Inspection on 19/10/09 for Holme Lodge Care Home

This is the latest available inspection report for this service, carried out on 19th October 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holme Lodge Care Home 24/10/07

Holme Lodge Care Home 24/05/07

Holme Lodge Care Home 26/04/06

Holme Lodge Care Home 15/11/05

Holme Lodge Care Home 12/07/05

Holme Lodge Care Home 13/10/04

Holme Lodge Care Home 14/06/04

Holme Lodge Care Home 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Holme Lodge Care Home 1 Julian Road West Bridgford Nottingham NG2 5AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Meryl Bailey     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Holme Lodge Care Home 1 Julian Road West Bridgford Nottingham NG2 5AQ 01159822545 01159825441 j.ollerenshaw@east-leonard-cheshire.org.uk www.lcdisability.org Leonard Cheshire Disability care home 20 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Service users shall be within category PD Date of last inspection Brief description of the care home Holme Lodge is a care home providing care and support for adults with a physical disability. All of the bedrooms are single; none have en-suite facilities. The home is situated in Lady Bay, part of West Bridgford, near Nottingham There is a pub, local shop and bus stop very close by and the amenities of West Bridgford and the city centre are only a short bus ride away. Further information and copies of inspection reports are available at the home by request. The fees at the home are based on individual needs. Currently, fees range from a minimum of £874 to a maximum of £1,100 per week. 2 1 1 0 2 0 0 8 20 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We did the inspection visit with one inspector. It was unannounced and took place on one day during the daytime. One method of inspection we used is called case tracking which involves us choosing a sample of people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at three peoples records. A tour of the premises included communal areas in use, bathrooms and some bedrooms. We also looked at recruitment records to find out if checks were carried out before new staff started working at the home and other records to see if staff were appropriately supervised and supported. Care Homes for Adults (18-65 years) Page 5 of 25 We have taken account of all the information we have received about the home since the last inspection. This includes the Annual Quality Assurance Assessment (AQAA), which the registered manager is required to complete to identify from their own quality monitoring what the service does well at and what they need to improve on. The AQAA form was returned before the site visit and was used to plan the site visit and to support judgements made in this report. We also sent out surveys to the home to be completed by staff and people living there or their relatives. This was so that we could give people more opportunity to tell us about what it is like at the home. Unfortunately, we have not received any completed forms and the comments made in this report are those made on the day to the inspector. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 7 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured their needs will be assessed prior to moving in. Evidence: There were currently 15 people resident in the home and one of those was there for a short stay for respite. We looked the files for five people and found comprehensive pre placement assessments of needs. The manager and senior staff had visited people before they moved into the home to carry out assessments and give information about the home. Individual interests and specific needs were noted. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is well planned to so that staff know how to meet needs and people are enabled to make their own decisions. Evidence: We looked at Individual Support Plans seen for five people and they were clearly set out for each person. All the plans included details of skills and interests. For one person there was an additional communication book with pictures to support information about likes, dislikes, interests and daily routine. People had signed their plans or made their individual mark to confirm they agreed with the content. The plans of those that were living there permanently had been reviewed regularly. People kept their own plans in their own bedrooms. In discussions with staff it was clear that they were aware of individual needs and action plans. There was a key worker system and key workers had received additional training to support people with specific communication needs. People told us they enjoyed discussions with staff and felt enabled to make their own decisions. They told us they Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: could approach a particular member of staff if they wanted to change something on their individual plan. Risks associated with activities were assessed as part of the care planning. In some cases there were contributions from hospital consultants and other professionals about appropriate actions to reduce risks. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have choices in their lifestyle and are enabled to take part in activities appropriate to their age and preferences. People enjoy a range of healthy meals. Evidence: Peoples interests were detailed in their plans. People told us of visits to the theatre and to football matches. One person had been to Disneyland Paris for five days. Another person was looking forward to an exchange visit to a home in the south of England. Some people had enjoyed doing a little gardening with volunteers. There was a record of a Service Users meeting held 15 October when activities were discussed. A notice board contained information about events. There were photographs displayed on one wall of a trip to Twycross Zoo in August 2009. All volunteers received training using a standard induction and included safeguarding adults, the law and support. Some volunteers were escorts on on group trips. Others were involved in supporting people individually by arrangement so that they could access the community. One Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: volunteer was assisting with Speech Therapy. There was an Art class held on Saturday mornings that families could also join in. People we spoke with said they enjoyed the meals they had at the home and that they always had a choice. On the day of the inspection most people had chosen chicken and bacon supreme with vegetables. People said that staff offer to prepare something different if they dont like what is on the menu. From the records we could see there had been a variety of nutritious meals, with alternative provided for those requiring particular diets. We saw some meals liquidised or chopped to meet individual needs. Since the last inspection, new staff had been recruited to prepare the teatime meals so that care staff did not need to be in the kitchen. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met. Evidence: Personal care needs were clearly stated in the Individual Care Plans. People told us staff are helpful and considerate Staff show respect when they help me I get the help I need to wash. Professional contacts were listed on the files and this included opticians, dentists, chiropodist, physiotherapists and breast screening. For one person there were details of how food and medicines should be given by staff through a percutaneous endoscopic gastrostomy (PEG) tube. This did not include directions to flush the tube prior to giving medicines. However, one staff member described the procedure well, which included the correct and safe procedure. During the inspection visit the plan was adjusted to include clear directions about flushing the tube. Topical creams were administered by care staff during personal care and there were body charts within the individual care plans to clarify where the cream was to be used and records of the applications. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: All other medicines were recorded clearly on the Medicine Administration Record sheets. Since the last inspection there has been a change in the timing and the majority of medicines are given before meals to avoid distraction. We observed one of the senior care staff administering medicines during the afternoon. He wore a red tabbard so other staff would know he was not to be distracted and a trolley was used to take medicines to people wherever they were in the building. He initialed the chart after giving each medicine. When they start a shift senior staff check that the previous person has appropriately completed the chart before they leave the building. This ensures accurate records are kept of medicines administered. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are listened to and action is taken to safeguard people from abuse. Evidence: There were records of complaints and concerns together with records of action taken to these. No one had contacted the Commission about any concerns. People said that they knew who to speak to if they had any concerns and they said they could also discuss things in their meetings. One incident had been appropriately referred by Police and the Adult Social Care department under safeguarding adults procedures. Records showed that staff had received Safeguarding Adults training since the last inspection and there was more refresher training planned as needed. People told us they felt safe at the home. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean and maintained to an acceptable standard. Evidence: There had been no major changes to the premises since the last inspection. Some building work was planned for the beginning of November 2009 to provide a covered the entrance, replace some windows and replace the nurse call system. We saw the communal areas and a sample of bedrooms. All areas were clean or being cleaned during the inspection. Appropriate machines were provided in the laundry. The outside garden area had been improved by the involvement of volunteers. There were outside tables and chairs in a paved area with a small garden in a central secure area. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of staff are provided to meet peoples care needs. Recruitment procedures ensure suitable staff are appointed and appropriate training is given. Evidence: Some new staff have been recruited since the last inspection, but agency staff are still used regularly. However, the rotas worked showed that there were always sufficient staff to cover the shifts. There were four staff during each day and two staff at night to meet the needs of the current 15 people at the home. Catering and cleaning staff were in addition. Also the manager, training and administrative staff were on the premises during the day. We looked at the files of four staff. There was evidence that thorough checks had been carried out prior to new staff starting work at the home. There were records of induction and a three month probation period. Some staff files contained National Vocational Qualification (NVQ) certificates. The manager told us that 14 of the 16 permanent care staff hold NVQ at level 2 or above. Individual supervision meetings had not been regular during the year for all staff, but they had at least one recorded on their files. One of the staff responsible for holding these meeting had been away from work for several months, but had recommenced Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: supervision meetings on her return. The training officer showed us a clear matrix of training completed and needed. Supervision records included identifying training needs and this part of the record was passed to the training officer. Refresher courses were arranged as needed and a monthly report of training was completed. For example, eight staff needed refresher Fire training and this was planned for 2nd December 2009. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in place ensure the home is run in the best interests of people that live there. Evidence: The same registered manager has remained at the home. A quality manager was visiting on the same day as this inspection visit in order to monitor the conduct of the home. The manager completed the Annual Quality Assurance Assessment (AQAA) in September 2009. In this she has told us that service user satisfaction surveys are carried out and actions identified and acted upon. Two people had been involved in the interview process for staff recruitment. The manager stated that from listening to peoples views they have employed additional kitchen staff to provide to ensure a variety of meal options are available in the afternoons. Also, additional activities had been arranged to include weekly visits from a fitness instructor and they had also been able to match people with volunteers with similar interests to provide more individual activities. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: There were records to show that staff training in safe working topics was well organised and monitored. In the AQAA form, the manager gave us the dates of servicing of equipment and systems and all these were within the last 12 months, with the exception of the emergency call equipment, but arrangements had been made for this to be replaced in November 2009. Staff experienced some difficulty in resetting this during the inspection. All portable electrical appliances had labels to show they were tested in July 2009. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 36 If a staff supervisor is not available an alternative person should be provided to ensure all staff have regular supervision meetings six times a year. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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