This inspection was carried out on 12th July 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 made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
CARE HOME ADULTS 18-65
Holme Lodge Care Home 1 Julian Road West Bridgford Nottingham NG2 5AQ Lead Inspector
Joanna Carrington Unannounced 12/7/05 10.00am 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Holme Lodge Care Home Address 1 Julien Road West Bridgford Nottingham NG2 5AQ 0115 9822545 0115 9825441 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Leonard Cheshire Joanne Ollerenshaw PD 20 Category(ies) of 20 PD registration, with number of places Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 13/10/04 Brief Description of the Service: Holme Lodge is a care home providing care and support for up to twenty adults with a physical disability. There are residents living at Holme Lodge that may have a learning disability or a mental health difficulty in addition to their physical disability. All of the bedrooms are single; none are ensuite. The home is situated in Lady Bay, a residential area that is part of West Bridgford. There is a pub, local shop and bus stop very close by and the amenties of West Bridgford and the city centre are only a short bus ride away. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven hours on the 12th July 2005 and was its first statutory unannounced visit for this financial / inspection year. During the course of the inspection a partial tour of the premises took place and the main method of inspection was called ‘case tracking’ which involved selecting three residents and tracking the care and support they receive through the checking of their records, discussion with them, the care staff and observation of care practices. Staff records were also looked at. In total, three residents and four members of staff were spoken with. The registered manager was not available on the day of the inspection. The Care Supervisor, however, was available for discussion and feedback and was able to supply most of the documentation that was required for the inspection. What the service does well: What has improved since the last inspection? What they could do better:
Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 6 Care plans seen require to be in more detail so that they explain exactly how support is given. When checking Medication Administration Records staff explained how one resident will take tablets orally but is inclined to then spit them out once the member of staff is out of sight. A care plan is required outlining exactly what approach staff take in administering medication. This needs to be developed with both the involvement of the resident and Community Psychiatric Nurse. To ensure that the medication system is safe all ‘when required’ medications must be labelled as so, on the medication administration record and when either one or two tablets can be administered staff must record which. There should be risk assessments on file, alongside care plans that identify ways ultimately to promote residents’ independence and to indicate when restrictions are imposed on an individual’s freedom. Residents already sign their care plans but only the key-worker signs when the plan has been reviewed. For evidence that residents are involved in the review and have agreed any amendments then residents should sign on these occasions also. From discussion with one resident there appears to be some confusion and conflict between staff on how this person is to be supported with moving and transfers. This needs to be clarified and recorded clearly in her care plan and a referral to a specialist is recommended to ensure that agreed support is appropriate to this residents medical condition. The Care Supervisor reported that this has already taken place following discussion with Leonard Cheshire’s physiotherapist over this issue. From talking with staff it became apparent that not all staff are aware of the essential principles when working with disabled people. The Care Supervisor reported that there is Disability Equality Training provided by Leonard Cheshire but on the staff files seen there was no evidence that these particular staff have ever attended this course. This is a learning need which is required to be met in order to ensure that the residents are supported appropriately. 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. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Progress has been made with ensuring that residents moving and handling needs are assessed. EVIDENCE: Prospective residents’ do not move to the home until the placing authority has provided a community care assessment and there was evidence of these assessments on the files seen. In addition to this at the previous inspection the need for moving and handling assessments for all residents was identified. Of the three files seen each contained this assessment, which is essential for ensuring that support provided is given appropriately and safely. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 While residents know their assessed needs and can choose to have ownership of their care plans further detail is required to ensure that staff are consistent in how needs are met. There is no evidence of risk assessments that identify benefits for residents to take acceptable risks as part of an independent lifestyle. EVIDENCE: Unless residents have opted not to, care plans are owned by residents and kept in their respective bedrooms. Of the three residents files that were looked at all of the sections within the existing care plans are now filled in compared to at the last inspection. Care plans are recorded in the first person, which supports the fact that the respective care plans are owned by the residents’ themselves. There is evidence that residents are involved in the development of care plans as these are signed. It is recommended that residents also sign when reviews have taken place and when subsequent amendments to care plans have been made. One resident spoken with is not happy with the recommendations set by the home’s physiotherapist on ways staff are to transfer her. From talking with staff it also seems that there is some conflict around what is the best way to do this. The care plan for moving and transferring is not in enough detail so this does not ensure consistency amongst staff. It was recommended that a
Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 10 referral be made to a specialist team who may be able to advise on appropriate transfers etc. The care supervisor reported that this referral has already been made. One member of staff spoken with feels that residents right to take acceptable risks is promoted whereas another member of staff felt this was not always the case. One resident spoken with explained that she is not supposed to walk to the local shop on her own. The member of staff confirmed this but does feel that this would be acceptable. There was no evidence of a risk assessment on this resident’s care plan. A risk assessment would identify the benefits of taking this risk and promote her independence and what measures can be agreed to minimise any identified risk. On all three residents files looked at the care plans lacked accompanying risk assessments. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 16 and 17 Residents have opportunities to access community facilities and be a part of the local community. Resident’s right to privacy is not respected unless all staff ensure that they obtain permission before entering bedrooms. Residents are offered nutritious meals with progress now made on residents being able to choose alternative options. EVIDENCE: From talking with both residents and staff it is evident that there are various opportunities for accessing the community. There are residents that attend courses at the local college. One resident is currently part of a Nottingham city theatre group and is busy with rehearsals. Staff will be taking residents along to watch the production. Residents with an interest in gardening get to visit garden centres in the area and there are regular trips out to the local pub. Residents are also involved in fundraising for Leonard Cheshire in the nearby town. While talking with one resident in their bedroom a member of staff entered the room quite abruptly to put away laundry, without knocking on the bedroom door first. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 12 All residents spoken with are happy with the quality of meals on offer at the home and confirmed that each morning they are informed of what the options are. This was recommended at the last inspection in order to ensure that all wishes can be accommodated prior to the meal. The menus show that a variety of balanced nutritious meals are served and there is always a choice of meals available each day. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 21 Residents’ health needs are well addressed but in order to promote and maintain good health better monitoring of weight is required. Some improvements to the system for medication administration is needed to ensure that it is safe. Progress has been made in obtaining the wishes of residents regarding death and dying. EVIDENCE: There was evidence on the three resident’s files seen that residents have regular health checks and chiropody appointments. Residents receive support from specialist health care professionals such as dieticians, community psychiatrists and psychologists when necessary. However, not all residents are being weighed monthly which was recommended at the last inspection. On one resident’s care plan it was identified that this person’s weight is to be recorded every three months despite a report on file from the Speech and Language Therapist expressing concern about this resident’s weight. This therefore suggests that their weight needs to be monitored more closely. Medication administration records (MAR) were examined as part of the inspection. On one MAR chart seen the instructions for ‘when required’ (PRN) medication were not clear. It did not identify this medication as ‘when
Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 14 required’. Staff confirmed that it was. The instructions stated either one or two tablets to be given. It needs to be recorded on the MAR chart how many tablets have been administered for each dose. It was explained by a senior member of staff how one resident continually deceives staff by taking the medication but will then later spit it out. This member of staff described her methods to try and encourage this resident to take their medication, necessary for her mental health. It was also explained how the Community Psychiatric Nurse has attempted to address this issue with the resident. There is no care plan on this resident’s file outlining an appropriate and consistent approach to be taken in managing this situation. This is required with both the resident and community psychiatric nurse involved in developing this care plan. On the three files seen residents wishes in relation to death and dying are now documented. This was set as a requirement at the last inspection. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Residents are assured that staff are aware of and adhere to the local Adult Protection Policy and Procedures. EVIDENCE: Members of staff that were spoken with demonstrated an awareness of their role and responsibility in accordance with the Nottinghamshire Committee for the Protection of Vulnerable Adults (NCPVA) Policy and Procedures. Since the last inspection there has been an incident of adult protection in which a resident made an allegation of abuse against a member of staff. As required, the manager of the home notified the Adult Protection Unit and Commission for Social Care Inspection and also sought advice to ensure that the Nottinghamshire procedures were being correctly followed. The member of staff remains suspended while this continues to be investigated. At the last inspection it was recommended that further training be identified for managing aggressive behaviour. This training has not yet been sourced / taken place. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The home is as homely and comfortable as it can be while it waits for its much needed re-provisioning to a new site. EVIDENCE: The Care Supervisor ensured that all staff and residents are being kept up to date with any news. Residents spoken with confirmed this. Unfortunately, no new developments could be reported except that there have been some difficulties in obtaining land. No further refurbishment or renewal is taking place at the home because of the re-provision to a new site. Carrying out this re-provisioning remains as a requirement in this report with the same deadline, for the work to have commenced and be completed by 01/04/07. This standard will be assessed at the next inspection to ensure that the current environment remains at an acceptable standard. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 36 Training and support of staff needs to improve to ensure that residents benefit from an effective staff team and that their needs are met. Staffing levels are currently an issue for the home, which also impacts on the effectiveness of the staff team. EVIDENCE: The Care Supervisor reported that there have been some difficulties in recruiting to vacant posts and with longstanding suspensions of two staff this has also affected staffing levels. It is apparent that the morale of staff is very low at the moment and staff spoken with reported that they are pulling together as best they can to work extra hours so that minimal staffing levels are maintained. The rota for the previous four weeks was examined at the inspection and showed that due to annual leave and unforeseen sickness there were fourteen occasions when staffing was not at its required minimum level. This situation must be reviewed urgently to ensure that the needs of residents can be adequately met. Mandatory courses and other relevant training courses are provided by the organisation, Leonard Cheshire and one member of staff spoken with praised the corporate induction that he is in the process of. However, other staff felt that they had not recently accessed enough training and could not recall going
Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 18 on mandatory refresher courses such as Food Hygiene. Three staff files were looked at and training records indicated that for some staff refresher courses are overdue. Discussion with staff identified that there is a learning need into disability awareness and the principles of working with disabled people. Although Leonard Cheshire does provide a Disability Equality course the training records for these staff showed that this course had not ever been attended. Staff files also showed that supervision has become well overdue. When members of staff are under a disciplinary investigation then it is absolutely essential that supervision sessions for these individuals occur regularly. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) X None of these standards were assessed on this occasion. EVIDENCE: Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 1 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x x 3 x x 2 3 Standard No 31 32 33 34 35 36 Score x x 1 x 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Holme Lodge Care Home Score x 2 1 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 21 no 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 6 Regulation 15(1) Requirement Ensure that care plans include enough detail on how support is given so that there is a consistent approach that the resident agrees to. Ensure that activities in which service users participate in are free from avoidable risks and that there are risk management strategies / assessments attached to care plans that are reviewed. Ensure that all staff conduct themselves in a manner that respects the privacy and dignity of service users at all times. To promote the health of service users ensure that service users weight is monitored and recorded according to their individual needs and current health. Ensure that advice is sought from the CPN on an appropriate and consistent approach necessary for staff to take in supporting one resident to take their medication. This is to then be recorded in detail on a care plan. For safe administration ensure Timescale for action 31/08/03 2. 9 13(4)(b) 14(2)(a) (b) 30/09/07 3. 16 12(4)(a) 30/09/05 4. 19 12(1) 31/08/05 5. 19, 20 13(1)(b) 13(2) 15(1) 31/08/05 6. 20 13(2) 31/08/05
Page 22 Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 7. 24 23(1)(a) 23(2)(a) 18(1)(a) 8. 33 9. 35 18(1)(c) 10. 11. 36 18(2) that instructions on medication administration records are clearly labelled and that the exact quantity of PRN medication given is recorded. Carry out intention to reprovision the physical environment over the next 3-5 years Ensure that staffing levels do not fall below what is appropriate for meeting the needs of service users. Ensure that all staff receive training appropriate to the work they are to perform. This includes mandatory and refresher training as well as identified training to meet individual staff training needs. Ensure that persons working at the home are appropriately supervised. 01/04/07 31/08/05 30/09/05 31/08/05 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. Refer to Standard 6 19 Good Practice Recommendations It is recommended that residents also sign to say they agree with any (or no) amendments at each review of their care plan. It is recommended that the weight of all residents is monitored and recorded on a monthly basis. Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Edgeley House Tottle Road Nottingham NG2 1RT 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 Holme Lodge Care Home C03 C53 S8697 Holme Lodge V242036 120705 Stage 4.doc Version 1.40 Page 24 - 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!
