radiators at Tanglewood are now all covered which reduces the risk of scalding to residents. Regular fire drills and fire training are now in place, which will help to improve staff knowledge and confidence and help to reduce serious risk to residents and staff in the event of a fire. The assessment that the manager completes before a person moves to Tanglewood is now properly recorded and kept on record and provides a valuable record of a residents abilities before living at Tanglewood. Regularly reviewed risk assessments are now on record for each resident these will help to clearly show what risks there are for each resident and how these risks can be reduced. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Each new resident has a pre admission assessment on file; this helps to show that at the time of moving to the home, that Tanglewood was the right choice of home and that the services provided could meet the known care needs of the prospective resident. EVIDENCE: The inspector read two pre admission assessments of prospective residents and spoke with the manager who confirmed that each prospective resident is visited in person and has a needs assessment undertaken either in the persons own home or in hospital. The inspector also saw evidence of documentation from other agencies such as social services and hospitals that provide additional care needs assessment information. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 A good care planning system is in place, which makes sure residents health; personal and social needs are clearly recorded and met in a respectful and dignified way. The monthly review of these care records however is not evident. EVIDENCE: The inspector read x3 residents care records and could not find a record that shows that a monthly review of care needs is carried out. The inspector spoke with the manager who advised that reviews do take place but are not clearly recorded. A key worker informed the inspector that key workers carry out reviews of care and that they do this ‘every few months’. Another key worker told the inspector that they review care on a monthly basis. The residents spoken with could not confirm whether or not staff talk to them about the care they receive. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X EVIDENCE: X Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Appropriate action is taken by the home to safeguard residents from abuse. EVIDENCE: The inspector spoke with care staff, spoke with the manager and read documentation signed by staff to declare they have read and understood the Adult Protection guidelines. The manager advised the inspector of the advice she had received in relation to ‘rolling out’ the training she had received to staff at the home. The manager advised that all care staff have seen the ‘No Secrets’ video and have read and understood the Adult Protection guidelines. Two staff were spoken with and confirmed they had done this. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 24 Tanglewood is a safe and pleasant home for residents to live in. EVIDENCE: The inspector toured parts of the home with the manager and observed that following the previous inspection, that all hot water supplies in the home (except for the kitchen) are now fitted with thermostatic valves that regulate the water supply. The inspector ran a hot tap and the water was comfortably warm. The inspector met the maintenance man for the home and saw documentation demonstrating contractual maintenance checks have been undertaken. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Staff are busy but are able to make time to respond in a timely and respectful manner to residents needs. Staff receive training to ensure they have the skills necessary to meet residents needs. EVIDENCE: The inspector spoke individually with the manager, staff, deputy manager and residents and was advised all confirmed that the current staffing levels meet the needs of the current residents. The inspector was advised that 16 staff are employed at the home and of these, 11 staff either have completed or are undertaking NVQ Level 2, 1 member of staff has completed NVQ Level 3, 1 has almost completed NVQ Level 3 and 1 has just begun NVQ Level 3, the Registered Manager is undertaking NVQ Level 4. The inspector saw evidence of training in staff records and staff spoke to the inspector about training they have received. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Certain areas of Health and Safety at Tanglewood must be improved. EVIDENCE: Standard 38 was revisited as recommendations and a requirement had been made at the previous inspection. The inspector spoke with the registered manager, toured the home and read maintenance records and saw that most contractual maintenance checks have been undertaken. The inspector saw that all radiators in the home are now protected with radiator covers, which will reduce the risk of injury to residents. The inspector randomly checked window openings on the upper floor after being advised all windows are now restricted on the upper floor- the inspector found the window openings checked to be restricted. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 16 A resident explained to the inspector how they tell the difference between the call bell and the fire alarm. The inspector saw evidence that staff had received suitable fire training in June 2005-12-20. The manager advised the inspector that the water had been tested in respect of Legionella and written evidence of this was provided the day following the inspection – in the form of a letter from the contractor. The inspector was advised that testing for asbestos at Tanglewood to meet Health and Safety legislation as identified at the previous inspection has not yet taken place. Notification in writing was also received in relation to this the day following the inspection – advising that this has been arranged for early in the New Year. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X 3 X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP38 Good Practice Recommendations The individual plan of care should be reviewed on a monthly basis – this should be clearly recorded. Assess risk of Legionella and asbestos to meet Health & Safety legislation. Health and Safety Executive (1993) Health & Safety in Residential Care Homes (HS (G) 104). Sudbury: Health and Safety Executive. Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tanglewood DS0000022174.V272991.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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