Archived: Tanglewood

Updated 30 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was completed by one inspector.

Service and service type

Tanglewood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was no registered manager in the service. A deputy manager had recently been appointed to lead the service.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection and sought feedback on its current performance from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We met with the three people who used the service. We also spoke with four members of care staff, the new deputy manager and the provider’s regional manager.

We reviewed a range of records. This included two people’s care and medication records. We also looked at staff files in relation to recruitment training and supervision. A variety of records relating to the management of the service were reviewed, including policies, procedures, and staff rotas.

After the inspection

Following the inspection, we spoke with the relatives of each of the three people the service supported. We also reviewed the information we had requested from the service during the inspection.

Updated 30 April 2020

About the service

Tanglewood is a residential care home providing personal care for up to three people with learning disabilities. At the time of our inspection three people were using the service.

The service is a detached single story building with enclosed rear garden. The accommodation is sub divided into two, the main house where two people live and an adapted annex for the third person. It is located in a rural area near St Austell, Cornwall and people were unable to access the local community without support from staff.

People’s experience of using this service and what we found

An analysis of rotas found that on nine occasion in the three weeks prior to our inspection staffing levels within the service had been unsafe. Staff recognised that people had been exposed to risk as a result of low staffing levels and told us, “The staffing honestly is a little bit scarce. We do have short periods of time where the overlap is not quite right” and “In my opinion it was not safe, it was horrendous. I managed, there was no incident, but you are just waiting for something to happen.”

Relatives told us they felt staffing levels in combination with high staff turnover had exposed people to risk. They told us “There is no continuity. It is not the nice calm orderly place that it used to be”.

Incidents had not been reviewed and analysed to identify patterns or trends. Unplanned restrictive practices were used during the inspection as staff had not followed guidance included in people’s care plans.

All necessary staff pre-employment checks had been completed to ensure people’s safety and staff understood local safeguarding procedures. Medicines were managed safely and there were systems in place to protect people from financial abuse.

All new staff received induction training and supervision had been provided. System to ensure training was regularly updated were not entirely effective and additional training updates were arranged following the inspection. The service was well maintained and action had been taken to address issues identified during our previous inspection.

There was limited evidence of best interest decision making available and there was a lack of evidence available to demonstrate the provider had acted on a recommendation issued by the commission in relation to restrictive practices following our last inspection.

People had limited choice and control of their lives. Tools developed to support people to make decisions were not being used by staff as they were concerned subsequent changes to plans as a result of staff availability my cause people additional anxiety. Staff were caring and responded promptly to people’s needs.

People did not receive person centred care as care plans were not fully understood by staff and did not always reflect peoples current support needs. Staff had been provided with guidance on how to meet people’s communication needs but this guidance had not been consistently followed.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. Staffing levels and the availability of staff who were able to drive had limited people’s ability to access the community. Tools designed to enable people to participate in decision making around activities were not being used as staff did not know if staff would be available to support people to engage with activities they had planned. Staff told us, “[We are] very short staffed, it’s a very big issue with continuity and non-drivers. It restricts the guys from going out for activities. [Person’s name] does not do anything” and “[People] are often stuck in the house. It is only at changeovers really that they get to go out or when we have three [staff] like today.”

Relative’s were concerned that the lack of access to the community and activities was impacting on people’s behaviour. They told us, “We took [Persons name] out by ourselves because we were fed up of [our relative] being left in the service”, and “[My relative] is not occupied and is not getting the attention [they] need. [Person’s name] is becoming bored and frustrated and unfortunately this is showing in [their] behaviour.”

Complaints received had not always been fully investigated and there was a lack of evidence to demonstrate what action had been taken to address issues identified as part of the complaints process.

There was a lack of consistent leadership in the service. The registered manager had moved to another of the provider’s services prior to July 2019. No new registered manager had been appointed and no notification of the registered managers absence had been submitted to the commission. Relatives and staff reported there had been six different managers since the registered managers departure. A new deputy manager had recently been appointed but rotas showed low staffing levels had meant this manager had spent the majority of their time providing care.

The provider’ quality assurance processes were ineffective. Audits had been completed but had not resulted in action being taken to ensure compliance with the requirement of the regulations. Relatives told us they had lost confidence in the provider and were seeking alternative care placements. Their comments included, “It is not a very good picture really. It is just rather depressing thinking of the situation [My relative] is in.”

Managers accepted that the service was not meeting people’s needs and following feedback at the end of the inspection the provider has begun taking action to improve the service’s performance. Additional resources had been made available and an action plan developed to drive improvement in the service’s performance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good overall but requires improvement for effective. (Report published 23 December 2017)

Why we inspected

The inspection was prompted in part due to concerns received in relation to staffing levels and the quality of support people were receiving. A decision was made to bring forward this inspection to examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.