Care Home: Tanglewood

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What the care home does well An excellent quality of care and support is given to the residents living in Tanglewood who benefit from a family style environment. Communication is supported well within the home with residents being able to make their needs and wishes known and the owners and staff interpreting and responding to them. The day is well organised so that there is a mixture of daily household chores, outdoor activities, activities set in the community and leisure both in and outside the home. The home considers holidays an important part of individual lifestyles. Annual holidays are planned with the service users who like to go abroad if possible. The home is warm, spacious and comfortable. Staff said that the people living here get the benefit of a family home. The owners and staff are motivated and continue to improve and develop the services provided to the people living in the home. There is a good NVQ training programme and staff have been encouraged to continue to develop their skills.The staffing is flexible to accommodate different activities. Service users can choose what they want to participate in and the routines in the home are planned around this. The owners and staff are motivated and continue to improve and develop the services provided to the people living in the home. The manager has a clear idea of what the home needs to provide and is responsive to the comments received about the service provided. What has improved since the last inspection? Planned activities have risk assessments that are clearly written with steps taken to reduce identified risk. It also states why the activity is beneficial and the risk is worth taking. Since the last inspection visit the extension has been built including a spacious decking platform outside. The home now has a large sitting/dining room with glass patio windows and doors leading outside to the decking. There is also a new downstairs bedroom. What the care home could do better: There are no requirements or recommendations made from this inspection. The owners have identified areas that they would like to develop and written these in the AQAA. For example: "Utilise the additional internal and external communal living areas to provide new sensory experiences." This includes designing a sensory garden. They demonstrate an ongoing commitment to improving and developing the service to the people who live in the home. CARE HOME ADULTS 18-65 Tanglewood 252 Canterbury Road Hawkinge Folkestone Kent CT18 7AY Lead Inspector Julie Sumner Unannounced Inspection 30th April 2008 14:00 Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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 DS0000023272.V361096.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 Adults 18-65. 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 DS0000023272.V361096.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tanglewood Address 252 Canterbury Road Hawkinge Folkestone Kent CT18 7AY 01303 891616 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) kay.hull@care4free.net www.dolphin-tanglewood.co.uk Mrs Kay Hull Mrs Kay Hull Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th January 2007 Brief Description of the Service: Tanglewood is a detached house with gardens at the front and rear, on the outskirts of Hawkinge, near Folkestone. The home is owned by Mr and Mrs Hull. It is registered for 3 people with learning disabilities who live as part of the family. The owners work together in the home and employ 3 staff who work various flexible part time hours to support the people living in the home. The owner’s daughter, who has previously worked in the home now works occasionally as a volunteer. There is a vacancy since the new extension has been built, which includes a new ground floor bedroom. The home is suitable for people with mobility difficulties. There is a ramp at the back of the house, leading from the new decking area, that adjoins the new living room down to the back garden. Residents have their own bedrooms and an especially adapted shower room/toilet on the ground floor. There is also a large lounge/dining room and kitchen. Accommodation used by Mr and Mrs Hull and staff is on the first floor, including an office where care documentation is kept. The fees for this service range between £1023 and £1027 per week. Information about the home is on their website: www.dolphin-tanglewood.co.uk and the home can be contacted by e-mail to kay.hull@care4free.co.uk. The home can also be contacted for CSCI reports for prospective service users and the statement of purpose and service user guide containing information on the home’s services. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This report is based on information received about Tanglewood including an annual quality assurance assessment completed by the owner and an unannounced site visit to the home lasting just under 4 hours. Information was gathered for this inspection in a variety of ways both prior to and during this visit to the home. The people living in Tanglewood have limited verbal communication skills. They were able to participate in the visit a little by responding to simple questions and were assisted by staff. General observations were made during the day of how the people living in the home are supported. The staff spoke about their role in the home. There was a tour of the building and various records were inspected. What the service does well: An excellent quality of care and support is given to the residents living in Tanglewood who benefit from a family style environment. Communication is supported well within the home with residents being able to make their needs and wishes known and the owners and staff interpreting and responding to them. The day is well organised so that there is a mixture of daily household chores, outdoor activities, activities set in the community and leisure both in and outside the home. The home considers holidays an important part of individual lifestyles. Annual holidays are planned with the service users who like to go abroad if possible. The home is warm, spacious and comfortable. Staff said that the people living here get the benefit of a family home. The owners and staff are motivated and continue to improve and develop the services provided to the people living in the home. There is a good NVQ training programme and staff have been encouraged to continue to develop their skills. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 6 The staffing is flexible to accommodate different activities. Service users can choose what they want to participate in and the routines in the home are planned around this. The owners and staff are motivated and continue to improve and develop the services provided to the people living in the home. The manager has a clear idea of what the home needs to provide and is responsive to the comments received about the service provided. 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. 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 DS0000023272.V361096.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear assessment process to make sure the needs of individuals can be met. EVIDENCE: Since the new extension has been built there is vacancy for a third person to move in. The home has a website with information about the home and service provided. Initial assessments are usually carried out by the care manager. The owner also carries out an assessment and visits are arranged. The people living in the home have the opportunity to get to know the prospective person to make sure they are compatible. The owner said their views are taken into consideration before a decision is made. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The key principal of the home is that people living here are in control of their lives and they direct the service. EVIDENCE: Care plans contain clear information about how the person communicates, what their preferences are and who is important to them. Day to day records are kept in the diaries. Communication assessments have been carried out with the speech and language therapist when the people living here moved in. Various communication methods have been tried. The owners said that they would consider further support with this to enable the people living in the home to develop their communication skills. They also said that they would consider ways to introduce person centred planning. The risk assessments have been re-designed and included steps for why the activity would be beneficial, what the risks are, and what steps staff should take to minimise the risk. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 10 The owners and staff were observed interacting with the people who live in the home in a way that offered them choices about what they want to do, what they want to eat and other general aspects of day to day life. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Routines are very flexible and they can make choices in all the day to day areas of their life. EVIDENCE: The home provides a family social environment. The owner and staff said there is lots of contact with family and friends visiting. They all go on an annual holiday. The most recent holiday was in a specialised music therapy centre in Normandy. Each individual experienced one-to-one music sessions with a music therapist. The people living in the home are given opportunities to try different activities. They have some activities that they like to participate in regularly. Preferred activities range from various music activities, going to the gym, swimming and one person really likes to go out in the local woods for a walk Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 12 and likes to spend time in the garden. He spoke about this and then went outside during the visit. Photos were seen of individuals participating in various activities and on holiday. There is a large flat screen digital TV on the wall of the lounge and stereo surround sound to assist with the experience of listening and watching films and programmes. During the tour of the home, the owner said that one of the people living here really likes to sit in this room with the TV on. The owner said that there is very good involvement with the families of the people living in the home. There is a really complimentary testimonial on the home’s website from one of the families. No physical restrictions were observed in the home. Routines are arranged around the individual needs of the people living in the home and what activities are planned. Individuals were observed making their needs known and the owners and staff responded positively to them. Meals are home cooked. The owner is the main cook and the people living in the home help with some of the preparation because they enjoy it. They are encouraged to try different foods and indicate which ones they prefer. The menu is organised around what is healthy and wholesome and their preferences are taken into account. One of the people living in the home said they like curry best. They all eat as a family. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living here receive effective personal and healthcare support using a person centred approach. EVIDENCE: The owners and staff have got to know the people living in the home very well and are able to interpret their wishes. The individuals were observed to be able to communicate with some speech, gestures and some behaviours to make their needs known. Care plans clearly state how wishes are indicated. The people living in the home are assisted to attend regular health check appointments including dentist and optician. All appointments are recorded in the home diary. Individuals have been supported through health conditions that needed medical intervention. The owners have good contacts with the local community health professionals. Both are registered with the Kent Association for the Blind. The speech and language therapist and occupational therapist have been involved when required. The owners said that they would introduce health action plans. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 14 There is a small amount of medication in the home. Prescribed medication was discussed with the owner and the records were viewed. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals can feel confident that their wishes and feelings will be taken into account and that what they want and need matters and is given priority. EVIDENCE: The home states its aim is to provide a safe and secure home for the people who live there with well trained and motivated staff. Observation confirmed that the people living in the home are able to make their wishes and feelings known by using both verbal and non-verbal communication. The owners and staff were observed to be attentive and responsive. The home has a complaints procedure which is included in the service user guide. They have had no complaints and have a good dialogue with other professionals and families of the people who live there. Staff have attended adult protection training. Staff discussed some of the content of the NVQ, which also has a section on safeguarding adults. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The living environment is appropriate for the particular lifestyle and needs of the people living there and is homely, clean, safe and comfortable and well maintained. EVIDENCE: A tour of the home and garden was carried out with the owner. The accommodation is on the ground floor and the home is wheelchair accessible. The shower room has been adapted to suit the people living there. A new extension has been built and includes a new bedroom. This has been registered and now waiting for a new person to move in. The new bedroom has an en-suite wet room and toilet. There is a large kitchen, which opens from a breakfast bar into the new spacious living room. It has a dining area and a comfortable seating area. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 17 Patio doors and windows across the back wall give good natural light and lead onto the new decking platform and the back garden. The manager said that they are planning to plant a sensory garden. There are some hanging plants on the new decking frame and this is going to be further developed. There is a slope down to the garden that is wheelchair accessible. In the AQAA the manager said they plan to utilise the new internal and external communal living areas to provide new sensory experiences. The home is clean and fresh. Some of the staff are employed to support with the cleaning. There laundry is next to the shower room and is appropriate for the home. The manager also said there are plans to create a new laundry facility. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has plentiful staff available at all times to support the needs, activities and aspirations of the people using the service in an individualised and person centred way. People who use the service are positively involved in the choice of staff and their opinions are acted upon. EVIDENCE: This is a family home and the owners are part of the staff team and support individuals living in the home. Two staff were able to participate in the inspection visit and talked about their role in the home. Staff work flexibly. The team is made up of the 2 owners, 3 care staff and a family member who work together. The owner said that staff study NVQ level 3 because she thinks it is more relevant to their role in this home. Two staff have achieved NVQ level 3. These two staff spoke about the NVQ training. One of the staff has just started studying it. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 19 Staff were observed to interact positively with the people who live in the home. They were responsive to their needs and encouraged communication and participation. Staff said the lifestyle of the people living in the home is varied and active. They are able to do what they want. Throughout the visit the people living in the home were animated, focused and smiling. There is a stable staff team. The owner said that it may be necessary to employ another member of staff when another person moves into the home, depending on their assessed needs. All relevant recruitment checks have been carried out. Skills for care induction training is in place. There is a staff development programme. Staff working within Tanglewood have been trained in all mandatory training and extra training has been provided to meet the needs of the individuals living in the home, for example, support with visual impairment. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager has a clear understanding of the aims and focus of the service. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. EVIDENCE: The owner, Kay Hull, manages the home. She has previous experience of working in a care home for people with learning disabilities. She has achieved the National Vocational Qualification level 4 in management and the Registered Management Award. Staff said the owner is very approachable. They enjoy working here and being part of the family environment. The people living in the home smiled a lot and looked like they enjoyed the interaction they had with the manager. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 21 There was a discussion about quality monitoring within the home. The people being supported live in the home as part of the family. The owner explained how they support individuals to communicate their feelings and this determines what happens in the home. Individual behaviour and wellbeing indicates whether they are happy with what is being provided. The owners explained that they also receive feedback from families and other professionals who support the people who live in the home. One of the families has written a positive statement about the home and what it provides, which is on the homes’ website. This was viewed. The owners have demonstrated in discussion that they have a clear idea of how to develop the service provided to the people living in the home. The AQAA clearly states when maintenance checks have been carried out and all relevant ones are included. All the decking surfaces have been coated with non-slip coating, which had just been completed at the time of the inspection visit. Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 4 x 3 x x 3 x Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 23 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. 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. Refer to Standard Good Practice Recommendations Tanglewood DS0000023272.V361096.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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