Inspection on 06/09/06 for Holm Lodge

This inspection was carried out on 6th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Holm Lodge 27/10/05

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 Unannounced Inspection 7th September 2006 10:30 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.V304010.R01.S.doc Version 5.2 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.V304010.R01.S.doc Version 5.2 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.V304010.R01.S.doc Version 5.2 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. 27th October 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. Information is provided to prospective residents and others by a comprehensive statement of purpose and service user guide whilst interested parties can contact the home via the telephone; the home also keep a copy of the most recent inspection report on site. At the time of the inspection visit fees at the home ranged from £337 to £500 per week with additional charges for such services as hairdressing, chiropody and personal magazines etc. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 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 unannounced inspection visit took place on a weekday in September and lasted approximately 5 hours. At the time of the inspection the home were accommodating 13 residents. The Inspection included a tour of the premises, both inside and out, and it’s facilities with many residents agreeing for their bedrooms to be viewed. Care staff were observed carrying out their duties throughout the visit along with the general daily routines and events of the home. A number of records and documents required by regulation were also seen during the site visit including the accident book, the fire safety record, the complaints book, the medication administration record book and a sample of staff records. The Inspector spoke with the registered manager, a senior carer and two members of care staff. Approximately five residents were spoken to during the inspection, whilst two visiting relatives were also spoken with at the time. A relative and a social worker were contacted by telephone following the site visit. 3 completed questionnaires were received from residents and one from a relative and viewed prior to the completing of this report. What the service does well: What has improved since the last inspection? Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 6 The home have made improvements to their admission procedures to ensure that no resident moves into the home without first having their care needs fully assessed and recorded and that each resident benefits from having their care needs suitably reviewed. Improvements have also been made to the homes medication administration procedures and all records of medication given was found to be clear, accurate and up to date; this indicates that the medical needs of residents are now being addressed more thoroughly. 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.V304010.R01.S.doc Version 5.2 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.V304010.R01.S.doc Version 5.2 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): 2, 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Holm Lodge ensure that no resident is admitted to the home without first having their care needs fully assessed and that such needs can be met by the service. Where ever possible the resident and their family carers play an active role in the move in process. EVIDENCE: Since the last inspection just one new resident has been admitted to the home. Records confirmed that this resident was visited by the registered manager prior to moving in and they themselves visited the home twice with their next of kin to partake in lunch and meet the staff and other residents. The residents next of kin confirmed that this had taken place and noted that the home did all it could to make the visits as ‘pleasant as possible’. This residents care plan confirmed that a written assessment of need was completed prior to their arrival and contained care needs assessment of all key aspects of the residents needs such as their physical, health care, social and Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 9 emotional care requirements. This resident had a completed and signed contract of residency including the terms and conditions of their stay and confirmation that the first month of residency was considered as a trial period. The registered manager stated that it is vital that residents are able to play an active role in the move in process and outlined the sensitive manner that this residents move was dealt with at ‘their pace’. Holm Lodge do not offer intermediate care services. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning at the home contains sufficient guidance for care staff to ensure they are able to meet the assessed health care needs of each individual resident. The system of medicine storage and administration ensures that the medical needs of residents are not compromised or placed at risk, whilst residents are treated with respect and dignity. EVIDENCE: The last inspection found that a resident had been admitted to the home without having a completed care plan in place. Three care plans were seen during this inspection including the one pertaining to the most recently admitted resident. All care plans confirmed that the home incorporate the individual care needs of residents into suitable plans of care that highlight particular care needs such as the physical, social, health care and emotional needs of residents with descriptions of how such needs will be met by care staff. One resident who suffers from short term memory loss is assisted to remember issues, events or appointments by care staff who leave messages and reminders in their diary. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 11 Residents are registered with local GP’s and records confirmed that health appointments such as dentist, opticians and chiropodists are arranged when necessary. Care plans are reviewed regularly by the manager or her senior staff with evidence of the changing needs of each individual resident being suitably assessed. Each resident has a daily log that is completed by staff at the end of each shift, on closer inspection it was found that not all residents have comments made in their daily logs every day. The registered manager noted that staff usually add notes when something has occurred for the resident, though acknowledged that such daily logs should contain a comment on every resident ever day and accepted that this would be considered good practice. The previous inspection report highlighted a concern that the homes medication storage and administration system was found to have a number of errors in regard the accuracy of recording of medication administered. The medication administration records were viewed on this occasion and were found to be accurate and up to date with no errors. The registered manager stated that she a senior member of staff monitor medication procedures on a daily basis. The medication storage cupboard was seen to be well maintained and no medication was found to be out of date or inappropriately stored. Interactions seen between staff and residents indicated that residents are treated with respect, dignity and care. Many residents stated that they are treated ‘extremely well’ by staff and one resident noted that ‘they wouldn’t want to live anywhere else as you are looked after here’ whilst another confirmed that ‘staff always tell you what they are doing’. Staff encouraged residents to engage in the daily routines of day, such as the lunchtime meal in an unhurried and patient manner with obvious care and understanding of the individual needs of each resident. One relative spoken with noted that the home had been ‘brilliant’ in caring for their mother. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 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, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from appropriate routines and opportunities are provided to allow them to pursue their individual and group interests and activities. The home encourage and support residents to maintain contact with their families/carers and friends. The dietary needs of residents are met. EVIDENCE: Residents stated that the daily routines of the home are ‘relaxed’ with mealtimes taking place ‘at reasonable periods of the day’. Residents can choose what time they would like to get up in the morning or retire to bed in the evening. Some residents choose to take their meals in their rooms, though most were seen to enjoy the lunchtime meal that was taken in the dining room in a pleasant atmosphere. The home continue to employ the services of an activities co-ordinator who visits the home, though the registered manager stated that she now comes just once a week as residents did not appear to wish to take part in two activity sessions a week. One resident noted that activities at the home were ‘ok’ and allowed them to ‘keep busy now and again’. Activities include group games such as quizzes, skittles and exercise. Occasional excursion visits are Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 13 facilitated by the registered manager who takes residents out for drives in her car and to visit local places of interest. Several residents commented that they are able to engage in their chosen religion either by attending their local church. The home have a relaxed visitors policy and residents can have guests visit them at any reasonable time of the day. The visitors book confirmed that some residents receive regular visits from their families/carers and friends. Relatives stated that they feel they can visit the home ‘whenever they wished’ and noted that the home was ‘settled and happy’ when they arrive. The homes menu was viewed and this was seen to offer residents a varied, nutritious and appetising diet. Most residents spoken with commented positively on the meals they receive and stated that the food was ‘very nice indeed’. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home have a suitable written complaints procedure that encourages residents to express their concerns, whilst residents are protected from the risk of harm, neglect or abuse. EVIDENCE: The home has a suitable complaints procedure which clearly outlines it’s responsibility for addressing any concerns or complaints made about the home, it’s staff, or the service it offers. A copy of this policy and procedure was clearly displayed in a communal area of the home, whilst the homes statement of purpose has been up dated to include the details of who to contact in the event of needing to complain. The complaints book was viewed and was found to not contain any entries since the last inspection. Residents stated that ‘they could always talk to the registered manager’ if they had any concerns. No resident spoken with expressed any concerns that they felt unable to complain should they need to. No complaints have been made to the CSCI since the last inspection. 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 and refresher adult protection training occurs yearly. No Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 15 adult protection matters have been reported to the CSCI since the last inspection. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 16 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, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suitably maintained both inside and out and residents benefit from spacious, homely surroundings and personalised bedrooms. The health and safety of residents, staff and visitors is adequately addressed to ensure that no one is at risk of injury or harm. EVIDENCE: A tour of the premises confirmed that Holm Lodge is furnished with domestic style fittings and carpets and is kept warm and airy, with a satisfactory level of natural and artificial light. A number of residents agreed to have their bedrooms viewed. These were found to be clean and well maintained and had been individualised by the resident with personal items such as photographs, pictures, and ornaments. One resident noted that Hold Lodge is a ‘fantastic place to live’. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 17 Holm Lodge was found to be well maintained both inside and out, with a satisfactory standard of decoration visible throughout the home. The home was found to be clean, tidy, and free from offensive odours or smells. The homes stairlift was tested and was found to be in good working order. Fire records confirmed that regular fire alarm and emergency lighting checks had been completed, whilst the fire safety equipment had been recently serviced. Evidence of staff attending fire safety training was also seen. The most recently employed member of staff was able to describe exactly what the homes safety procedures were in the event of a fire. The accident record book was viewed and this evidenced a satisfactory standard of the reporting of incidents with clear descriptions on the nature of the incident and any outcomes that occurred as a result. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 18 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, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Holm Lodge deploy suitably experienced care staff to meet the assessed needs of residents, in numbers that reflect the needs of residents during the day and night. Residents are protected by the homes recruitment procedures and benefit from staff who are committed and caring. EVIDENCE: The staff rota was viewed and this confirmed a satisfactory level of staff care cover during the daytime, notably at busier times of the day night time cover is provided by one ‘waking night’ carer with one ‘sleep in’ carer. An ‘on-call’ system is in place whereby the registered manager can be contacted for support when she is not there. Records indicate that many care staff employed at Holm Lodge have had previous experience in the care industry. The home has a suitable induction and training programme that addresses such areas as adult protection, safe handling and lifting, health and safety, first aid, and medicine administration for which certification has been given. Several care staff have now completed the National Vocational Qualifications (NVQ) Level 2 in care. Residents stated that care staff are ‘lovely and caring’ and it was clear that care and support is provided to residents in an individual and sensitive manner with care staff obviously having a good understanding of each resident in their care. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 19 The home had employed just one new members of staff since the last inspection. The staff record in question confirmed that all necessary Criminal Records Bureau (CRB) or Protection of Vulnerable Adults (POVA) checks had been completed prior to them starting to work at the home. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 20 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, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager conveys a wealth of relevant experience and knowledge and manages the home for the benefit of residents. Residents live in a safe environment that is managed in a manner that is relaxed and caring. EVIDENCE: The registered manager of Holm Lodge commands a vast understanding of the needs of residents. She has obtained a number of relevant qualifications including the National Vocational Qualification (NVQ) Level 4 award in Care and Management. It was clear that the home is managed in the best interests of residents and the atmosphere created by the management approach is one of a relaxed, open and caring environment. One resident stated that she could always ‘speak to June’ (the registered manager) whenever she needs to. It is Testament to the registered manager that there has been no requirements Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 21 made as a result of this inspection, thus indicating a gradual improvement in care provision over the course of the last few inspection visits. The registered manager did accept that the current system of in house quality assurance could be improved further and acknowledged that although she and her senior carer regularly review records etc that there needs to be a suitable format for recording their findings. Care staff stated they were ‘well supported’ by the registered manager and felt they could talk to her should they have any concerns or issues. The registered manager provided evidence of a new formal supervision format and stated that all staff appraisals have been completed for this year and she is now starting the process of formal supervision. The home is not involved in managing any of the personal finances of residents. Records confirmed that the management approach in regard health and safety issues are suitably addressed. Records such as the fire log, hot water temperature checks and electrical maintenance files were found to be up to date and accurate. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 22 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP33 OP33 Good Practice Recommendations Residents daily logs should contain comments every day to ensure a consistent and regular approach is taken to record the daily lives of each resident. The home should consider leaving quality assurance questionnaires in a communal areas of the home for relatives and visitors to complete whenever they wish. The registered manager should consider developing a format for the monthly reviewing of care practices such as checking medication and care plan records to ensure the home can evidence it’s own quality assurance measures. Holm Lodge DS0000021139.V304010.R01.S.doc Version 5.2 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.V304010.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!