Inspection on 03/05/05 for Tanglewood, St Austell

This inspection was carried out on 3rd May 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tanglewood, St Austell 19/03/10

Tanglewood, St Austell 17/02/09

Tanglewood, St Austell 23/02/07

Tanglewood, St Austell 16/11/05

Tanglewood, St Austell 07/12/04

Tanglewood, St Austell 10/06/04

Tanglewood, St Austell 11/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Tanglewood Coombe Road Lanjeth High Street St Austell PL26 7TL Lead Inspector Richard Coates Announced 03 & 05 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tanglewood Version 1.10 Page 3 SERVICE INFORMATION Name of service Tanglewood Address Coombe Road Lanjeth High Street St Austell PL26 7TL 01726 71088 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) Spectrum Miss Sharon Elizabeth Conibear Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places Tanglewood Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: noner Date of last inspection 7 December 2004 Brief Description of the Service: Tanglewood is a residential detached bungalow in the village of Lanjeth, near St Austell. It has a large garden with a patio, lawn and fishpond at the back and car parking space at the front. The home provides accommodation and care for up to three service users with a learning disability. The home is run by Spectrum, an organisation which provides specialist services for people who have autistic spectrum conditions. The aim is to provide service users with a homely environment in a community setting and enable them to enjoy ordinary valued living. Senior managers from the organisation are available to provide specialist input when required. The accommodation consists of three single bedrooms, a large lounge, separate dining room, kitchen, bathroom and an activity room. The office is also used as the staff sleeping-in room. Care staff provide care and support within a relaxed and friendly atmosphere. There are opportunities for social activities, and contact with families and friends is encouraged. The home has two vehicles. Tanglewood Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on Tuesday 3 May 2005. An unannounced inspection will be carried out later in the year. The inspection was facilitated by the kind assistance of the registered manager, residents and staff. The inspector was at the home for about eight hours and spent time with staff and service users observing the daily life of the home, including lunch with service users and a family member, had discussions with the registered manager and staff, toured the premises, and examined policies and procedures, records and care plans. The last inspection was in December 2004 and the report set three requirements. Two of these have been met in full. What the service does well: What has improved since the last inspection? Individual information provided in the statement of terms and conditions in the service users guide for the recently admitted service user complies with the requirement set. Care plans identify objectives for the service users. The bathroom floor has been retiled and the flooring replaced. Some doubleglazing has been replaced. Tanglewood Version 1.10 Page 6 Staff records are now accessible in the home through a computer link to Sterling Court, Spectrum head office. A quality assurance questionnaire has been sent to families and representatives, and the registered manager is developing consultation with service users using ‘widget’ symbols. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tanglewood Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Tanglewood Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 5 The needs and aspirations of a service user who had recently moved from another Spectrum home had been assessed and the information was available for the staff and manager at Tanglewood. The service users guide issued to this service user included a statement of the terms and conditions under which the service is provided. EVIDENCE: The records for the service user who had recently moved to the home showed a well-planned introduction process with a number of visits to Tanglewood, outings with the service users, and meetings of the staff involved reviewing progress. Detailed assessment information was provided in the “Internal Service Needs” document and other care planning documentation. The service users guide, in addition to other information required by regulation, specified the room to be occupied on a floor plan, stated the benefits to be paid to Spectrum and the level of the personal allowance to be paid to the service user, and set out the terms and conditions for the service. The service users guide also provided information about the contract for the service between the commissioning authority and the provider. Tanglewood Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Service users have detailed written care plans which inform and direct staff in meeting their assessed needs. The care plans include detailed risk assessments which specify interventions. EVIDENCE: The care planning documentation comprises the individual plan which is reviewed six monthly and sets objectives, a summary care plan which directs and informs staff about daily support needs, the risk assessment and safe working practice record and records of monthly reviews. The care planning formats are thorough and person-centred. The care staff maintain a daily log and there are risk assessments for specific areas – for example ‘hot surfaces’. The documentation provides evidence of regular review. The daily logs are informative but could detail more clearly how the objectives in the individual care plans are being worked towards and met. The registered manager is developing the use of ‘widget’ symbols for communicating with service users about the service users guide and care plan. Staff communicate with service users about their care plan during their daily support and contact. Staff interact appropriately with service users and support them in decision making and structuring their activities. Tanglewood Version 1.10 Page 10 Staff use communication methods specific to each service user for assisting with decisions and making choices – for example choices of food and drink. There are specific written ‘procedures’ for staff for supporting and engaging service users in activities and choices. Detailed risk assessments were available in respect of the service user who had recently moved in, covering environmental risks, specific individual risks, the current safe working practice document, and assessments drawn up for new activities – for example attending the gym. Tanglewood Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards will be included in the unannounced inspection later in the year. EVIDENCE: Tanglewood Version 1.10 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The personal support provided to service users meets their needs as identified in the care plan. There are arrangements for meeting the service users’ physical and emotional health needs to ensure their continued wellbeing. EVIDENCE: Care plans demonstrate that the service users complete most of their self-care, requiring some assistance and prompting from care staff. Staff discussed how they support service users to be as independent as possible, provide required assistance in private and are sensitive to service users’ preferences and chosen routines. Daily routines are flexible; times of getting up and going to bed depend on individual daily activities. A close relative of one service user who visits regularly had confidence in the care, support and stability provided and said that the service user was happy and well settled. When she has raised issues they have been dealt with positively and non-defensively. She feels that she is kept well informed and consulted on appropriate issues. She always receives a warm and friendly welcome from staff and service users. All service users are registered with a local GP, and visit a dentist regularly. One service user has a specific healthcare need which involves regular Tanglewood Version 1.10 Page 13 attendance at appointments. Another has regular appointments with an optician for an identified need. Service users are weighed regularly. None has specific nutritional needs, but the home strives to provide a balanced and healthy diet. The provider has a policy and procedure for the management of medicines and has issued a further guidance note to staff following comments in recent inspection reports on its homes. This material needs to be reviewed and updated to provide staff with guidance on current good practice. Spectrum is currently carrying out a general review of policies and procedures. The registered manager at Tanglewood has drawn up her own supplementary guidance for staff on safe handling of medication and has set up clear and effective systems for obtaining prescriptions and medicines, checking and storing medicines, administering medicines and returning unused medicines. The manager carries out a weekly audit of medicines in the home. None of the current service users are assessed to be safe in administering their own medicines. The manager has completed a certificated course in the safe handling of medicines from a suitable outside provider. Other staff have not completed such training, having received in house training which has not been evidenced as complying with the standard. A bottle of medicine, a controlled drug, dispensed 14 months ago and as yet unused, and prescribed as ‘as required’, had been sent with a service user from her previous Spectrum home. The registered manager was concerned about this and had arranged an appointment with the GP to review the medication. This service user had not required this medicine for a significant period of time yet there is no evidence that this has been reviewed. This raises concerns in the broader context of this provider about the awareness of staff in relation to reviews of medication. This home was dealing with the issue. Tanglewood Version 1.10 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards will be included in the unannounced inspection later in the year. EVIDENCE: Tanglewood Version 1.10 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards will be included in the unannounced inspection later in the year. EVIDENCE: Tanglewood Version 1.10 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 Spectrum employs sufficient qualified staff to support service users. The evidence from a recent recruitment record showed that service users are supported and protected by the home’s recruitment policy and practices. Arrangements for induction and foundation training appear satisfactory and staff have attended a range of courses. However, the provider needs to review the arrangements for regular refreshers in required areas and adequate training in the safe handling of medicines. Staff are well supervised, with a clear understanding of their roles and responsibilities, but the provider is not carrying out annual appraisals. EVIDENCE: The roster details that two staff are on duty during the day and evening and one member of staff sleeps in at night. This level of staffing meets the needs of service users and allows support for individual activities, outings and one to one work. All the current staff are women but male staff from other Spectrum establishments are occasionally rostered for specific activities. There are five staff and four are qualified at level 2 NVQ (above for the registered manager). The fifth member of staff is working on NVQ 2 currently. One of the current members of staff is below 21 years of age. National minimum standard 33.10 states that staff left in charge of the home should be at least 21. This member Tanglewood Version 1.10 Page 17 of staff regularly undertakes sleeping in duties when she is the only member of staff on the premises. It is recommended that the registered manager records a written review of this member of staff’s suitability for sleeping in duty, taking into account this workers skills and experience, the size of the home and the available on call services provided by Spectrum. The records of a recent recruitment were accessed through a recently installed computer system linked to Spectrum head office. These records showed a detailed application form, notes made during the interview, required material to confirm identity, two references, copies of qualification certificates, the Criminal Records Bureau disclosure and POVA check, and a photograph. The registered manager reported that all staff receive a copy of the General Social Care Council code of practice, and a copy was available in the office/sleeping in room. The induction training record and handbook for a recently appointed member of staff complied with the industry standard set by “Skills for Care”. Dates had also been booked for required courses for this member of staff. A second member of staff reported that the induction had been a good introduction to the work. This member of staff had also had training in first aid, health and safety, food and hygiene, and challenging behaviour. Staff complete ‘foundation training’ before moving on to NVQ 2 in care. Records show that staff receive six weekly one to one supervision in private with the registered manager. The registered manager has supervision with a Spectrum manager. Staff meetings are diaried six to eight weekly with agenda and minutes submitted to head office. However, there are no arrangements for annual appraisals or summative performance review and assessments of the staff’s training and development needs. A member of staff reported that she received good and effective supervision from the registered manager and was able to raise issues and obtain resolutions. She felt that the team worked very well together to ensure a good quality of life for the service users. Tanglewood Version 1.10 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 41, 42 The registered manager is competent and experienced, and expects to complete her NVQ 4 in management soon. She runs the home to meet its stated purpose and aims. Spectrum have introduced a number of quality assurance strategies, but no summaries of outcomes have been made available. The records in the home complied with regulations and protected the rights and best interests of service users. With one identified exception, there were systems in place in the home to protect the safety and wellbeing of service users. EVIDENCE: The registered manager has worked for Spectrum for some years and has been at this home since 2003. She is currently working to complete the NVQ level 4 in management. It is recommended that the registered manager checks her planned training against the recent guidance issued by the commission on qualifications for registered managers. She has completed the NVQ assessor award. Tanglewood Version 1.10 Page 19 The home has recently sent questionnaires to families and representatives and these have just been returned. The registered manager has been using ‘widget’ symbols to obtain the views of a service user with limited communication. The provider has not yet made available a summary and analysis of the outcome of the survey. There is no written annual plan for the home, but the registered manager is required to submit a monthly report to management and this is used to identify areas for maintenance and development. The records for service users and the one inspected for staff complied with the regulations. The inspector also examined the visitors’ record, accident record, staff roster and record of fire drills. However the provider has not submitted reports to the commission of regular monthly monitoring visits under regulation 26. Spectrum provides a policy and procedure on health and safety at work and guidance and procedures on a range of related areas. The pre-inspection questionnaire provided a list of required safety checks and maintenance records. A random sample of these was checked against the original records and found to be accurate. Detailed risk assessments have been completed for all service users. Staff receive training in food hygiene. The registered manager has completed a fire risk assessment for the premises, but the provider has failed to comply with recommendations in respect of fire alarms and emergency lighting made in a letter dated 14 January 2005 from the Chief Fire Officer. A requirement has been set in respect of this matter. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) Tanglewood Version 1.10 Page 20 “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x 3 2 x Tanglewood Version 1.10 Page 21 yes 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 20 Regulation 13(2) Requirement The registered provider must make arrangements for the recording, handling, safekeeping,safe administration and disposal of medicines into the home including 1. A full review of the homes written policies and procedures to comply with the Royal Pharmaceutical Society Guidelines, June 2003 and current best practice and 2. Provision of training for all staff who handle medicines in the safe handling of medicines. The registered person must make available a summary of the outcomes of the quality assurance process. This requirement is a partial renotification from the last inspection report The registered person must supply to the commission a copy of the report of the visit made to the home each month under regulation 26. The registered person must install the additional smoke detectors and emergency lighting as set out in the letter Version 1.10 Timescale for action 15 July 2005 2. 39 24 15 July 2005 3. 41 26(5) 31 May 2005 4. 42 23(4) 15 July 2005 Tanglewood Page 22 from the chief fire officer dated 14 January 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. Refer to Standard 36 7 Good Practice Recommendations Staff should receive an annual appraisal to review performance and agree personal development plans. Daily records should detail more clearly how the objectives set in individual care plans are being met. Tanglewood Version 1.10 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Version 1.10 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!