Inspection on 27/10/05 for Holm Lodge

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holm Lodge 06/09/06

Holm Lodge 07/06/05

Holm Lodge 15/03/05

Holm Lodge 26/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holm Lodge Lewes Road Ringmer East Sussex BN8 5ES Lead Inspector Kevin Whatley Announced Inspection 27th October 2005 10:00 X10015.doc Version 1.40 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 Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 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 Older People. 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. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holm Lodge Address Lewes Road Ringmer East Sussex BN8 5ES 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) 01273 813393 Mr Sri Ratnasinkam Mrs Saraswarthy Ratnasinkam Mrs June Woolley Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That a maximum of fourteen (14) Serivce Users are to be accommodated. That Service Users must be aged sixty-five (65) years and over on admission. 7th June 2005 Date of last inspection Brief Description of the Service: Holm Lodge is a large detached house set over two floors with a newly completed extension; this has subsequently increased accommodation space from nine to fourteen beds, whilst adding a further dinging room and lounge area. Resident bedroom accommodation comprises of fourteen single bedrooms all with en-suite facilities, located on the ground and first floor. On the ground floor are two lounges, two dining rooms, with small conservatories at the rear and extension side of the home. The first floor is accessible by a stair lift. Holm Lodge is situated off the main road in Ringmer, close to Lewes town, and within easy reach of local facilities. There is a car park at the front of the home, and a large garden at the rear. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Holm Lodge will be referred to as ‘residents’. The announced inspection took place on a weekday in late October and lasted for approximately five hours. At the time of the inspection the home was accommodating fourteen residents and was therefore fully occupied. The inspection included a tour of the premises and it’s facilities, with many residents also consenting for their bedrooms to be viewed. Approximately three residents were spoken with individually, whilst several others commented on their care during a group discussion. The manager, the proprietor, and two members of care staff were spoken with during the visit; whilst an activities facilitator who was carrying out a weekly visit was also spoken with, as was a friend and a relative of two resident’s who were visiting at the time. Care staff were also observed carrying out their duties. A number of records and documentation required by registration were also inspected. The inspection also included assessing the actions taken by the home in relation to requirements made following an inspection carried out by the Commission for Social Care Inspection (CSCI) Pharmacist Inspector on 8th June 2005 following concerns identified at the last inspection in May 2005. What the service does well: What has improved since the last inspection? Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 6 Since the last inspection the home have implemented new policies and procedures for the storage and administration of medication. The homes activity programme has been improved to include a twice weekly visit by an activities co-ordinator who engages residents in exercise and interesting events. The homes overall environment has been improved further with the development of the outdoor area and summer house, whilst the extension to the office enables the manager suitable space and privacy to undertake her duties. The manager has now achieved the required National Vocational Qualification (NVQ) level 4 award in Care and Management. 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. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Holm Lodge provides prospective residents and their relatives/carers with sufficient information regarding the services it offers, though a review to up date these documents should be undertaken. The ensure that residents are protected by appropriate terms and conditions of residency. The home must ensure that no resident is admitted to the home without recorded assessments. EVIDENCE: The homes statement of purpose and residents handbook were seen. Both documents contain relevant information regarding the nature of the services offered at the home including the aims and objectives of care provision, the services provided as part of the fee, such as ‘good home cooking’ and optional ‘manicure and hand massage’, and those that are not such as ‘dry cleaning’ and hairdressing’. The documents also contain details of the homes complaints procedure including the contact details of the Commission for Social Care Inspection (CSCI), whilst the residents handbook has the contact details of ‘age concern’ advocacy services. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 9 The statement of purpose has not been updated since the new extension was completed and now needs to contain details of the extra rooms and space currently available, whilst the qualifications of the manager also need to be included. A number of terms and conditions of residency were viewed, these were found to contain necessary information including the basic services being offered, such as 24 hour personal care, and extra services that incur additional charges such as chiropody, hairdressing, and newspapers. Files were also seen to contain social services contracts where relevant. A number of care plans were viewed. These confirmed that all permanent residents had their care needs assessed by the manager prior to admission. Files contained pre admission information and professional assessments of the psychological, mental health, and health care needs of residents. Evidence was seen of pre-admission questionnaires being used by the home to inform their own needs and risk assessments. However the files relating to residents who were admitted to the home on a ‘respite’ basis, did not contain completed care needs or risk assessments. The manager stated that she had visited these residents prior to admission, though there was little evidence to support this fact or any evidence to support the level of care required to meet such resident’s needs. A number of the ‘respite’ residents files contained medical assessments that stated that they had been identified as having Dementia type illnesses. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. A majority of residents benefit from having their needs assessed and subsequently incorporated into appropriate plans of care, however the home fails to include the needs of respite residents in such care planning. The home have made improvements to their medicine administration procedures to comply with the requirements of registration, though they must strive to be consistent with medication issues. Residents are treated with respect, dignity and care. EVIDENCE: A number of the residents care plans were seen and this confirmed that the home have a suitable system for needs assessment and care planning. Care plans contained relevant information on the physical, emotional, social and health care needs of residents. Care plans contained risk assessments in relation to areas of concern including mobility and the risk of falls. Plans of care outlined the assessed needs of residents and clarified the manner that such needs are to be carried out by care staff. Of concern was the fact that a majority of the care plans relating to ‘respite’ residents who had previously resided at the home for short periods did not Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 11 contain completed care plans and indeed some contained no care plan whatsoever. All residents are registered with a local G.P and documentation showed that residents are supported to attend necessary health care appointments with their Dentists and Opticians. Records indicated that the home liaises appropriately with health care professionals such as the District Nurse service and the Community Psychiatric Nurse. Details were noted of such services being swiftly requested by the home to visit residents to assess their particular health care problems as and when required. Following issues noted at the last inspection the CSCI Pharmacist Inspector visited the home in June 2005. A number of requirements were made as a result of this inspection in regard the storage and administration of medicines within the home. A view of the medicine storage facilities and administration records found that there have now been notable improvements made to the overall system, including the development of suitable policies and procedures to address all aspects of medication within the home. However a tour of the premises discovered several items of prescribed medication, namely creams, in bedrooms belonging to residents not named on the medicine. Staff were seen to interact appropriately with residents, treating them with respect, courtesy and care. Residents stated that care staff were ‘fantastic’ and ‘very caring’, whilst relatives comments in pre-inspection questionnaires included ‘staff are most supportive and caring’. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15. Residents have the opportunity to engage in their chosen interests, whilst the home have improved the programme of activities. Residents benefit from nutritious and home cooked meals that meet their dietary needs. EVIDENCE: A number of residents were spoken to regarding the opportunities they have to pursue their interests and hobbies. One resident attends their local church once a week and several others commented that the home provide visits to the local shops to allow them to purchase personal items etc. Records indicated that there have been previous trips organised by the home to visit show gardens and tea shops. The manager stated that it is envisaged that the home will organise a trip this Christmas to attend a show. The home also provide resident’s with information, in both the residents guide and displayed in the home, that explains clearly the choice they have to access independent support or advice outside of the home. The information sheet is well prepared and contains the contact details of the local branch of Age Concern. On the day of the inspection an activities co-ordinator was observed facilitating an interactive quiz between a group of residents. The quiz involved the use of old proverbs and sayings and was clearly an activity that residents enjoyed Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 13 and engaged fully in. The co-ordinator stated that she visits the home twice a week, one day being an exercise based event with the second aiming to be more focused on memory awareness type games. It was clear that the activity enhanced the energy levels amongst those who participated. The homes menu was viewed and this confirmed that residents benefit from a varied and balanced diet. The cook stated that since the home has expanded to accommodate fourteen residents that she has been able to meet the needs of the extra numbers without any major difficulties, despite a relatively small catering area. The lunch provided on the day of the inspection was well prepared and tasty and residents enjoyed their meals in one of two dining rooms. Residents stated that the meals provided at the home were ‘very good’ and ‘lovely’. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were inspected. The home ensure that there are suitable policies and procedures in place to address residents views, concerns, and complaints. Residents are protected from the risk of harm, abuse, or neglect. EVIDENCE: The homes complaints book was viewed. This indicated that no complaints had been received by the home since the last inspection; CSCI have not received and complaints since the last inspection. The homes complaints policy clearly outlines the manner in which the home have to address any concerns or complaints, including the timescales by which any investigation has to be completed. The policy is clearly displayed in the home. A comment received from a relative found that an issue they had was dealt with by the manager in a timely manner. The home have a suitable adult protection policy with clearly defined procedures for staff to follow in the event of any suspicion of abuse, neglect or harm being caused to residents. Adult protection is included in the staff induction process. Care staff spoken to displayed an acceptable understanding of relevant adult protection processes and issues. Many of the residents at the home voted in the last election either by post, or were encouraged and supported to visit the local polling station in the village. Many of the residents are local to the area and have subsequently maintained strong links with friends and relatives, who visit them on a regular basis. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 and 26. The home is generally well maintained throughout with suitable and homely furnishings and fittings. Resident’s personal space is appropriately individualised whilst communal areas offer sufficient space and comfort. Holm Lodge is clean, hygienic and tidy. EVIDENCE: Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 16 A tour of the building found that the home is in a generally good state of repair throughout, although the extension appears more modern and comfortable. Residents have easy access to all areas of the home with a stair-lift available for those requiring assistance to the upper floor. All areas were free from hazards and obstructions and all residents have the opportunity to use one of two lounge areas. The outside of the property continues to be upgraded and the garden and decking area now offers residents ample and pleasant outdoor space, when the weather permits, including a small summer house. Resident’s rooms were seen to be pleasantly decorated with personal items such as photographs, pictures and ornaments adorning every room. All areas of the home were found to be clean and hygienic. Since the last inspection a small extension has been added to the managers office, this has now allowed her to have suitable space to carryout her duties appropriately including much needed storage space for records etc. Records confirmed that fire safety equipment is maintained by a service contractor, whilst staff have attended fire safety training; confirmation of recent fire alarm checks were found along with evidence had of a recent fire drill. All other records relating to the health and safety of the premises were found to be up to date and accurate, including regular water temperature checks. An inspection was carried out of the homes kitchen area by an Environmental Health Officer in May 2005, no requirements were made as a result of this visit. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. The home deploys suitable numbers of care staff to meet the assessed needs of residents. Staff are experienced and carryout their tasks in a caring and professional manner. The home must continue to develop their training programme, whilst supporting their care staff toward achieving the required qualifications in care. EVIDENCE: The staff rota indicated that there is a minimum of three care staff on duty between 8am and 2pm with a senior member of staff leading the shift, with two staff on duty during the afternoon/early evening; the manager is available to offer assistance most weekdays. At night the home deploy one ‘waking night’ member of care staff who is supported by another ‘sleep in’ member of care staff. The home also employs a fulltime cook and a domestic assistant. No new members of staff have been employed since the last inspection. Staff files confirmed that new staff undertake an induction programme that addresses all relevant areas of care including the protection of vulnerable adults, safe handling and lifting and medicine administration. Since the last inspection staff have undertaken further training in medicine and polypharmacy, moving and handling and infection control. No care staff at the home currently hold a National Vocational Qualification (NVQ) level 2 award in Care, though two are currently undertaking the course. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 18 A large number of the care staff employed at the home have worked there for sometime and had worked within the care industry prior to starting at the home. All care staff were seen to be competent in the duties they carried out and were seen to treat residents with respect, care and patience. Residents commented that care staff were ‘brilliant and caring’ and stated that ‘they could not be better looked after’. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37 and 38. The home is managed appropriately in a manner that is relaxed and supportive for both residents and staff alike. The manager must review the lack of a formal supervision system. Residents interests are protected by the homes policies and procedures and record keeping. EVIDENCE: Holm Lodge has been managed by Mrs Woolley for a considerable number of years. Mrs Woolley has considerable experience of offering care to vulnerable adults and commands a vast knowledge in relation to meeting the assessed needs of residents within the home. The manager has recently completed the required NVQ level 4 award in Care Management. The atmosphere in the home was found to be relaxed, homely and caring. Residents stated that ‘you wouldn’t find anywhere better than here’ and commented on the positive relationships they share with Mrs Woolley. Care Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 20 staff stated that they were supported in their work and noted that they felt they could speak to the manager should they have any concerns or views. A requirement in the previous report stated that the manager must implement a suitable system for the formal supervision of care staff. A format for observing staff undertaking practical care tasks has been started that includes discussing the managers findings and addressing any short falls in practice. A format for the yearly appraisal of care staff has also started to be implemented, however the formal supervision of staff, involving one to one discussions with the manager have yet to be established. Records maintained at the home, as required by registration, were legible, relevant, and concise, confidential information concerning staff and residents is stored in the office in lockable cabinets. The addition of an extended office has allowed the manager the opportunity to have store all records more appropriately. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 3 3 Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 22 YES 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. 1 Standard OP3 Regulation 14(1) (a) Requirement The home must not admit any resident to the home without firstly completing and recording a full care needs assessment. The home must ensure that all residents have completed and up to date care plans, notably those residents receiving ‘respite’ care. That prescribed medication is only administered to the named resident and suitably stored at all times. That 50 of care staff must obtain NVQ level 2 in Care. That the home implements a formal staff supervision programme outstanding from previous inspection). Timescale for action 27/10/05 2 OP7 15(1) 27/10/05 3 OP9 13(2) 27/10/05 4 5 OP28 OP36 18(1) (a) 17(2) 27/04/06 27/04/06 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 Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 23 1 OP1 2 OP19 The homes statement of purpose should contain information regarding the recent additional bedrooms and extension space; the managers recent NVQ award also needs adding the document. The toilet and bathroom doors should have suitable signs fitted. Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Holm Lodge DS0000021139.V249768.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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