Inspection on 08/06/06 for Tanglewood Care Home

This inspection was carried out on 8th June 2006.

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

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

Other inspections for this house

Tanglewood Care Home 23/10/07

Tanglewood Care Home 27/01/06

Tanglewood Care Home 10/08/05

Tanglewood Care Home 04/02/05

Tanglewood Care Home 15/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tanglewood Care Home 36 Louth Road Horncastle Lincs LN9 6EN Lead Inspector Mick Walklin Unannounced Inspection 8th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tanglewood Care Home DS0000002521.V297563.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 Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tanglewood Care Home Address 36 Louth Road Horncastle Lincs LN9 6EN 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) 01507 527265 01507 527965 hazel.whittaker@twhealthcare.co.uk www.tanglewoodcarehomes.co.uk Tanglewood (Lincolnshire) Limited Mrs Hazel Whittaker Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (9) of places Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 5 service users accommodated within the main body of the home under the category of PD (5) and can be aged between 50 and 64 years. Up to five of the following rooms may be used to accommodate people within the category PD: 16, 17, 18, 19, 40, 41, 42 & 43. Occupancy When used by service users within the category PD, these rooms will be used on the basis of single occupancy and, where they are otherwise used by Older People as double rooms, the overall occupancy will be reduced proportionately. Up to four service users can be accommodated in the bungalows and can be aged between 35 years and 64 years under the category PD (4). Condition of Registration The home is registered to provide personal care with nursing for service users of both sexes. The maximum number of service users to be accommodated is 55 under the category of Old Age (OP) not falling within any other category. One service user can be accommodated within the main body of the home under the category of PD (1) and can be between 35 and 64 years. 27th January 2006 4. 5. 6. Date of last inspection Brief Description of the Service: Tanglewood is situated in the market town of Horncastle, which has a range of local services and facilities. It is one of a group of homes operated by the same company. It is set in its own landscaped gardens and comprises of a main home with rooms on two floors which can be accessed by a lift or stairs and four bungalows within the grounds each having lounge, bathroom, toilet, kitchen and bedroom facilities. There are car-parking facilities to the front of the property. The home is registered as a care home with nursing for up to fifty-five older persons; however, within these numbers it is also registered to provide care for up to nine service users with physical disabilities within the age range of fifty to sixty four years. The home has developed a comprehensive statement of purpose, which makes reference to the principles of care such as privacy, dignity, independence and choice. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of Tanglewood Care Home, and through undertaking a visit to the home. The fieldwork visit took place over 7 hours. The main method of inspection used was called case tracking which involved tracking the care three residents receive, through the checking of their records, discussion with them and the care staff and observation of care practices and interactions. A tour of the premises was conducted with the manager. Documentation relating to the management of the home was also inspected. Three feedback forms were received from relatives, but the pre-inspection questionnaire, together with a batch of feedback forms, which were posted to the Commission by the manager, appear to have been lost in the post. What the service does well: What has improved since the last inspection? What they could do better: Medication should be locked away at all times, to prevent residents being put at risk. Residents records should be securely stored to protect confidentiality. Monthly monitoring visits by the Registered Provider or their representative should be carried out, and a written report from the visit should be available. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 6 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 Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission procedures ensure that prospective residents needs can be met. EVIDENCE: One of the people case tracked had been admitted to the home in April. He had been visited whilst in hospital by staff from the home to conduct the preadmission assessment, which was seen on his file, together with nursing and hospital discharge assessments. He said that because he was in hospital at the time, he had been unable to visit the home, but his daughter had visited on his behalf. He pre-admission assessment contained a range of information to enable the manager to decide if the home could meet his needs. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans contain a good range of information, but are not stored securely to protect residents confidentiality. There are good arrangements with local health care providers, but medication storage is inadequate, which could potentially put residents at risk. EVIDENCE: Care plans contain a good range of assessments, including a ‘top-to-toe’ assessment. There are a range of risk assessments, and care plans are reviewed every month. Residents and their relatives are asked whether they want to be involved in the care plan, but one resident said that although staff ask him, he was not bothered. There are good arrangements in place to meet residents health needs, and those interviewed confirmed that medical attention is summoned promptly when required. All residents are registered with one of two local surgeries, and Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 10 district nurses, chiropodists, opticians and audiologists visit regularly. Input from the Community Psychiatric Nurse, and Physiotherapist are as required. There is difficulty in registering residents with dentists, but a local emergency service is available. The home uses a pre-packed medication administration system, and is administered by senior carers and qualified nurses. Administration of homely remedies are agreed with the GP. One resident said that he self-administers medication, and does his own blood monitoring, and a risk assessment was in place for this. Medication administration and stocktaking arrangements are satisfactory. Medication is stored on shelving in clinical rooms on the ground and first floors. The doors to these rooms were left unlocked for a period on the day of the inspection, and sometimes left wide open. It was also noted that medication which had been delivered from the pharmacy, and left in a carrier bag on the nurses station desk, was not locked away promptly. The manager took prompt action to rectify these deficits when brought to her attention, and therefore the overall rating for this section remains unaffected. Interactions between staff and residents were friendly and respectful. Staff were able to describe how they maintain residents privacy and dignity, and examples of this were seen throughout the day of the inspection. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. There are a good range of activities for residents to participate in, to ensure that they have a stimulating and enjoyable timetable. Standards of catering are good, and reflect individual choices. EVIDENCE: The home has an enthusiastic Activities Co-ordinator, and an Entertainments Committee has been set up, involving relatives, residents and staff. They meet on a regular basis to plan activities for the forthcoming month. Activities and entertainments are well publicised, and preparations were in hand for the forthcoming summer fete. The Activities Co-ordinator said that she chats with all new residents to ascertain their interests and hobbies, and documents these. She also keeps records of all activities undertaken, together with individual records of residents participation. She has recently attended a course about mental and physical stimulation, and is looking to improve activities for those residents who are cared for in bed. All residents interviewed Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 12 were happy with the level of activities available, and several residents and staff commented that this had improved since the Activity Co-ordinator took up post. One person, who lives independently in one of the bungalows, said that he regularly accesses local community facilities, and helps with activities within the home. Residents commented that the standard of catering is satisfactory or good. There is a choice of two main meals, and one resident said that the kitchen staff will always prepare him an alternative meal if he wants something different, such as salad. Another said, “I haven’t had any meals that I’ve been unhappy with”. Two feedback forms received from relatives identified that residents requiring soft diets are not well catered for. One commented “the diet could be improved, as sweets are often in a liquid form, and there is no choice”. Another said “people who cannot feed themselves do not get much of a choice of food – sometimes just a bowl of soup”. The manager is aware of these issues and has taken steps to improve the situation. The Head Chef of the company has trialled some new soft diet alternatives at one of the other homes, so that only foods that can be pureed successfully will be served. Soft diets served on the day of the inspection were well presented. An additional 28 hours staffing has been allocated to the kitchen, to ensure that the teatime menu is more wholesome. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have confidence in the complaints procedure, and adult protection procedures ensure that residents are protected. EVIDENCE: The complaints procedure is displayed in the reception area, and in each bedroom. A suggestions box is also situated in reception, and the manager said that she has an open door policy for residents and relatives, and has daily contact with residents. A resident said that he had made a complaint in the past, and he had been satisfied with the prompt response, with one of the Directors coming to see him the following day. One feedback form stated that the relative knew how to make a complaint, but it was “not easy and not always appreciated”. A poster is displayed in the managers office and the two nurses stations, which gives details of steps for staff to take if they suspect or witness adult abuse. The Lincolnshire Adult Protection Committee Policy is also available for reference. All staff interviewed demonstrated a knowledge of the correct procedures, and were aware of their responsibilities for reporting abuse. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is decorated and furnished to an exceptionally high standard, providing a homely, comfortable and spacious environment for residents to live in. EVIDENCE: The home is exceptionally well-decorated and maintained, with comfortable and spacious communal areas, and personalised bedrooms. All residents interviewed praised the standard of their accommodation. One said, “It’s like a top hotel – I’m more that satisfied”. Another said, “I couldn’t wish for better”. The home has a team of Chambermaids and a Housekeeper, who maintain a very high standard of cleanliness. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels allow adequate levels of support to be provided to residents. Recruitment and selection procedures are robust to ensure that residents are protected, and staff receive training to equip them with skills necessary for their roles. EVIDENCE: Staff said that staffing levels are adequate for the needs of residents, “but we are always busy”. Another said, “It is not always easy to meet all residents needs - it depends on the mix of residents, and some have needs that can change daily”. Many residents require two staff to assist them, so there were times when all staff on the floor were occupied, and there were delays in answering call bells. Residents were generally satisfied with the staff. One commented “Most of the staff are very good indeed – they look after me well, and are kind”. Another said, “They respond very quickly if I call them in an emergency”. One relative commented “There are not enough staff around – if mum had a fall they wouldn’t know”. Another stated “We have not found it easy to communicate with staff in order to improve care”. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 16 The company employs a Training Officer, and training plans were not available for inspection, as they are held centrally. The manager explained that she also has a training budget, and is able to book training directly. A number of staff have undertaken, or are undertaking National Vocational Qualification training, and staff described training opportunities as “good”. The files of three recently recruited staff were inspected, and all contained evidence of a formal recruitment and selection procedure, and the necessary documentation for the protection of residents. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 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 organised, but confidential records should be stored more securely, and visits by the registered provider should be recorded. EVIDENCE: The manager is a Registered General Nurse who works as supernumerary. Staff described her as “very supportive, caring about her staff”, and the Care Team Leader was also praised for her support, being described as “brilliant”. There are good systems in place for monitoring the quality of the service, with residents/relatives meetings held ever 3-6 months, and an annual quality assurance survey, which is currently being undertaken. Responses from the Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 18 survey are sent directly to the Directors for review. Exit interviews are conducted for all staff. However, although visits by the Registered Provider are undertaken, there are no record of these, and no evidence that a written report of the visit is prepared, as required. Arrangements for dealing with residents finances are satisfactory. Residents families or representatives are responsible for finances, and money for incidental expenses is documented, and the three balances checked were correct. Residents confidential records were not kept locked on the day of the inspection, and some were left out on a desk at the nurses station unattended for a long period. The manager took prompt action to rectify these deficits when pointed out, and therefore the overall rating for this section remains unaffected. Health and safety documentation is well organised, and working practices in the home are generally safe. However, there were times in the day when hoists are left in corridors, presenting a possible trip hazard for residents, and an oxygen cylinder was found stored in one of the stair wells, and the manager agreed to arrange to have this moved to the appropriate storage facility. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 4 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 2 3 Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13(2) Requirement The registered person must arrange for medications to be stored securely. The registered provider, or their representative, must visit the home at least once a month to inspect the care home, and prepare a written report on the conduct of the home. Timescale for action 31/07/06 2. OP33 26 31/07/06 3. OP37 12(4) The registered person must 31/07/06 ensure that residents records are stored in a way that maintains confidentiality, and meets data protection requirements. Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tanglewood Care Home DS0000002521.V297563.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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