CQC report explained · a residential care home
What the CQC found at Tanglewood
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. There were enough staff, risks and medicines were managed safely, although two staff files initially lacked full employment histories and checks on some previous care work.
- Effective?
- Good
- People received appropriate support with health, food, communication and consent. Staff had relevant training, but specialist feeding training had not yet been followed by a competency check or a clear refresher plan.
- Caring?
- Good
- Staff treated people with warmth, kindness, dignity and respect. They understood people's non-verbal communication and involved them in day-to-day decisions.
- Responsive?
- Outstanding
- Care was highly personalised and adapted to people's changing needs, interests and communication styles. Inspectors found creative activities, community involvement and individual goals that improved people's confidence and quality of life.
- Well-led?
- Good
- The home had an open, inclusive culture and staff worked well as a team. Audits, meetings, feedback and an improvement plan were used to monitor quality and make changes.
What inspectors found, February 2020
Rated Good overall, with Outstanding responsive care and only minor shortfalls in staff checks and specialist training.
This was an unannounced planned inspection on 03 January 2020. The inspector observed care, reviewed records and spoke with staff, managers, relatives and health professionals. Six people lived at the home, all with learning disabilities or autism and complex health or physical needs.
Inspectors found people were safe, supported by enough staff and given their medicines correctly. Staff were kind, respectful and trained to meet people's needs. The home worked with health professionals and supported people with food, communication, choice and independence.
Responsive care was rated Outstanding. The home offered creative activities, community links and personalised goals that helped people build confidence and skills. Overall, the home was rated Good, as were Safe, Effective, Caring and Well-led. Responsive improved from Good at the previous inspection in July 2017.
Personalised support
Care plans reflected people's individual needs, preferences and life histories. Staff supported people to make choices and develop independence.
“People received highly personalised care that responded to changing needs, focused on their strengths, empowered them and gave them choices.” from the report
Creative activities
The home created varied activities and adapted them to people's abilities and interests. People were supported to join community activities and maintain relationships.
“The home was innovative in the way they helped stimulate people and develop their interests.” from the report
Kind and respectful staff
Staff knew people well and understood how to communicate with those who could not speak. Observations and feedback showed warmth, dignity and respect.
“Throughout the inspection we observed staff interacted with people in a calm and gentle way.” from the report
Safe medicines and staffing
There were enough staff to meet people's needs, and medicines were securely stored, administered and recorded.
“Medicines were safely managed. People's medicines were securely and safely stored.” from the report
Positive leadership
Staff, relatives and health professionals described the management positively. The home used audits, meetings and feedback to identify improvements.
“There was visible leadership and management presence at the service.” from the report
Incomplete employment checks
needs fixingTwo staff records used old application forms and did not contain full employment histories. Some checks on previous health and social care work had not been completed, although the report says this was addressed.
“However, we found for two staff an old application form had been used and their full employment history had not been requested” from the report
Specialist feeding competency
needs fixingStaff had specialist feeding training, but the home had not completed competency checks or clearly planned refresher training. The report says this had not affected anyone's care and action was arranged after the inspection.
“Staff had received training on specialist feeding regimes but there was no competency assessment to assure the provider of their continued competence” from the report
- 01Have all staff files now been checked to confirm full employment histories and previous health and social care checks?
- 02How is staff competence with specialist feeding regimes assessed and refreshed now?
- 03How would you adapt activities and communication for my relative's particular interests, needs and non-verbal communication?
- 04How do you involve families in reviews and tell them about changes in health, care or support?
- 05How do you measure whether individual goals are improving a person's independence and quality of life?
This was an unannounced inspection covering all five key questions and the overall service; the previous overall rating was Good in July 2017, while Responsive improved to Outstanding. This explanation was written from the published report of 5 February 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2017
Rated Good and remained Good; inspectors found safe, kind and personalised care, with some fire and water safety actions still being addressed.
This was a comprehensive inspection on 08 June 2017. One inspector observed care, reviewed records and spoke with staff, relatives and health and social care professionals. The five people living at the home could not communicate their views directly, so the inspector observed how staff supported them.
The home was rated Good overall and remained Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines arrangements, suitable risk assessments and staff who understood people's complex health and support needs.
Inspectors saw calm, respectful and individual care. Relatives and health professionals described staff as proactive and highly knowledgeable. People's care plans, activities and links with health professionals were tailored to their needs, and the home had effective complaints and quality-checking systems.
Personalised health support
Staff responded promptly to changes in people's health and followed professional advice. Inspectors found clear improvements in some people's health, behaviour and wellbeing.
“Excellent quality of direct care. Implementation of monitoring and treatment plans is excellent.” from the report
Kind and respectful care
Staff understood people well, did not rush them and supported them with warmth, dignity and respect.
“We observed that staff were calm and sensitive and had a sense of fun when they interacted with people.” from the report
Safe medicines arrangements
Records showed medicines were given as prescribed. Staff had to demonstrate their competence before administering medicines, and medicines were stored securely.
“Medicines administration records showed that people received their medicines, including 'as required' medicines when they should and how they were prescribed.” from the report
Effective leadership and checking
Relatives and professionals found the home approachable and well managed. Audits and action plans were used to identify and complete improvements.
“The systems to monitor the quality of the service remained effective.” from the report
Fire and water safety follow-up
minorThe London Fire Brigade had identified actions needed to maintain fire safety. The fire risk assessment and an action plan were in place, but a new legionella risk assessment was still being arranged during the inspection.
“A new legionella risk assessment to ensure water safety was being arranged at the time of the inspection.” from the report
- 01What actions from the London Fire Brigade's fire safety visit were completed, and when?
- 02Was the new legionella risk assessment completed, and were any further actions needed?
- 03How are staff trained to recognise non-verbal signs of pain, distress or changes in health?
- 04How are relatives involved in reviewing and changing each person's care plan?
- 05How do you make sure activities remain personalised to each person's interests and communication needs?
This was a comprehensive inspection covering all five key questions; people could not communicate their views directly, so the inspector used observations, records and feedback from relatives and professionals. This explanation was written from the published report of 5 July 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Tanglewood
3 rated inspections over 5 years: the service has held its Good rating throughout.
- February 2020Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- July 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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