Tanglewood - Care Inspectorate

TanglewoodCare Home Service Children and YoungPeopleCarlisle RoadAbingtonBiggarML12 6SD

Type of inspection: Unannounced

Inspection completed on: 11 June 2014

ContentsPage No

Summary 31 About the service we inspected 42 How we inspected this service 53 The inspection 94 Other information 205 Summary of grades 216 Inspection and grading history 21

Service provided by:Partners In Care Ltd

Service provider number:SP2007008923

Care service number:CS2007144754

If you wish to contact the Care Inspectorate about this inspection report, please callus on 0845 600 9527 or email us at [email protected]

Inspection report continued

Tanglewood, page 2 of 23

SummaryThis report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change after this inspection following otherregulatory activity. For example, if we have to take enforcement action to make theservice improve, or if we investigate and agree with a complaint someone makesabout the service.

We gave the service these grades

Quality of Care and Support 5 Very Good

Quality of Environment 5 Very Good

Quality of Staffing 5 Very Good

Quality of Management and Leadership 5 Very Good

What the service does wellThe young people in the service were happy living in the Tanglewood Drive. The staffwere positive and warm in their interaction with the young people. Staff practice isyoung person centred. Staff are fully aware and respect the preferences and needs ofeach of the young people. Young people were progressing well and the outcomeswere good.

What the service could do betterThe service could review the current documentation in use with a view tostreamlining and reduction to avoid the duplication currently in operation.The area manager was seeking to improve links with looked after childrens nursesfrom placing local authorities.

What the service has done since the last inspectionThe service has improved the quality of the care planning documents to ensure theycapture the assessed needs of young people.

ConclusionThe staff team at Tanglewood continue to provide a high level of support and care tothe young people in a welcoming and nurturing environment.



1 About the service we inspectedThe Care Inspectorate regulates care services in Scotland. Information about all careservices is available on our website at www.careinspectorate.com

Tanglewood is a care home offering a service for up to three children and youngpeople between the ages of twelve and eighteen. There were three service users atthe time of this inspection and we met with all of them.This service was previously registered with the Care Commission and transferred itsregistration to the Care Inspectorate on 1 April 2011. Since June 2009 it has beenowned and managed by Pebbles Care Ltd but has continued to trade as Partners inCare Ltd. The service operates from a modern detached house in the village ofAbington in South Lanarkshire and aims to "provide a safe, structured and nurturingcare experience which reflects that of normal family life". The service is specificallygeared toward young people experiencing "crisis" and seeks to introduce "structure"and "stability" into their lives. Tanglewood works closely with another service operatedby the service provider in a nearby village; although operating as separate servicesthey share senior management and staff support arrangements.

Based on the findings of this inspection this service has been awarded the followinggrades:

Quality of Care and Support - Grade 5 - Very GoodQuality of Environment - Grade 5 - Very GoodQuality of Staffing - Grade 5 - Very GoodQuality of Management and Leadership - Grade 5 - Very Good

This report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change following other regulatory activity. You canfind the most up-to-date grades for this service by visiting our websitewww.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of ouroffices.



2 How we inspected this service

The level of inspection we carried outIn this service we carried out a low intensity inspection. We carry out theseinspections when we are satisfied that services are working hard to provideconsistently high standards of care.

What we did during the inspectionThis unannounced inspection was carried out over two days on the 4th and 11th June2014. During the course of the inspection we spoke with two young people, tworesidential workers, and the senior, deputy and area manager. The condition of thephysical environment was examined. We considered the views expressed in 3questionnaires returned by young people and four staff questionnaires. Relevantrecords were examined some of which included:The support plans for two young people,Complaints log,Medication Records,Incident recordings,Young people meeting minutes,Team meeting minutes,Health and Safety Records,Unit Development Plan,Monthly quality assurance reports.The newsletter.Feedback on the inspection findings was provided to the district manager on the 11thJune 2014

Grading the service against quality themes and statementsWe inspect and grade elements of care that we call 'quality themes'. For example,one of the quality themes we might look at is 'Quality of care and support'. Undereach quality theme are 'quality statements' which describe what a service should bedoing well for that theme. We grade how the service performs against the qualitythemes and statements.

Details of what we found are in Section 3: The inspection

Inspection Focus Areas (IFAs)In any year we may decide on specific aspects of care to focus on during ourinspections. These are extra checks we make on top of all the normal ones we makeduring inspection. We do this to gather information about the quality of these aspects



of care on a national basis. Where we have examined an inspection focus area we willclearly identify it under the relevant quality statement.

Fire safety issuesWe do not regulate fire safety. Local fire and rescue services are responsible forchecking services. However, where significant fire safety issues become apparent, wewill alert the relevant fire and rescue services so they may consider what action totake. You can find out more about care services' responsibilities for fire safety atwww.firelawscotland.org



What the service has done to meet any recommendations we madeat our last inspectionFollowing the last inspection the service received two recommendations. These aredetailed below with an account of progress made.

1. The service should develop the way it plans to identify and meet young people'stherapeutic needs and records progress, achievements and outcomes for youngpeople. National Care Standards, care homes for children and young people. Standard4: Support arrangements. There was detailed account of the progress and needs ofyoung people. Regular key work time was recorded and could evidence how staffwere supporting young people.

2. Staff should update individual risk assessments often enough to ensure that theytake account of any changes and progress and provide an accurate description ofcurrently identified risks and arrangements to manage these. National Care Standards,care homes for children and young people. Standard 6.5: Feeling Safe and Secure. Riskassessments were updated as appropriate.

The annual returnEvery year all care services must complete an 'annual return' form to make sure theinformation we hold is up to date. We also use annual returns to decide how we willinspect the service.Annual Return Received: Yes - Electronic

Comments on Self AssessmentEvery year all care services must complete a 'self assessment' form telling us howtheir service is performing. We check to make sure this assessment is accurate.The service provided a self assessment which identified strengths and areas forimprovements.

Taking the views of people using the care service into accountWe spoke with two young people. Young people confirmed being involved in carereviews and being offered the opportunity to write their own report. Young people allsaid that they had staff members to whom they could talk to when upset or worried



and confirmed having individual time with key worker. All could give examples ofrecent activities and ways in which staff had helped them. The food was described asbeing fine and all young people regarded the environment to be comfortable. Allthought the rules were fair.

Taking carers' views into accountWe did not speak with any parents or carers.



3 The inspectionWe looked at how the service performs against the following quality themes andstatements. Here are the details of what we found.

Quality Theme 1: Quality of Care and SupportGrade awarded for this theme: 5 - Very Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the care and support provided by the service.

Service strengthsAt this inspection we found that the performance of the service was very good for thisstatement.

The staff team in Tanglewood valued the participation of the young people and thiswas carried out in a variety of ways.Time was spent with young people prior to formal care reviews seeking their views inpreparation for the review. This meant young people were prepared and able toactively engage in decision making about their future plans. Some young peoplecompiled their own written report 'Having Your for consideration at reviews. Therewas evidence that staff and management advocated on behalf of the young people tocase manager in formal settings.Young people were involved in compiling their own support plans and riskassessments.Tanglewood team operated a key worker system and staff member's used individualtime with young people to discuss current issues, future plans and aspirations.Young people now attended house meetings to discuss group living issues andcontribute to planning activities, menu planning, house rules, proposed housedecoration and holiday plans.Yong people were encouraged to personalise their own bedrooms and were allocatedfunds to do this. As a result the bedrooms were homely and posters and such likereflected the hobbies and interests of the young people.Young people confirmed their input and involvement into the choice of decoration ofcommunal areas. The artwork displayed through the house was created by youngpeople during arts and crafts sessions with staff.



Satisfaction questionnaires were routinely issued to young people to gather viewsabout the quality of care, the physical environment and the quality of staff andmanagement. This was linked to the improvement plan of the service. Examplesincluded more flowers in the garden which were then purchased and the building of apatio area, allocated television times and a restructuring of bedtimes.

Young people were asked to give their views about the positive attributes aboutindividual staff and identify areas in which they could improve. These were used indiscussion in one to one supervision and in staff appraisals.Young people had been involved to take part in the recruitment of new staff.

Young people joined the team meeting to talk about their care plan, progress andviews of the support.

Areas for improvementThe production of the Tanglewood newsletter was being resumed to issue to youngpeople, staff parents and stakeholders.

Grade awarded for this statement: 5 - Very Good

Number of requirements: 0

Number of recommendations: 0

Statement 3We ensure that service users' health and wellbeing needs are met.


All young people had care plans which were reviewed formally at six monthly intervalsor more often if necessary. The in house day to day support plans were updatedmonthly and were structured under the GIRFEC ( Getting it right for every child) well-being indicator and thus provided a person centred, holistic view of the youngperson's needs and abilities. Young people contributed to support plans by givingtheir views and signing if in agreement with the contents. These Monthly supportplans had action plans for the month ahead, such as, securing a college place, visitingflats in readiness for moving on. The progress made by young people was evidentwhen reading through monthly plans. Young people completed 'How you can care forme' document which detailed preferences, important people, daily routine and areasof support needed.The health and wellbeing needs of young people were promoted. Young people wereregistered with local general practitioners and underwent a health check at the pointof admission.



Young people were supported and encouraged to attend health appointments. Therewas evidence of young people attending dentists and opticians for routine check-upsin addition to attendance for treatment. Staff kept a detailed account of all healthappointments which were attended by young people.

Young people who required mental health services were receiving good support. Thishad involved regular input from child and adolescent mental health services. Theprovider also employed a child psychologist who provided individual work with youngpeople and consultation to staff.Staff members were proactive in ensuring young people received support andguidance from sexual health service as required. This meant young people wereinformed about sexual health and relationships.The service had clear guidance for staff in relation to medication management.Medication records were kept up to-date and administered as prescribed.Arrangements made for medications to be disposed of which were no longer in use.Young people were involved in menu planning and shopping for provisions. Youngpeople were positive about the meals provided and confirmed menus reflected theirfood preferences. Meals included healthy options with fresh fruit, vegetables andsalad provided daily. Homemade soup was available daily.Physical exercise was promoted and young people had been given the opportunity toparticipate in trying out new experiences when attending a residential holiday basedaround outdoor pursuits.Hobbies and interests were promoted. This included helping a young person withmusical talents join a local band and in house arts and crafts. Young people weresupported to make and sustain friendships and as a result young people weresocialising with peers in the community.All young people had school and work placements and there were good educationaloutcomes for young people. One young person had achieved SQA Highers whichenabled her to secure a college placement to pursue her chosen career. Anotheryoung person had successfully completed an alternative to school placementachieving certificates. Currently the service were funding a work placement for ayoung person in a local resource while applications for college courses were beingconsidered.The staff helped young people maintain contact with family and significant as part ofthe care plan. This included regularly escorting young people to contact andwelcoming family members to the home. Communication from staff with parents andfamily was described by parents as being good and reliable.The staff team ensure that transition plans for young people leaving the service waswell organised and progressed at a pace which young people felt comfortable with.This had meant revisiting plans when a young person expressed reservation and staffsupporting young people in the weeks following the move to independent living.Memory boxes were kept to add to the life story work for young people.



Areas for improvementThe service did not always establish links with the placing Local Authority LookedAfter and Accommodated Children's Nurse (LAAC Nurse). This was being addressed aspart of the admissions process.Not all young people had health record books which would facilitate a health historyto move to the next placement or with the young person when moving on toindependence. The manager advised that this would be addressed.We found that whilst the staff maintained good record keeping relating to youngpeople, the recording systems required the same information to be recorded innumerous places, for example, daily logs and activity sheets and different riskassessments proformas. This meant the task of record keeping for staff was onerousand not best use of their time. (Refer to recommendation)




Recommendations

1. The manager should identify ways to streamline and reduce the documentation toavoid unnecessary duplication and the demands on staff time. This is to meet withStandard 7.1. Management and staffing. National care standards for care homes forchildren and young people.



Quality Theme 2: Quality of EnvironmentGrade awarded for this theme: 5 - Very Good

Statement 1

We ensure that service users and carers participate in assessing and improving thequality of the environment within the service.

Service strengthsBased on our findings in relation to Quality Statement 1.1, we accept that a very goodstandard had been achieved in relation to this Quality Statement.

Areas for improvementNo additional areas for improvement were identified under this statement.




Statement 2We make sure that the environment is safe and service users are protected.


At the time of the inspection the house was furnished to a high standard, attractivelydecorated, clean and tidy. The environment was very well maintained.

Young people were helped to maintain a clean and safe environment and weresupported to keep their bedrooms tidy and clean. As a result the bedrooms werewelcoming safe and attractive areas for young people.

Staff followed safe food handling and hygiene practices. Cooked food and fridgetemperatures were monitored.

Electrical equipment testing was carried out routinely recent certificates indicatedthat all was in order.



Water outlet temperatures were monitored to prevent burns or scalds.

The service has a visitor's sign in book and visitors were asked to show identificationwhen appropriate.

There was an on call system is in place for staff to contact management in anemergency out with office hours. Staff confirmed this ensure that a response frommanagement was always readily available.

Staff members completed Incident forms to record any incident which involved theyoung person showing aggression, violence, verbal abuse, or threat of aggressiontowards a staff member or other young person. This included an account of how thesituation arose, what happened and the action which was taken to manage thesituation. These were signed by the manager who monitored how situations weremanaged by staff and identified when additional resources were required. We foundas staff developed relationships and got to know young people the instances ofviolent incidents reduced.

Staff members undertake CALM training to develop skills in intervention techniques touse in managing challenging behaviour. This training had been regularly updated.

Risk assessments were in place for young people identifying a number of potentialrisks to themselves and others. These were specific to the needs of the young person.Management plans were in place to manage, reduce or eliminate risk. This meantthat staff intervening appropriately when a young person exhibited crisis behaviours.Young people were involved in risk management plans and helped identify situationswhich could exacerbate risk and the interventions they found helped alleviate risktaking behaviour. We found the staff team were successful in helping young peoplereduce risk taking behaviour and develop alternative ways to manage stress andanxiety, such as going a walk, talking to staff and attending counselling.

Crisis management plans were in place and identified the circumstance in which ayoung person may become distressed and exhibit challenging behaviours. Theseincluded the intervention to use to diffuse the situation and offer reassurance to theyoung person.

Sanctions imposed on young people were clearly recorded and the managermonitored these closely. There were occasions when the manager overruled andremoved a sanction if she felt it inappropriate. This was understood and welcomed bythe staff team promoting good care and reflecting on practice.

Staff members were trained in Child Protection and were aware of the procedures tofollow in the event of a young person being at risk of danger and when to reportallegations of abuse.



Staff members followed procedures when young people absconded or failed to returnto the placement. This involved staff actively in trying to locate the young person inthe neighbourhood or at friends, notifying parents and the police. The home operateda traffic light system in partnership with the police in the event of a young personbeing missing from the placement. This meant priority had been given by the policein seeking a young person who was regarded as being particularly vulnerable.

Areas for improvementThe area manager is currently sourcing new bedroom door locks which allow staff tooverride the lock in case of emergency.






Quality Theme 3: Quality of StaffingGrade awarded for this theme: 5 - Very Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of staffing in the service.


Areas for improvementNo additional areas for improvement were identified under this statement




Statement 3We have a professional, trained and motivated workforce which operates to NationalCare Standards, legislation and best practice.


Regular team meeting were held. Staff described this as a worthwhile forum in whichto share practice ideas, plan and update on the progress of young people. Staffmembers who spoke with the Inspector stated that the staff team were supportive ofeach other and worked well together.

There was evidence of good systems of communication between staff teams. Thisincluded the use of staff planner with tasks allocated daily, informative shift handoverand good use of the staff communication book.

Staff stated feeling valued by the manager and motivated in their role. Supervisionwas held regularly and staff described this as supportive and useful for reflection onpractice.



Staff members were qualified to SVQ level 3 and HNC or above. Mandatory refreshertraining was made available and additional relevant training was provided. There waslearning and development strategy for staff across the organisation which detailedtraining priorities for the year ahead. The organisations training coordinator kept anoverview of all staff training needs and this linked to the training plan for the staff inTanglewood. Staff members told us that the training provided helped them providedskilled care to the young people in the service. Staff members were registered withthe Scottish Social Service Council (SSSC).

The area manager and deputy had completed the 'leadership and management'award course and SVQ 4. Senior workers had undertaken the SVQ award and wereprovided training in the supervision of staff. The team structure allowed for careerprogression for staff and in house, the manager made different opportunities for staffto develop their skills base and give diversity to their role. One example included theroutine quiz created by the senior worker which had questions regarding the nationalcare standards, legislation and the providers policies.. This ensured staff learned orupdated their knowledge about the national care standards for care homes forchildren and young people, legislation and the provider's policies. This was aninnovative way to give staff the opportunity to develop learning and keep updated ina stimulating way.

Areas for improvementThe manager now divides her time as manager of Tanglewood and area managerialresponsibilities, with the depute manager as the day to day manager. The providershould advise the care inspectorate if this situation is now part of a formal staffingstructure change.






Quality Theme 4: Quality of Management and LeadershipGrade awarded for this theme: 5 - Very Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the management and leadership of the service.


Areas for improvementNo additional areas for improvement were identified under this statement




Statement 4We use quality assurance systems and processes which involve service users, carers,staff and stakeholders to assess the quality of service we provide

Service strengthsAt this inspection we found that the performance of the service was very good for thisstatement.The service routinely issued questionnaires to parents and social workers to gathertheir views about the quality of service provided. Responses confirmed that parentsand social workers were very happy with the care provided to young people, thatenvironment was of good quality, staff members were skilled in caring for youngpeople and that the home was well managed.The service has good quality assurance systems. The depute manager provided thearea manager with a monthly report which reported on all aspects of the serviceperformance. This included examination of complaints, violent incidents, staffattendance, health and safety, staff training and the progress of the young people.Action plans were put in place. This ensured that the home was being well managedand the quality of care to young people was of a high standard.The service had a development plan which drove forward improvements to theservice.



The area manager continued to share her time between the service and otherexternal duties. This meant there was good communication with the depute manager,senior staff and young people and matters arising were resolved quickly. Seniormanagement meetings took place regularly.

Weekly reports were sent to case managers regarding the progress of young people.Notifications are made as appropriate by the service to the SSSC and the CareInspectorate.The service had a complaints system which was known to the young people andissues of dissatisfaction were recorded in the complaints book along with theresolution and action taken.

Areas for improvementThe service should continue to ensure that system are in place to monitor the highquality of the service.






4 Other information

ComplaintsNo complaints have been upheld, or partially upheld, since the last inspection.

EnforcementsWe have taken no enforcement action against this care service since the lastinspection.

Additional Information

Action PlanFailure to submit an appropriate action plan within the required timescale, includingany agreed extension, where requirements and recommendations have been made,will result in the Care Inspectorate re-grading a Quality Statement within the Qualityof Management and Leadership Theme (or for childminders, Quality of StaffingTheme) as unsatisfactory (1). This will result in the Quality Theme being re-graded asunsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 5 - Very Good

Statement 1 5 - Very Good


Quality of Environment - 5 - Very Good



Quality of Staffing - 5 - Very Good



Quality of Management and Leadership - 5 - Very Good



6 Inspection and grading history

Date Type Gradings

26 Jun 2013 Unannounced Care and support 5 - Very GoodEnvironment 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 5 - Very Good

4 Mar 2013 Unannounced Care and support 4 - GoodEnvironment 4 - GoodStaffing 4 - GoodManagement and Leadership 4 - Good

25 Nov 2010 Unannounced Care and support 5 - Very GoodEnvironment Not AssessedStaffing Not AssessedManagement and Leadership Not Assessed



31 May 2010 Announced Care and support 4 - GoodEnvironment 4 - GoodStaffing 4 - GoodManagement and Leadership 3 - Adequate

2 Feb 2010 Unannounced Care and support 4 - GoodEnvironment Not AssessedStaffing 4 - GoodManagement and Leadership Not Assessed

5 Oct 2009 Announced Care and support 4 - GoodEnvironment 4 - GoodStaffing 4 - GoodManagement and Leadership 4 - Good

10 Feb 2009 Unannounced Care and support 4 - GoodEnvironment 4 - GoodStaffing 4 - GoodManagement and Leadership 4 - Good

3 Nov 2008 Announced Care and support 3 - AdequateEnvironment 4 - GoodStaffing 4 - GoodManagement and Leadership 3 - Adequate

All inspections and grades before 1 April 2011 are those reported by the formerregulator of care services, the Care Commission.



To find out more about our inspections and inspection reportsRead our leaflet 'How we inspect'. You can download it from our website or ask us tosend you a copy by telephoning us on 0845 600 9527.

This inspection report is published by the Care Inspectorate. You can get more copiesof this report and others by downloading it from our website:www.careinspectorate.com or by telephoning 0845 600 9527.

Translations and alternative formatsThis inspection report is available in other languages and formats on request.

Telephone: 0845 600 9527Email: [email protected]: www.careinspectorate.com



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Tanglewood - Care Inspectorate

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