CARE HOMES FOR OLDER PEOPLE
Tanglewood Limers Lane Northam Bideford Devon EX39 2RG Lead Inspector
Jo Walsh Unannounced Inspection 5th February 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Tanglewood Address Limers Lane Northam Bideford Devon EX39 2RG 01237 473147 F/P 01237 473147 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Andrew Philip Frederick Tucker Mrs Alison Margaret Tucker Vacancy Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (17), Old age, not falling within any other category (17) Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. DE(E) Dementia - over 65 years OP Old Age MD(E) Mental Disorder - over 65 Date of last inspection 14th December 2005 Brief Description of the Service: Tanglewood is an older style detached property standing within its own large secluded gardens in a quiet residential area. The facilities of Northam and Bideford and the seaside villages of Westward Ho! and Appledore are 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 £350 to £420 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. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during a weekday in February and lasted for 6.5 hours. The main focus of the inspection was to seek the views of the residents to help gain an insight into their experiences of living at the home. 8 residents were spoken to and 7 returned a survey prior to the inspection. Their views and comments are included throughout the report. Three people were case tracked, meaning they were spoken to at length about their experiences of living in the home, and staff on duty were asked about their individual needs and preferences. In addition the records kept for these individuals were also looked at. These included care plans, medication records and records in relation to financial transactions made on behalf of residents. This process helps to identify how well the home is meeting the key standards that have been inspected. These are identified at the beginning of each section of the main body of the report. Prior to the inspection the home were asked to complete a pre inspection questionnaire, which provides information about how the home is maintained and what checks and training is in place to ensure that health and safety of residents and staff is not compromised. 3 comment cards were received from relatives and 3 from health care professionals. This information has helped to inform the inspection process. The inspector would like to thanks the residents and staff for their helpfulness through out the inspection process. What the service does well:
Tanglewood is a detached older style property set in it’s own grounds away from the main road, and provides residents with a homely, comfortable and pleasant environment that several residents described as ‘peaceful and relaxing.’ One resident said in their survey ‘I am very well looked after, the food is lovely and the staff are very good, I can not find any faults.’ Prior to new residents moving in, their needs are fully assessed to ensure that Tanglewood can meet their needs and to ensure that staff have good Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 6 information on which to plan for their care and support. Residents confirmed that they were able to view the home prior to making a decision to move in. Each resident has a plan that sets out their personal, health care and social needs. This helps the staff group to provide care consistently. Individuals preferred routines are clearly identified to ensure that where possible these are honoured. Residents said ‘We are very well looked after’ ‘the staff are very kind and helpful.’ One family recently wrote to thank the home for the care they provided to their relative ‘ thank you for caring for (my relative) for the past year with dignity, they were always treated well and looked smart. We were always welcomed by a friendly staff.’ Personal and health care needs are well met by a staff group that have regular training and support to do their job effectively. The staff spoken to have a good understanding of individuals needs and talked about making sure that they got to know individuals preferred routines. Residents are offered a choice and variety of meals that provides them with a balanced diet and takes into consideration their likes and dislikes. One resident said ‘excellent cooking and a good choice.’ Any concerns or complaints are taken seriously and acted upon to resolve issues. Residents said they would be able to discuss any concerns with their key worker or the registered provider. What has improved since the last inspection?
Following the last inspection the two recommendations have been completed, i.e., a survey has been done by an external professional firm to assess the risk of any asbestos in the building. The registered provider followed any recommendations the assessment highlighted. The other recommendation was to risk assess for Legionella. This risk assessment has been completed and the home are a low risk. Completing these risk assessments and taking actions to reduce possible risks has made the home a safer place for the residents and staff. The registered provider is in the process of refurbishing two bathrooms to provide a walk in shower room and an assisted bath that residents can sit in.
Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 7 These improvements will enhance the quality of care of residents and make bathing far easier for staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective new residents can be assured their needs will be fully assessed prior to moving in. EVIDENCE: Information was looked at for the newest resident and the home had a copy of the care management assessment and had completed their own assessment. This information included what the individuals personal and health care needs were as well as what they enjoyed doing socially. This information helps the staff plan for providing appropriate care and support so that they can ensure they can meet all needs. The resident who had most recently joined the home said they had had an opportunity to view several homes, and had been at Tanglewood previously for respite care and had decided that this home most suited them as it was ‘friendly and homely’
Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 10 Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are well met. Robust medication procedures ensure residents are protected. Residents are treated with respect and their privacy is upheld. EVIDENCE: Three individuals were case tracked and part of this process involves looking in detail at their care plans and asking staff what their needs are and how the assessed needs are being met. The care plans clearly identify what each individual’s personal and health care needs are and what support and care needs to be given. The information is clearly set out to enable staff to provide care in a consistent way. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 12 Residents spoken to said that their needs were well met, comments included ‘staff are very good, they sort things out for us’ ‘this is one of the best homes, staff are all very caring.’ ‘We are very well looked after here’ Staff spoken on the day of the inspection had a good understanding of the individual residents needs and said that as far as possible they try to honour individuals preferred routines. Staff were observed to be providing care and support in a very caring and respectful way. One resident needed some health care appointments sorting out and the care staff made phone calls and kept the individual informed of what they had arranged. Residents confirmed that they were able to see their GP when they needed, that they had access to visiting health care professionals such as district nurses, chiropodist and dentist and that if assistance were needed to get to a health care appointment this would be arranged for them. The medications are appropriately stored and only administered by staff that have had training and follow the homes procedures. This entails staff administering the medication from a blister pack and only signing for it when they have witnessed it being taken. This ensures that residents are protected form possible errors. One person self medicates and the registered provider said that they have completed a risk assessment for this and the individual has locked storage for their medications to be kept safely in their room. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social needs are well met and they are able to maintain contact with their family and friends. Routines are flexible and residents are encouraged to make choices. The home provides a well balanced diet that is varied and residents are given choices. EVIDENCE: Residents spoken to and some that returned surveys said that there was social activities to participate in. These included bingo, games, and music afternoons, trips out in the mini bus and a service from a local vicar. One resident said ‘you can please yourself if you want to join in, or if you prefer you can stay in your room.’ Another resident said they were able to get papers and magazines delivered and that two hairdressers visited the home if you wanted your hair done.
Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 14 Residents confirmed they were able to have visitors, and that they were made welcome. One said ‘they are always offered a cup of tea and made very welcome.’ A cordless phone is available for residents to have calls in private and one resident said that they could bring their own mobile phones if they so wished. Post was observed to be given to residents unopened and staff were observed chatting to residents about their family and when they visited. Residents spoken to said they were able to choose what time they got up and went to bed showing that routines of the home are flexible to suit individuals’ needs and wishes. Several residents were still in bed when the inspector arrived and staff confirmed this was their choice that several people liked a later start to their morning, which they honoured. One resident said that she liked to get up early and staff usually brought them a cup of tea in bed early that they really enjoyed. The home’s menus show that a good choice and variety is provided. The cook on duty said that they always cook with fresh ingredients, that at least two choices is always on offer and that individual likes dislikes and diverse needs such as specialist diets or being vegetarian are always catered for. Residents expressed a high level of satisfaction for the meals and choices on offer. One resident said ‘the cook is very good, she knows I like curry and always gives me one on a Friday, which I look forward to.’ Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents concerns and views are listened to and acted upon. Policies and procedures are in place to ensure the protection of residents. EVIDENCE: The home have a written complaints procedure and residents spoken to and those who returned surveys said they were able to talk to staff about any concerns they had and would be confident they would be sorted out. Relatives who returned comment cards said they were aware of the complaints procedure, none made any specific comments about this process. The home have had one complaint since the last inspection, which was form a relative and the registered provider looked into and resolved the issues raised within three days of receiving the letter. The inspector is satisfied the complaint had been dealt with appropriately. Staff spoken to on the day of the inspection were aware of what they should do if they suspect any form of abuse and said they had policies to refer to. Robust procedures are in place for the handling of residents’ finances so their best interests are protected.
Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 16 Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very clean, safe and well maintained, providing a comfortable and homely environment for residents. EVIDENCE: During this inspection a tour was made of most of the building, including several of the residents bedrooms. All areas viewed were fresh and clean. The communal areas are well furnished and decorated and residents said they felt comfortable and that the home was always warm. One resident said it was ‘very homely, that’s what I liked best about the place, and the grounds are so nice to look at.’ Residents are able to personalise their rooms and bring in items of furniture if they wish.
Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 18 The home employ domestic staff to keep the home clean and hygienic and cleaning equipment and gloves and aprons are available to ensure the risk of cross infection is reduced. The home have a sluice for commode pans, but staff have not been using this as they have had a spare bathroom, which was being used. The bathroom is now being refurbished and the registered provider has been advised to check with the clinical nurse specialist in infection control in respect of best practice for their home in sluicing of the commode pans. Although standard 22 was not looked at in specific detail, it was noted that the home only have one hoist on the ground floor. As there is only a stair lift to the first floor, the hoist would not be able to be used on this floor. The registered provider has been advised to seek advice from a specialist in moving and handling to ensure the home has the correct and sufficient equipment to ensure the safety of all residents and staff. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well trained and supported staff means residents’ needs are well met. Robust recruitment procedures ensure residents are safe. EVIDENCE: The staff rota shows that there are sufficient staff on duty per shift for the needs of the current resident group. This does need to be kept under review as the residents being referred for residential care are now having more complex needs. Residents spoken to said their needs were met by the number of staff on duty. Staff spoken to said that two care staff per shift was sufficient for the current needs of the residents, but that it will be better when they have a new registered manager who will be able to assist with some of the organising of residents health care appointments for example. The registered providers said that they ensure staff have updated training and already have over 50 of staff having achieved NVQ level 2 or above. It would be useful for staff to have training in the care of people with dementia. The registered provider agreed to look into this. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 20 Prior to the registered manager leaving in December the staff were having regular supervision, which gives them an opportunity to discuss how they are doing and what training might help to do their work more effectively. The new manager will need to ensure supervision is continued. The staff files were checked for two members of staff and they contained information that demonstrates the home ensure all relevant checks are completed. This helps to ensure residents are protected. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the residents. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are protected. EVIDENCE: Although the registered manager left in December 2006, the home is being managed via interim arrangements of the senior carer having day to day responsibility for residents needs and the registered providers coming in on a regular basis to ensure that key documents are kept up to date and to provide support to the staff group.
Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 22 Once the registered manager is in post and the providers are no longer having a day to day responsibility of overseeing the home, they should ensure they complete regulation 26 visits and reports, where they visit the home once a month, speak to staff and residents and look at the environment. A report should be completed to show all these things have been done and what areas have been highlighted as issues and what steps are being taken to improve the quality of care. Staff spoke to said that the registered providers had been coming in on a regular basis, to give them some support. A new manager has been appointed and will start as soon as all relevant checks have been completed. Regular surveys are given to residents and their family members to ensure they are satisfied with the care and support provided. The home also have six monthly residents meetings, where menus, outings and any issues that individuals wish to raise are discussed. The records of monies managed by the home on behalf of residents was checked and found to be well recorded and accurate. The pre inspection information details that all equipment is regularly serviced and that there are policies and procedures in place for all safe working practices. Staff spoken to confirmed that they have updated training in all areas of health and safety and have access to the policies. During this inspection the fire logbook was seen and appeared to be well maintained. Other records viewed included accident reports and staff records. Again these were well maintained. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. Refer to Standard OP22 OP26 OP30 Good Practice Recommendations The registered providers should consult with moving and handling specialist to ensure they have appropriate and sufficient equipment. The registered provider should consult with a clinical nurse specialist in infection control in respect of best practice for the home for sluicing of commode pans. Staff should have ongoing training in dementia care. Tanglewood DS0000022174.V316130.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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