CARE HOMES FOR OLDER PEOPLE
Tanglewood Limers Lane Northam Bideford EX39 2RG Lead Inspector
Adele Adams Unannounced 4th May 2005 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 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 Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Tanglewood Address Limers Lane, Northam, Bideford, Devon, EX39 2RG 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) 01237 473147 01237 473147 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 Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. DE(E) Dementia - over 65 years 2. OP Old Age 3. MD(E) Mental Disorder - over 65 Date of last inspection 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 room’s occupants and the home’s criteria on shared rooms is fully met. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 unannounced starting at 10:55 and ending at 17:25. The inspector looked around the home; this included viewing residents rooms, the bathrooms, toilets, laundry, 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 staff and residents both inside the home and in the grounds and read residents care records, staff records, duty rotas, policies and procedures What the service does well:
This inspection showed that the residents at Tanglewood are treated with courtesy and respect and that a lot of importance is placed on residents’ privacy and dignity, 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 in the inspection said these were some of the things that helped them decide to choose Tanglewood as their long-term home. The manager has developed good working relationships with health care staff. Local health care services are involved in residents care as they are needed and equipment to assist residents is also provided, this is done to prevent residents developing health problems and to assist in treating residents who have or do develop health problems. This gives residents, relatives and staff confidence that residents’ health 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 is good at supporting staff to attend training courses and makes sure training opportunities for staff are seen as important. The training helps to make sure that the care staff at Tanglewood have the up to date skills and knowledge they need to give a good level of care to residents.
Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
This inspection found that there are some serious risks to residents at Tanglewood that must be improved upon immediately, these are as follows: The hot water temperature at Tanglewood must be safely controlled to reduce the serious risk of scalding to residents. Radiators at Tanglewood must be covered to reduce the serious risk of scalding to residents. Regular fire drills and evacuations involving residents who are able and staff must be introduced to reduce serious risk to residents and staff in the event of a fire. This inspection found other areas for improvement, which are: The assessment that the manager does before a person moves to Tanglewood must be properly recorded and kept on record. Residents or someone with permission acting on their behalf should be involved in or agree to the care that is planned and must sign to show their approval or involvement. Regularly reviewed risk assessments should be on record for each resident to show if they are at risk from being in an upper floor room that does not have unrestricted window openings, or if they are at risk from being in rooms that have uncovered radiators. Health and Safety assessments for the risks of legionella and asbestos must be done to protect residents and staff. The staff at Tanglewood must attend Adult Protection Training to reduce risks to residents.
Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 7 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 contacting your local CSCI office. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 standard(s) 3, and 5 Each resident’s pre admission assessment documentation had not been kept; this makes it difficult to show that Tanglewood was the right choice of home. Residents find it reassuring that either they or their families can visit Tanglewood, which demonstrates their involvement in the decision making process. EVIDENCE: Residents’ pre admission assessments were not available to inspect, as these had not been kept, the manager advised notes are taken at the pre admission visit but have been destroyed once a plan of care is in place. Two residents told the inspector that the manager had visited them before they moved to the home and that a relative or person of trust had visited Tanglewood to check it was suitable for them before they moved in. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and10. 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. Residents are currently not involved in this process, if they were it would be commendable. The proactive involvement of health care staff helps to reduce possible health problems and risks for residents. EVIDENCE: The inspector read three residents records, these all provided detailed clear information about the resident, the assistance and care they need to keep in good health and how to give care in a way that makes sure residents privacy and dignity is always respected. Residents had not been directly involved in planning their care and were not aware of what information their records contain. Residents had not signed to show they had been asked to be involved in writing their care records or to say they did not want to be involved in this. Two residents told the inspector that care staff always knock before entering their rooms and always use the name the residents prefer to be known by. The inspector saw evidence in residents’ records and rooms of the involvement of a variety of health professionals, which included; the reablement team, district nurse and occupational therapist.
Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 standard(s) 12,13, 14 and 15 Residents at Tanglewood are able to have a full and varied life depending on their wishes, which shows that their independence is valued and encouraged. EVIDENCE: One resident told the inspector that their choice to live at Tanglewood was influenced by the home’s staff having respect for each resident’s wishes. Another service user explained that their life had improved since moving to Tanglewood as they had company and things to do again. One service user told the inspector of trips out and a planned trip to the theatre and how these are enjoyed. The inspector read the minutes of the last residents meeting which clearly showed that residents are able to clearly talk about their likes and dislikes and what they would like changed. Residents were seen with visitors and coming and going from the home. The inspector observed residents eating their lunch and a resident was observed being helped with their lunch. Changes to some the meals provided have been made at the residents’ request and the residents told the inspector they are really pleased about this. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 Tanglewood has a formal complaints procedure however, residents raise their concerns at their regular residents meeting, this illustrates that the manager and staff empower residents and act upon their views and requests. Staff have not had any adult protection training potentially placing residents at risk, this must be addressed. EVIDENCE: The complaints procedure is on display in the hallway, the manager advised there have been no complaints. Residents and staff spoken with knew what action to take if they had a complaint or concern. The inspector read the minutes of the last residents meeting. The Registered Manager has had recent adult protection training and there is good written information available for staff, two care staff were spoken with, neither had received training in this area but both were able to identify different types of abuse and describe that they would take responsible action but this does not replace the benefit of up to date training which helps to protect residents and give staff confidence. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 standard(s) 19, 24, 25 and 26 Tanglewood is homely, clean and pleasant. The environment does pose some serious health and safety risks to residents, which needed to be dealt with immediately. EVIDENCE: The inspector toured the home with the manager; this included viewing residents’ rooms, which contained personal possessions and furnishings, bathrooms, dining room and laundry. The home was clean; service user rooms were comfortable and homely. The inspector ran some hot taps in residents’ rooms; the water was very hot to the touch. The inspector recorded the hot water temperature in a resident’s room - Room 13, the hot water temperature was in excess of 50 degrees Celsius, and an immediate requirement was issued. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staff are busy but manage to make time to respond in a timely caring manner to residents needs. Residents are cared for by staff that have had the correct recruitment checks which minimises risk to residents safety. EVIDENCE: The residents spoken with during the inspection said that there that staff day and night always answer the call bell promptly, that staff are busy but try hard and that they felt the carers would not be able to care for them with less numbers of staff and if anything more staff were needed. The home is carrying 16 hours of staff vacancy, the manager advised the staff work hard. Staff spoken with told the inspector that they are always busy but manage to make enough time. The residents’ benefit from a formal staff handover at the end and beginning of each shift, which makes sure staff can be brought up to date with changes about residents and events. Staff records inspected show the correct documentation is now held at the home. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35 and 38. The manager runs the home effectively, always putting residents first. The manager has made positive changes in the home in relation to residents’ records, staff support and in creating an open inclusive atmosphere. Residents manage their finances if they are able to and there are good resident finance records in place. Health and Safety at Tanglewood must be improved. EVIDENCE: The manager’s behaviour was observed when she was with residents, staff and visitors. The inspector read documentation, residents and staff records and minutes of residents meetings. The inspector also spoke with 2 residents and 2 care staff about the manager and her role within the home, and asked how the residents’ finances are managed. The manager was unaware of testing for the risk of asbestos and legionella at Tanglewood to meet Health & Safety legislation. The inspector observed that
Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 16 the landing bathroom is easily accessible, that the radiator was uncovered, the heat could be felt at a distance – the radiator was too hot to touch by hand. The manager advised that the bathroom is no longer in use by residents but agreed it is accessible and could pose a risk to residents’ that may wander; therefore an immediate requirement was issued. The inspector observed that some residents’ rooms have window restrictors in place, it was noted that some windows on the second floor of the home were not restricted and risk assessments were not in place. None of the radiators in the home are covered. Service users spoken with were asked if they had heard the fire alarm being tested – they were unsure about this, staff were hesitant in their responses to questions from the inspector about fire drills. Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3
COMPLAINTS AND PROTECTION 1 x x x x 1 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 3 x x 1 Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 18 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 18 Regulation 13 (6) Timescale for action The registered person shall make 31 July arrangements, by training staff 2005 or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to all staff receiving recognised adult protection training. The registered person shall Immediate ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated . This refers to the hot water temperature of the service users handbasin which when teseted was in excess of fifty degrees celcius. The registered person shall Immediate ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. This refers to the excessive temperature of the radiator in the landing bathroom which poses a threat of injury to service users. The registered person shall after 15 June
Version 1.30 Page 19 Requirement 2. 24 13 (4) (a) 3. 38 13 (4)(c ) 4. 38 23(4)( e) Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc consultation with the fire authority- (e ) ensure by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as is practicable, service users are aware of the procedure to be followed in case of fire, including the procedure for saving life. 2005 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. 3. Refer to Standard 3 7 38 Good Practice Recommendations A pre admission assessment should be in place for each service user. The individual plan of care should be written with the involvement of the service user and signed by the service user or their representative. Regularly reviewed risk assessments should be held for each resident to show if they are at risk from radiators being uncovered and if there is, the action taken to reduce risk. Regularly reviewed risk assessments should be held for each resident to show if they are at risk from unrestricted window openings on the upper floor of the home and if there is, the action taken to reduce risk. 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. 4. 38 5. 38 Tanglewood Name D54-D07 S22174 Tanglewood V221871 110505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 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
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