Inspection on 23/01/09 for Tanglewood

This inspection was carried out on 23rd January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tanglewood 05/02/07

Tanglewood 14/12/05

Tanglewood 04/05/05

Tanglewood 09/12/04

Tanglewood 16/06/04

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Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tanglewood Limers Lane Northam Bideford Devon EX39 2RG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Taylor     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Tanglewood Limers Lane Northam Bideford Devon EX39 2RG 01237473147 01237429229 tanglewoodrch@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Alison Margaret Tucker,Mr Andrew Philip Frederick Tucker Name of registered manager (if applicable) Miss Mandy Jane Bateman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 17. The registered person may provide the following category of service only: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 65 years or over on admission - Code DE(E) Old age, not falling within any other category - Code OP Mental disorder aged 65 years or over on admission - Code MD(E) Date of last inspection 0 0 0 Over 65 17 17 17 care home 17 Care Homes for Older People Page 4 of 32 Brief description of the care home 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 all 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. The range of fees are from £340 to £437 per week and do not include chiropody, hairdressing, toiletries, or newspapers. A copy of this inspection report is kept at the home and made available on request. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two stars. This means the people who use this service experience GOOD quality outcomes. This was a key inspection of Tanglewood Residential Home under the Inspecting for better lives arrangements. We were at the home with people for 10 hours. We looked at key standards covering: choice of home, individual needs and choices, lifestyle, personal and healthcare support, concerns, complaints and protection, environment, staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 8 people that live at Tanglewood, we asked about their experiences and Care Homes for Older People Page 6 of 32 observed how staff looked after them. We met 3 staff and the manager and talked to them about their experience, qualifications and training. We sent surveys to 15 people living in the home and received 8 back. We sent surveys to 3 GPs and 3 other healthcare professionals and received none back. We also sent surveys to 15 staff and received 9 back. The comments people made, the results of the surveys and our observations are in the report. In January 2009, the fees ranged between £340 to £437 per week for personal care. Additional charges are made for chiropody, hairdressing, newspapers and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk What the care home does well: What has improved since the last inspection? What they could do better: Some of the people living in the home have complex nutritional needs. The home does not use a recognised tool to assess this to ensure that people get the right foods and stay healthy. Medicines must be stored safely at the correct temperature in a separate refridgerator Care Homes for Older People Page 8 of 32 so that they cannot be contaminated or contaminate the food that people eat. Night staffing arrangements should be kept under constant review to meet the assessed needs of people. This will ensure that there is sufficient support for in the event of an emergency and that peoples health and safety is maintained at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully involved in the assessment process and information is gathered from a range of sources to ensure that individuals needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. Evidence: In a survey 100 percent of people verified that they were given sufficient information before moving into the home that enabled them to make a decision about moving into the home. We met the newest resident and talked to them about how their needs were assessed. The person told us that they had chosen to live at Tanglewood because it has a good reputation. Information sent to the Commission by the manager verified that there is a waiting list for the home. The manager meets with a person before they move in to the home to do an assessment. A newly admitted resident told us that the manager had asked a lot of Care Homes for Older People Page 11 of 32 Evidence: questions to get to know them. The assessment template recorded the diverse needs that the person had, for example what significant people were important to them and detailed information about the persons physical disability. A social and economic history had been completed. Additional information about this persons needs had been obtained from the local authority supporting the move into the home. This information provided the team with a picture of the social network a person has, hobbies and interests, and past working life. We looked at 3 other care files for people living in the home and casetracked their needs. Assessments completed covered a persons mental capacity, tissue viability and risk of falls. A person with parkinsons disease was highlighted to be at high risk of choking but did not have a nutritional assessment on their file. We discussed this the manager who showed us information that had been obtained from the speech therapy department. The manager said that she would contact the speech therapist and ask for a nutritional assessment to be done for this individual. This will ensure that all staff have access to detailed information about the types of and presentation of foods that are appropriate for a person with swallowing difficulties. The manager verified that intermediate care is currently not provided at Tanglewood. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal, and health care needs are generally well met. Medication requiring cold storage is not always kept securely or in the right environment for safety and this may put people at risk. Evidence: 6 people living in the home returned surveys. 100 percent of people verified that they always received the care and support they needed and staff listen and act on their wishes. We looked at the care files for 3 people to establish whether they had a care plan that had been discussed and reviewed with them and or their advocate. Peoples needs included individuals with mental health issues and physical frailty. Documentation seen demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. In addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that ensures that people living Care Homes for Older People Page 13 of 32 Evidence: in the home receive appropriate care. Those that were able to told us that the manager had spoken to them about their needs and aspirations and had been totally involved in the care planning process. The content of their care plan had been discussed and agreed with them. People had signed their care plan to denote this discussion. All the care plans seen had been regularly reviewed. We tracked the care of a person who was physically disabled and unable to weight bare. We spoke to the individual who told us that she was satisfied with her care. She said that she was very comfortable and was sitting on pressure relieving equipment to prevent her skin from breaking down. We also read a handling plan, which stated that staff always had to use equipment to transfer from chair to chair or bed. The person pointed out the equipment in the room that staff used to do this, which was hoist. She told us that staff always explain what they are going to do before moving her. We later observed two staff moving the person. They did so, by explaining first what they were going to do and then used the equipment provided to safely transfer the person back to bed for a rest in the afternoon. We also monitored the decision making process about bedrails that were attached to a persons bed. We looked at how decisions had been made with regard to the use of bed rails and any risks that had been highlighted. We read the individuals care file and saw that a consent form for bedsides had been discussed and agreed with the person. Their mental capacity had also been assessed and highlighted who should be involved in decision making for all aspects of care for the individual. We saw that bedside bumpers were in situ on the individuals bed and that risks of entrapment had been minimised as a result of bumper cusions being in place. One area where we felt the information was less robust was in recording individuals personal preferences, routines and social activities. We discussed this as part of our feedback following the inspection, and said that plans could be made more person centred by including preferred daily routines for individuals. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. We were told that staff always knocked before entering their rooms and treated people as individuals. We observed that people were able to make informed choices about their clothes and jewellery, where they spent their day and what time they got up and went to bed. The home uses a monitored dosage system and medicines that do not require Care Homes for Older People Page 14 of 32 Evidence: refridgeration are stored securely in a locked cupboard. Staff showed us that medicines requiring cool storage are held in the kitchen refrigerator that is not locked. This is not sufficiently secure. Senior staff verified that they are responsible for stock taking. Records of ordered drugs and a register of controlled medicines were seen. The manager verified that no individuals were prescribed controlled medicines at the time of the inspection. The system was easy to audit and we tracked medication given to 3 people. We observed medication being given to people after the lunch. This was done safely and records were completed appropriately after each person had taken their medication. 2 other care staff told us that medicines are only adminstered by people that are trained to do this. They told us that training had taken place and covered the safe management of medication. We concluded that people receive the right medication at the right time by suitably qualified and experienced staff. However, medication systems require improvement to ensure that people are given medicines that are stored at the correct temperature and kept securely in the right environment to avoid the risk of contamination of food or by food that is eaten by people living in the home. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Tanglewood are able to exercise a good degree of choice and control over their lives. Evidence: Information provided by the manager verified that 100 percent of people living at Tanglewood are of christian faith. The home has close links with the Church of England congregation in Northam and services are held at the home. 1 person said there is Communion every week for people to join in if they want to. Another person told us that they used to go to church every week but had chosen to stop going after having had a bad fall. 50 percent of people who returned surveys felt there were sufficient social activities to participate in. We followed this up by meeting a group of 7 people in the dining room after lunch to find out what they would like to do and improvements they would like to see with regard to activities and events. People said that they were satisfied and able to do whatever they wanted to and we were unable to establish why some people in surveys indicated that this was an area to be improved. The manager showed us a quality survey report done in December 2008 that took account of peoples views. The Care Homes for Older People Page 16 of 32 Evidence: report highlighted some people chose not to take part in activities on offer and invited families and friends to make suggestions as to how they could change this. Similarly, information sent to the Commmission highlighted that the team are searching for more activities and events that encourage people to enjoy life outside of the home such as gardening for example. We saw that raised beds and level areas are under construction in the garden. The manager verified that this project had been delayed due to poor weather and hoped that this would be completed in Spring, so that people could enjoy sitting out and doing light gardening if they wished to in the Summer. We case tracked a person who is physically disabled and immobile. We spoke to them about how they occupied their time to establish how much say they had about how they spent their time. They told us that they preferred to stay in their room and liked to watch the television, which was tuned into a favourite programme when we met them. We observed that staff regularly engaged with this person, by popping in and out, chatting about family and events. The person enjoyed this company and the regular contact ensured that the person did not become isolated. Information sent to the Commission verified that 5 volunteers visit people at the home and help to provide a range of activities including bingo, games, music and movement, trips out in the mini bus, and PAT a dog. People said they can have visitors whenever they wish to and that they were made welcome. We talked to 7 people after lunch about Christmas and they told us that it was very enjoyable and jolly with lots of good food, drink and presents. We observed a cordless phone being taken to a person so that they could talk to their relation. Staff verified that there are people that have chosen to have a own mobile phone or a landline installed in their room. We observed the post arriving and being given to people unopened. The atmosphere was open and friendly between staff and people living at Tanglewood. In a survey, 100 percent of people responding indicated that the meals were always very good. Information sent to the Commission verified that fresh vegetables and meat are sourced locally. Additionally, a quality assurance audit before Christmas had examined the level of satisfaction that people experience with meals in the home. The menu was displayed on the notice board and offered people 3 main courses at lunchtime, which included fish and chips, chicken curry, soup. A record of meals provided demonstrated that there is a wide variety of meals that cater for individual needs. We observed people being asked if they would like seconds. After lunch a carer asked everyone what they would like for the evening meal and wide variety of light meals were offered. 1 person confirmed that they often have a meal that is different from the advertised meals and we observed the individual ask for something different Care Homes for Older People Page 17 of 32 Evidence: poached egg on toast. The staff responded to positively to this checking out with the person exactly how they would like it cooked. None of the people required assistance with feeding, however we did see that plate guards and non slip mats were being used by some individuals that enabled them to feed themselves. Therefore, people were encouraged to be as independent as possible. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tanglewoods policies ensure that people are protected and able to voice their concerns, safe in the knowledge that these will be acted upon. Evidence: 100 percent of people responding in a survey verified that the staff listen and act on their wishes. The comments people made included Staff are always so kind and I like it very much at Tanglewood. Information that the provider sent to the Commission verified that no complaints had been received in the previous 12 months. Similarly, the Commission has not received any complaints about the service. We saw a copy of the complaint procedure in the bedrooms we looked at. The manager verified that every individual and their relation had been given an updated procedure in 2008. There is an open management style, which actively encourages feedback and people are confident that their views and concerns are acted upon. Information sent to the Commmission verified that 70 percent of staff hold an NVQ in care, part of which is about safeguarding people. Additionally, staff told us that policies and procedures are discussed with them. Training records demonstrated that all of the staff have done an abuse awareness course and are examined to determine their level of understanding. Mental Capacity Act training had been arranged for all the staff. The manager verified that no safeguarding or POVA referrals had been made in the last 12 months. Care Homes for Older People Page 19 of 32 Evidence: We saw a copy of the Alerters guide. The home also had a whistleblowing policy, which all of the staff we spoke to understood. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged individuals that might otherwise become isolated due to frailty and choosing to stay in their own room. A relative told us that the staff were kind and caring. Another visitor commented that their relative was contented. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Tanglewood live in a clean, well maintained home which meets their needs. Evidence: 100 percent of people responding in a survey felt that the home was always fresh and clean. Information sent to the Commission verified that there is a maintenance person that works 16 hours per week. 1 person that we met verified this and said xxx does checks and mends things. The manager showed us the refurbishment plan, which demonstrates that there is continual replacement and renewal of furniture and planned decoration of areas that look tired. Since the last inspection, a bathroom had been refurbished and 4 bedrooms had been decorated and new carpets and furniture purchased. 1 person that we met whose room had been decorated told us that it had cheered me up and I love the bright colours, which I chose. Maintenance certificates for gas, electrical and fire installations verified that external contractors had inspected all of these. A new central heating boiler had been fitted, which had improved the heating in the home for people living there. We met a number of people throughout the course of the inspection that choose to spend their time in their own room. Bedrooms varied in size and layout. All were personalised and spotlessly clean and provided comfortable private space for the individual concerned. We looked at the duty rosters and saw that there is a cleaner on Care Homes for Older People Page 21 of 32 Evidence: duty every day. 1 person that we met said I like my room its cosy. We tested lights in corridors and some bedrooms, all of which were in full working order. People showed us the furniture they have, which includes bedside tables and lights for subtle lighting during the evening and at night. Information sent to us by the provider verified that the department of health guidance has been used to find out the effectiveness of infection control practices in the home. Additionally, 15 staff have attended training about the prevention and management of infection control. We observed that there was a plentiful supply of aprons and gloves, which staff used appropriately. We also observed that staff follow good handwashing techniques after caring for a person whose care we tracked. The laundry was clean and well organised. The manager verified tha advice had been taken from the infection control nurse specialist about how best to clean bedpans, whilst at the same time protecting people from the risk of cross infection. Best practice was being followed. People told us that they had been asked whether they wanted to have a flu vaccination in the autumn, which most had chosen to have. As a result of these measures, people living in the home had only experienced the usual seasonal colds and there had been no outbreaks of other types of infection. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices at Tanglewood are robust and therefore protect the people living there. The training and development programme ensures that competent and knowledgeable staff cares for people. Evidence: In a survey 100 percent of people tell us that staff are always available when they need them. One person wrote they always come when I need them. Similarly, staff verified that there are usually enough staff to meet the individual needs of people who use the service. We examined duty rosters for four weeks up to the week of the inspection. On the day of the inspection there was 2 carers, the manager on duty during the day till 8pm and 2 staff on duty at night. Additionally, there was 1 cleaner and cook on duty. Staff we spoke to told us that they were busier in the mornings but did not feel rushed. There were 14 people living in the home and we observed that their needs were attended to promptly and people appeared relaxed. We examined the files of 3 staff, which included a volunteer and a newly recruited carer. Two satisfactory written references had been obtained for all of the staff prior to employment or engagement as a volunteer. Pova checks had been undertaken and criminal records bureau certificates had been obtained also before employment commenced. The home had a written procedure about recruitment and retention of Care Homes for Older People Page 23 of 32 Evidence: staff and it was clear that this had been followed to protect the people living in the home. Information that the manager had sent us verified that a wide range of training had been provided over the last 12 months. Records demonstrated that 70 percent of the care staff had achieved the NVQ level 2 award in care or above. We saw individual training files, which contained further evidence of specialist training having been provided e.g dementia awareness. Induction records seen demonstrated that training meets the appropriate standards set out by the Skills for Care. We spoke to staff about their experience and training opportunities in the home and people verified that this was regularly offered to them. The training and development plan for the home contained information for the period 2008-9 and reflected the needs of people currently living in the home so would ensure that staff have the knowledge and understanding to meet these needs. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run home, where their views count and improvements are made. Health and safety is promoted and ensures that people living and working in the home are protected. Evidence: We toured the premises and saw that the certificate of registration was displayed in a prominent position where people living in the home and visitors could see it. The Registered Manager has a number of years experience in running care homes. She has achieved the NVQ level 4 in care and management. She uses the internet extensively, in particular the Commissions professional website, to keep up to date thus ensuring that the care delivered is best practice. Additionally, The manager showed us written confirmation of places booked on a mental capacity act training course for herself and the rest of the team. Throughout the inspection we found that she had a clear understanding of her role in meeting the stated aims and objectives of the home. Similarly, she provided the Commission with detailed information in a document Care Homes for Older People Page 25 of 32 Evidence: entitled AQAA (Annual Quality Assurance Assessment). In it she outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had been improved. We observed that there are clear lines of accountability within the home. We observed people being asked for feedback about lunch, their care and activities during the inspection. There is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager whenever they wish to do so. A newsletter is published and there is a biannual meeting that takes place to which relatives and advocates are invited. People told us that Tanglewood is well run and they feel comfortable and well looked after. An internal survey had been done in December 2008, which the manager had used to identify areas for improvement. Similarly, people living in the home some of whom had been supported by relatives to fill the survey forms in made comments like: Staff are always so kind and I like it very much at Tanglewood they are very good as I am a picky eater. For people that are unable to look after their own money, Tanglewood holds a small float of money for people whose relatives are unable to do this for them. Money is kept in secure facilities. People we spoke to verified this and told us that either they managed their own money or relatives did this for them. We saw records that the home kept for the 4 people we tracked and checked that balances were correct. We saw receipts that corresponded with purchases made for people for items such as toiletries or chiropody. Records accurately recorded balances that were held in safekeeping. The manager verified that quality assurance checks are done weekly to ensure that peoples finances are in order. Appraisal records were seen in the staff files we looked at. Staff told us that the manager and provider were always approachable. We looked at 3 records, 2 were for care staff both of whom had had a 1:1 with the manager or senior care assistant in the last 12 months. The manager verified that supervisory management training had been arranged for the senior carer as part of their learning and development plan. Information sent to the Commission also verified that the manager works alongside staff every day. This has ensured that staff consistently follow best practice when caring for people and have also had the opportunity to reflect and identify any gaps in their knowledge and experience. Comprehensive Health & Safety policies and procedures were seen, including a poster stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We saw various examples of this with regard to audits done, which included fire safety and first aid equipment. As we toured the building we observed cleaning materials were Care Homes for Older People Page 26 of 32 Evidence: stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, and staff told us that the alarm was test regularly. A certificate verified that an engineer had checked the fire equipment. First aid equipment was clearly labelled. Nearly all of the staff on duty held a current first aid qualification. Risk assessments for the environment had been reviewed since the last inspection. Maintenance certificates were seen for the heating, electrical and fire alarm systems. The manager had verified in information sent to the Commission that portable electrical appliance checks had been done and we were told by people living there that an electrician had looked at their appliances. Since the last inspection, advice had been sought from a moving and handling specialist to ensure the home has the correct and sufficient equipment to ensure that staff and people living there are protected. The manager told us that new equipment would be ordered if peoples needs required it. We discussed dependency levels of the people living in the home and particularly looked at the night staffing arrangements, to establish whether this met peoples health and safety needs. Dependency levels were low during the period when we inspected, 1 person required assistance to move their position in bed at night. Additionally, 3 peoples assessments indicated that they would need more assistance than just instruction if they had to evacuate the home in the event of fire. The other people living in the home were quite high functioning and everyone living on the first floor was able to manage the stairs alone for example. A fire risk assessment had been completed with detailed information about how people would be assisted at night in the event of fire for example. However, there is some distance between the home and the Coach House where night sleeping in staff are supposed to stay. Whilst there is a call bell system in this building, we were unable to check this, we were concerned there might be the potential for support to be delayed in getting to the waking member of staff in the event of an emergency. We reported our concerns to the fire safety officer and health and safety officers and asked them to consider the safety of people living in the home and staff working there. The fire safety officer reported that there must be a sufficient number of persons to enable a safe evacuation of the property in the event of a fire taking into consideration the structural fire precautions within the building. They advised the Commission that at the current time it would seem reasonable in this case to have one waking and one Care Homes for Older People Page 27 of 32 Evidence: sleeping in night staff to satisfy this requirement. However, this will need to be constantly reviewed as peoples needs change to ensure that safe evacuation of the premises can be undertaken in the event of fire. We discussed this with the manager who demonstrated that she is very aware of this matter and has the authority to increase staffing levels as peoples needs dictate. Similarly, other sleeping arrangements within the home have been muted but would require changes to the office. We concluded that the health and safety of people living, working and visiting the home was being met at the time of the inspection. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must ensure that medicines requiring cool storage are kept in a separate locked refrigerator. This is so that medicines are stored safely at the correct temperature and cannot be contaminated or contaminate food that people eat. 12/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The nutritional needs of people living in the home should be known by being properly assessed. Staff should have access to detailed information about the types of and presentation of foods that are appropriate for an individual to ensure that the person has a balanced diet that is also safe for them. Night staffing arrangements should be kept under constant review to meet the assessed needs of people. This will ensure that there is sufficient support for in the event of an 2 38 Care Homes for Older People Page 30 of 32 emergency and that peoples health and safety is maintained at all times. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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