CARE HOME ADULTS 18-65
Tanglewood Larch Avenue Holbury Southampton SO45 2PB Lead Inspector
Craig Willis Unannounced 18.04.05 12:55 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Tanglewood Address Larch Avenue Holbury Southampton SO45 2PB 02380 243091 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) New Support Options Ltd Ms Diane McCarthy CRH 5 Category(ies) of Learning Disability 5 registration, with number of places Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Residents in the category LD are only to be admitted between ages of 18 years and 65 years Date of last inspection 22.11.2004 Brief Description of the Service: Tanglwood is registered to provide care and accommodation for five adults with learning disabilities between the ages of 18 and 65. The home is managed by New Support Options and is owned by Swaythling Housing Association. The home is situated in a residential area of Holbury, close to local amenities such as shops and transport services. The home has a car that service users are able to access when there is a member of staff registered to drive working. The home has five bedrooms, four on the first floor and one on the ground floor. There are two lounge rooms, a dining room, kitchen, a bathroom and a shower room. The home has a large enclosed garden to the rear. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first statutory inspection of the year April 2005 to March 2006 and took place over five and a half hours. Three of the service users were spoken with during the inspection and the inspector met with the manager and one member of staff. A tour of the communal areas of the home took place and the inspector saw the bedrooms of two service users. What the service does well: What has improved since the last inspection?
Great improvements have been made to the home since the last inspection. People living at the home now have an up to date care plan that sets out how staff should support them. Carpets and furniture in both of the home’s lounge rooms have been replaced, new wooden flooring has been laid in the dining
Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 6 room and damaged plasterwork in the hallways has been repaired and redecorated. The manager is meeting all her staff for formal supervision meetings and staff say they feel supported by the manager. Changes in the people living in the home mean that food is not now locked away and people are able to eat and drink when they want to. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and5 The home’s assessment process and information supplied to service users is good and enables an informed decision about admission to the home. EVIDENCE: Since the last inspection one new service user had moved into the home. This service user said that they had visited the home on two occasions before moving in, meeting the staff and service users. Records indicated that one of these visits had been an overnight stay. The manager had met the service user before these visits to complete needs and risk assessments and copies of the care management assessment were available on the service user’s file. The service user had been supplied with a statement of terms and conditions of residence, which set out the fees, room to be occupied, services provided and the rights and responsibilities of service users and staff. A statement of purpose is available, as is a service users’ guide, which has been made more accessible by the use of pictures and symbols to aid understanding. The service user confirmed that they were aware they would not be able to smoke in the building before they moved to the home. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 There are clear care planning and risk assessment systems in place, which provide staff with the information required to meet the needs of service users. EVIDENCE: The care plans of three of the service users were viewed during the inspection and action had been taken since the last inspection to ensure information on how to meet the assessed needs of service users was available. These plans were drawn up from the needs assessment and had been reviewed on a monthly basis. The manager reported that training was being provided for staff and service users on the introduction of person centred planning, and one service user had devised a draft person centred plan with the help of external facilitators. Risk assessments had been completed for all service users and had been reviewed monthly. The assessments included action that staff should take to minimise the identified risk. It was noted that the daily record diaries that staff completed for service users did not always contain information that was relevant to meeting the needs of service users and therefore not useful in reviewing the care plans and risk
Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 10 assessments. The manager agreed to ensure staff were given training in the use of these records. This will be followed up at the next inspection. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14, 15 and 17 The home offers service users a good range of educational and leisure opportunities and encourages service users to maintain family relationships. Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: Service users were supported to attend sessions at a local day service and a college. Those spoken with said that they enjoyed the courses they attended. One new service user said they were keen to start attending a local day service and the manager reported that this person had visited the service and a planning meeting with their care manager was to be held the following week. Service users spoken with said that they enjoyed going to the pub and to a local car boot sale. The manager reported that service users also attend a local club, bowling and horse riding. Evidence was seen of family involvement in care planning and service users were supported to maintain contact with family and friends.
Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 12 The home has a planned menu that provided a balanced and varied diet. Service users spoken with said they liked the food and were able to have alternative meals if they wanted. Since one service user moved out of the home, service users are able to access food at any time as there are no longer locks on the cupboards and the fridge. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The personal and health needs of service users are met with evidence of access to a range of NHS services. The medication system at the home is well managed, which protects service users. EVIDENCE: Records indicated that service users were supported to attend a range of health services including, GP, dentist, optician, neurologist, psychiatrist and the community nurse. Records of appointments contained details of the advice given by the practitioner. Two service users spoken with said that they received the support that they needed and in the manner they prefer. The medication administration records had been fully completed and medication was appropriately stored in a locked cupboard in the office. Records were available of medication received, administered and returned to the pharmacy and the stock of medication matched the records. Staff had received training in the administration of medication, which included an assessment of their knowledge and practice. This assessment was repeated every six months. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a satisfactory complaints procedure which service users knew how to use. Suitable procedures are in place at the home to protect service users from abuse. EVIDENCE: The home had a complaints procedure available which sets out who will investigate a complaint, the time within which a complainant can expect a response and the contact details of the Commission for Social Care Inspection. The procedure was available in a picture and symbol format to aid understanding. Two of the service users spoken with said that they would talk to their keyworker or the manager if they had a complaint. No complaints had been received since the last inspection. The home had suitable adult protection procedures in place and the manager demonstrated a good understanding of the operation of the POVA list. Money that the home looked after for two service users was checked and the balance recorded was found to match the balance held. Receipts were available for expenditure made on behalf of service users and the money was individually stored in a safe. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 25 Recent investment has significantly improved the appearance of the home creating a comfortable and safe environment for service users. EVIDENCE: Since the last inspection new carpets have been fitted in the two lounge rooms and new wooden flooring has been fitted in the dining room. New sofas and chairs have been bought for the lounges and damaged plasterwork in the hallways has been repaired and redecorated. Two service users’ bedrooms were seen and they reported that they had been suitably furnished and decorated to meet their needs. Both of the rooms seen had been personalised by the service user and contained a bed and good quality bedding, a wardrobe, chest of drawers, a sink and a bedside cabinet with a lockable space. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 36 The recruitment procedures at the home are good with sufficient and wellsupervised staff available to protect and support service users. EVIDENCE: The recruitment records of three staff were checked and found to contain two written references, an application form, full work history and evidence of qualifications. There was a record of an enhanced Criminal Records Bureau disclosure in place for all staff. The manager reported that she was keen to involve the service users in future recruitment interviews for staff and one service user was undertaking training to interview for staff. Since the last inspection the manager has been meeting with staff to provide formal supervision every two months and staff spoken with confirmed that they met with the manager and felt supported by her. The home had a rota, which indicated which staff had covered shifts. Generally the home had two staff between 7.30am and 3pm, two staff between 2.30pm and 10.30pm and two staff ‘sleeping-in’ between 10.30pm and 7.30am. In addition to this, extra shifts were used to enable service users to take part in their planned activities. Service users spoken with said that there were enough staff to meet their needs.
Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home has good systems to ensure the safety and welfare of service users. EVIDENCE: The home had records of the fire alarm system being serviced within the last month and that staff were conducting weekly checks of the alarm. There had been two fire drills in the last year and staff and service users had received fire safety training twice in the last six months. The home had current gas and electric safety certificates. The fridge and freezer temperatures were taken and recorded and food was suitably stored. The home’s water system had been checked for legionella. Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x x x x Standard No 11 12 13 14 15
Tanglewood x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x 3
Version 1.20 Page 19 H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc 16 17 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 20 No Are there any outstanding requirements from the last inspection? 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. 1. 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. Refer to Standard Good Practice Recommendations Tanglewood H54 S12373 Tanglewood V218880 18.04.05 stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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