CARE HOME ADULTS 18-65
Tanners Wood Close 5&5a Tanners Wood Close Tanners Wood lane Abbots Langley, Herts WD5 0HR Lead Inspector
Tom Cooper Unannounced 19 September 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 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. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tanners Wood Close Address 5&5a Tanners Wood Close, Tanners Wood Lane, Abbots Langley, Herts, WD5 0HR 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) 01923 270270 01923 270095 Hertfordshire County Council Brenda Chance CRH Care Home 8 Category(ies) of LD-8 registration, with number of places Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The home may accommodate a maximum of eight service users with learning disability for periods of respite care. Date of last inspection 25th February 2004 Brief Description of the Service: Tanners Wood Close respite care unit is a local authority facility operated by Hertfordshire County Council, located in a quiet residential area of Abbots Langley. Local amenities and shops are close by. The respite facility comprises two wheelchair-accessible bungalows providing eight places within a large site that includes other residential provision excluded from the registration and therefore not inspected by the CSCI as a residential home but as a domiciliary service. The service provides mainly short stay accommodation on a pre-arranged rotational basis for over 100 service users with learning disabilities, many of whom have complex needs. Staffing numbers and skills and appropriate special equipment are provided that reflect the diversity of the client group accommodated. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the first to take place following the registration of the respite care unit separate from the rest of the complex at Tanners Wood Close. The inspection was conducted on a weekday over the late morning and early afternoon. One service user was at home during the inspection, with the others all out at their various day care activities. Discussions were held with the service user, the manager, team leaders and the members of staff on duty. Five service user’s files and care planning information were examined, as well as relevant health and safety documentation including the records of accidents, incidents, fire alarm tests, service users’ money held and medication. A brief tour of the premises was also carried out. The inspection indicated that the service was running smoothly, with caring and motivated staff operating well organised systems designed to maintain the standard of care provided. The respite facility represents an invaluable local resource and it was most positive to learn that the unit runs at virtually 100 occupancy. What the service does well:
The service user spoken with said that he liked living in the home and got on well with staff. The unit provides a good level of well trained staff, who are knowledgeable about the needs of the service users using the facility. Service users are able to continue following their usual patterns of life while staying at Tanners Wood Close, supported by staff as appropriate. Individual needs and preferences are clearly documented in their personal files and there are effective communications systems in place to ensure that staff on each shift are kept well informed of developments and current priorities. Records inspected indicated a consistent approach from staff, especially when dealing with difficult behaviour presented by service users. The bungalows are pleasantly decorated, well equipped and well maintained and provide a safe, accessible environment that is reasonably homely. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 8 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 Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 9 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 3 Prospective service users’ individual needs and aspirations are assessed and recorded. Prior to admission staff match the assessment information obtained to the home’s service capacity to determine that the individual’s needs can be met. EVIDENCE: The service user spoken with indicated that he was satisfied with the ability of the home to meet his needs and expectations. Five service users’ care plans examined contained a good level of detail regarding their individual needs, personal preferences and any special communication, medical or physical issues to be addressed, such as epilepsy or difficult behaviour. The building is well equipped to meet a number of special needs, for example poor mobility, with assisted bathing facilities, wide corridors and doorways. Weekly menu planning ensures that the food provided is suitable for the service users in the unit at any particular time. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 10 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 All service users admitted have their individual needs and progress documented in their care plans. Staff support service users to make decisions for themselves and provide assistance as appropriate. EVIDENCE: All care plans examined contained detailed assessments of their individual needs, including physical, medical, psychological, emotional and social details. In addition, there were notes of specific likes and dislikes, aspirations and agreed strategies for dealing with behaviour problems. Daily records were kept, highlighting any particular issues occurring. There were also detailed records of any incidents or accidents involving service users. Risk assessments were in place covering moving and handling. Other risk assessments were seen that were in need of reviewing and updating to ensure that staff are aware of and have access to relevant and current information. Staff spoken with were aware of the differing requirements of the service users in the unit at the time and were able to describe in detail how they worked
Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 11 together to provide consistent care for them and supported them to make decisions for themselves while in the unit. Records were seen of money held on behalf of service users and these were in order. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 12 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) 14 Service users engage in appropriate leisure activities, supported by staff. EVIDENCE: Care plans seen contained details of individual preferences and regular activities undertaken. The service user spoken with said that he was happy with the lifestyle he was able to follow in the home. Staff said that individual service users attended several different clubs and they provide some activities in the evenings, depending on the preferences of the individuals in the unit at any given time. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 13 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) 19 20 Staff provide service users with personal support in accordance with the assessment information in their care plans and the homes policies and procedures. The home has a well organised system for storing, handling and recording medication. However, care must be taken to ensure that all doses of medication administered to service users are recorded on the MAR sheets. EVIDENCE: Service users’ personal files contained a good level of detail regarding their physical and emotional needs as well as instructions to staff on the agreed approach to be taken to meet them. Specific management plans were in place for predictable situations occurring such as epileptic seizures necessitating the use of rectal diazepam. There were also protocols for the use of other PRN (as required) medication, signed by staff and the service user’s GP as well as an emergency procedure for staff to seek external professional advice in the event of any confusion over a service user’s medication. This is a wise precaution bearing in mind the frequent changes of service users passing through the respite unit. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 14 Medication was kept in a secure place and was properly stored. The Nomad weekly dosette system was in use for the one longer stay service user. Medication training is covered during induction and the pharmacist visits periodically to give refresher training and check the system. Staff on duty were familiar with the operation of the system and confidently explained it. However, several signature gaps were found on the MAR sheets therefore a requirement has been made that accurate medication records must be kept. Service users assessed as capable self-manage their medication with monitoring from staff to ensure safe performance. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 15 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) 22 23 Service users and their relatives can be confident that their views are listened to and acted on. The home has suitable policies and procedures that protect service users from abuse and neglect. EVIDENCE: The home is subject to the Hertfordshire County Council complaints procedure, available in written form in the home. This contains the required elements to meet the standard. Following any investigation of a complaint details are sent to the Adult Care Services department for monitoring. The home also has adult protection policies and follows the Hertfordshire inter agency guide for responding to allegations of abuse against vulnerable adults. The manager described a current example of the procedure being operated in relation to a complaint made by a service user, whereby all the correct steps had been taken to protect service users. In accordance with the procedure a full internal investigation had been delayed pending conclusion of the police investigation. Staff were aware of the adult protection procedure and the whistle blowing policy. Suitable forms are used to record any allegations or incidents. The topic of adult abuse is covered in staff foundation training and all staff also receive training in Breakaway techniques. The service user spoken with declined to comment on the complaints procedure, however he appeared to enjoy friendly and open relationships with
Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 16 staff and care plan documentation seen included frequent references to service users’ ongoing expressions of opinion about situations occurring in the home. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 17 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) 24 30 The premises provide a safe, comfortable and reasonably homely environment in keeping with the home’s statement of purpose. The home is clean and hygienic. EVIDENCE: The premises are on one level and are fully wheelchair accessible, with wide corridors and doorways and adequate communal and bathroom space. Furnishings and fittings seen were of good quality and in domestic styles. There is a hard-wired fire alarm system with smoke detectors in every room. Records seen showed that the alarms had been tested weekly. In the kitchen, fridge temperatures had been recorded daily. Some minor signs of wear and tear were evident in the premises. For example, the kitchen worktop was chipped in one place, causing a potential hygiene problem. The dining room carpet was quite heavily stained and should be replaced as it rather spoils the otherwise well presented communal areas. The manager said that these problems would be attended to in due course as part of the programme of planned maintenance.
Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 18 All areas seen were clean and tidy and fresh smelling. Appropriate hand washing facilities were in place in bathrooms and toilets. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 19 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 Adequate numbers of competent and well trained staff are provided at all times. EVIDENCE: Staff confirmed that the there were normally four staff on duty available to provide care during the day shifts, although extra staff would be deployed if a service user requiring one to one attention were admitted. Rotas were available for inspection. These levels are considered adequate to meet the needs of service users. Staff confirmed that handovers between shifts always take place so that incoming team members can be apprised of any developments and the priorities set for the shift. Regular ‘house’ staff meetings are also held, at which current care matters and other issues are discussed, with minutes taken. Staff also have access to regular relevant professional training. Staff said they felt well supported and described teamwork and communications within the home as good. The service user spoken with said that he was happy with the performance of staff. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 20 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) not inspected on this occasion. EVIDENCE: Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 21 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. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x 3 x x x Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Tanners Wood Close Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 22 No 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 YA20 Regulation 13 (2) & 17(1)(a) Schedule 3(3)(i) Requirement Accurate medication records must be kept i.e. all medication doses administered to service users must be signed for. Timescale for action Immediate from 19th September 2005 and henceforth 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 YA 6 & 42 YA 24 Good Practice Recommendations Risk assessments relating to individual service users should be regularly reviewed and updated as necessary and review dates should be recorded. The dining room carpet should be deep cleaned or replaced. Tanners Wood Close I52 s64254 Tanners Wood Close v247295 190905 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House, 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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