Inspection on 21/10/08 for Holme Lodge Care Home

This inspection was carried out on 21st October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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 29/01/2009.

Inspecting for better lives 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:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Meryl Bailey     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shona Johns Type of registration: Number of places registered: Leonard Cheshire Disability care home 20 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 up to twenty adults with a physical disability. Some people living at Holme Lodge may have a learning disability in addition to their physical disability. All of the bedrooms are single; none are en-suite. 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. 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 £612.32 to a maximum of £969.83 per week. 20 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 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: one star adequate 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 Commission for Social Care Inspection is upon outcomes for service users 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 reviewed all of the information we have received about the home since the last report of our key inspection in October 2007. Services are now required to fill in a document called an Annual Quality Assurance Assessment (AQAA), in which the registered manager identifies from their own quality monitoring what the service does well and what they need to improve. We received a completed AQAA form in Care Homes for Adults (18-65 years) Page 5 of 26 September 2008. We considered this in planning the visit and deciding what areas to look at and the information has been taken into consideration within this report. We carried out the inspection visit with one inspector. It was unannounced and took place on one day during the daytime. The main method of inspection we used is called case tracking which involved us choosing a sample of people who live at the home 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 staffing records and other records connected with the running of the home. A partial tour of the premises was made, but we did not see every bedroom. What the care home does well: What has improved since the last inspection? What they could do better: Staff should record all significant information in the daily notes to ensure other staff have the information they need to meet health needs. Ensure accurate records are kept of all medication administered to people. This is to make sure that people are always offered the medication they are prescribed to promote their health and wellbeing. When people are prescribed medicines on a when required basis staff must follow clear guidelines, ensuring medication is used and given appropriately and recorded consistently. Care Homes for Adults (18-65 years) Page 7 of 26 The manager should review the procedure for accepting deliveries of new stocks of medication into the home. Arrangements should be made to train or otherwise make staff aware of the updated procedures for investigating allegations or suspicions of abuse. They should designate specific staff to kitchen duties in the evenings so that the senior workers other tasks are not compromised. Staff should have regular supervision meetings with their senior or manager. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 26 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. Clear information is available about the service and people can be assured their needs will be assessed prior to moving in. Evidence: Since the last inspection the Service User Guide has been amended to give information about short breaks. At this inspection there were two people staying for a short break and 15 permanently resident at the home, though one was in hospital. We looked the files for five people currently using the service 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 26 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 planning arrangements enable staff to meet needs and people are enabled to make their own decisions Evidence: We saw some clear individual support plans and others were developing. People had signed their plans or made their individual mark to confirm they agreed with the content. One person explained to us that staff review the plan with her and show her any amendments made. 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 key workers and felt enabled to make their own decisions. People living at the home were also involved in the recruitment process and one person was Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: involved in shortlisting and on the interviewing panel. We saw risk assessments on peoples files, which cover activities of daily living as well as individuals chosen activities and interests. Advice of hospital consultants and other professionals, such as a speech and language therapist, had been taken and appropriate actions proposed to reduce risks. Care Homes for Adults (18-65 years) Page 12 of 26 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 at Holme Lodge so that they can take part in activities appropriate to their age and preferences. Evidence: A few people attended day centres during the inspection. Some told us they enjoyed doing craft work on some mornings within the home and there had been a change of room used for this, with staff now bringing craft work to the lounge rather than people going up to the top floor via the lift. The individual support plans showed us that people were consulted about their main interests. The manager had arranged to accompany two people to a football match on the evening of the inspection day. There was also a licensed bar within the home. One person told us he regularly meets friends in the city clubs. He also takes part in wheelchair rugby. Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: People told us staff arranged taxis so they could visit family members. Staff told us some family visit people at the home and stay for tea. Two people told us separately that staff were very kind and always respectful. We observed staff being patient in communication with people. People we spoke with said they enjoyed the meals they had at the home and that they always had a choice. The manager told us a new chef had been appointed since the last inspection. The menu records showed there were two choices for the main meal each day. On the day of the inspection the choice was Beef Stew or Salmon. 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, such as people with diabetes. In the afternoon, after the chef had left for the day, there was no one to assist in the kitchen, which meant the senior care assistant was preparing food for tea as well as being responsible for medication. See staffing section. Care Homes for Adults (18-65 years) Page 14 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care needs are being met but current practices could put peoples health at risk if medication is not given as prescribed. Evidence: We spoke individually to two people who told us they were satisfied about the way staff assisted them with their personal care. We also saw that clear directions were given in the individual support plans showing preferred routines. Each person had been assessed for the size of hoist sling required and had their own individual sling. There were records that hospital appointments had taken place and visits from medical professionals, including district nurses, who visited the home on a daily basis to provide nursing care. However, staff did not clarify the outcome of these visits and any follow up action needed was not clear. Daily notes were generally very brief. Training records showed that staff had been trained to use specialist feeding equipment (PEG feeding). Current medicines were mainly kept in a secure trolley and other stocks were held in a Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: locked cupboard. Staff told us that medicines are delivered and they sign a delivery note, but on the copies we saw, there was nothing specified to show what was being delivered. During the last key inspection in October 2007, we found that the number of tablets in stock was not always added to new stock to keep a record of what was kept for people. This time we found these numbers were included on the record sheets. There was a clear system for recording when medication was administered on the Medicine Administration Record (MAR) sheets, but on examining these we found several gaps and inconsistencies in the recording. It was not clear if some medicines had been given or not. Staff thought it was more likely that they had been given, but some staff had forgotten to initial the record. There were inconsistencies in the way staff had recorded whether or not they had given medicines they were prescribed when required - PRN. Most instructions with names of medicines and doses were printed on the sheets by a pharmacist, but there were some that were handwritten. No one had signed these and there was no evidence that they had been checked by a second person. As there had been previous breaches of the regulation relating to medication, we issued a notice under the Care Standards Act that allowed us to take away copies of these sheets as evidence of the inaccurate records. Care Homes for Adults (18-65 years) Page 16 of 26 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: People we spoke with said they would speak to the manager if they wanted to make a complaint. The procedure was on a notice board and the manager told us that the subject is always on the agenda of meetings with people in the home. She had received one complaint during the previous 12 months and had kept records of the investigation and response. Training records showed that staff received training in the protection of vulnerable adults two years ago. There had, though been changes in staffing during the past two years and no training had been given to refresh previous staff or to cover the new local Safeguarding Adults procedures. Staff spoken with understood the principles of Safeguarding Adults and said they would inform the manager if they had any concerns or suspicions. Care Homes for Adults (18-65 years) Page 17 of 26 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 not totally suitable for disabled people, but adaptations have been made and they are clean and maintained to an acceptable standard. Evidence: The building is on three floors and the layout is generally the same as at the last inspection. The design of the home is not conducive to promoting peoples independence. For example, there are a lot of stairs and the tea-making kitchen is not wheelchair accessible. We found that it was mainly being used by staff. However we found alternative facilities within the dining area. A lift is provided and some maintenance work had recently been done on this. The manager told us that a new building has been proposed on the same site, but no plans have been submitted to the Commission. We saw the communal areas, a sample of bedrooms and the toilet and bathing facilities. All areas were clean or being cleaned during the inspection. Appropriate machines were provided in the laundry. Care Homes for Adults (18-65 years) Page 18 of 26 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 adequate 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 on duty with the use of temporary staff from agencies. Recruitment procedures ensure suitable staff are appointed and appropriate training is given. Staff are not always deployed or supervised appropriately. Evidence: The rota showed there were 5 staff on duty to meet the needs of the 16 people. The manager, administration staff, chef and domestic workers were in addition to this. At night, between 9.15pm and 7am there were two staff on duty. However, as at the last inspection there were still insufficient permanent staff. Three staff on duty were from an agency. The manager told us that she had appointed new staff within the last year and advertised again recently. As reported under Standard 17, there was no dedicated person to provide the evening meal. Some preparation had been done by chef, but we observed the senior care assistant warming the spaghetti and preparing toast. This was at a time when her attention was needed for medication. Staff files were examined including one new staff member. There was evidence of a criminal record bureau check and two written references prior to the staff commencing their employment. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: There were clear training records that showed at a glance which staff needed training. Safe working training and developmental were included and the three most recently employed staff had all completed an induction. Moving and handling people included specific training about hoisting. Where some essential training had not already been completed there were dates booked. Though Safeguarding adults training had not yet been booked (see standard 23). Thirteen of the sixteen permanent staff had all achieved the national vocational training in care at Level 2 and three were working towards level 3. There was no evidence on the staff files that they have had regular 1.1 supervision meetings to discuss their progress and any concerns. However, staff spoken with said that the manager was very supportive. Care Homes for Adults (18-65 years) Page 20 of 26 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. Consistent management is provided and peoples health and safety within the premises is promoted. Evidence: The manager has been at the home since July 2007 and is registered with the Commission. There were records in the form of house meeting minutes and also of individual discussions with people asking them about the quality of care and what things can be improved. The manager completed the Annual Quality Assurance Assessment in September 2008. In this she has told us that meal choices were increased as a result of the comments people have made. As already reported in the previous section, staff traing in safe working topics was well organised and monitored. We saw labels attached to bathing equipment and hoists to show they were serviced at the beginning of October 2008. All portable electrical Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: appliances had labels to show they were tested in June 2008. There were records of regular Water checks and in the kitchen there were records of temperatures for the fridge, freezer and cooked meat. There was also a gas safety certificate dated June 2008. Care Homes for Adults (18-65 years) Page 22 of 26 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 26 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 1 20 13 Ensure accurate records are kept of all medication administered to people. This is so that people are always offered the medication they are prescribed to promote their health and wellbeing. 12/12/2008 2 20 13 When people are prescribed medicines on a when required basis staff must follow clear guidelines for their use and recording, ensuring medication is used and given appropriately and recorded consistently. This is so that people are always offered the medication they are prescribed to promote their health and wellbeing. 12/12/2008 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. Care Homes for Adults (18-65 years) Page 24 of 26 No. Refer to Standard Good Practice Recommendations 1 19 Staff should record all significant information in the daily notes to ensure other staff have the information they need to meet health needs. Review the procedure for accepting deliveries of new stocks of medication into the home. Arrange training or otherwise make staff aware of the updated procedures for investigating allegations or suspicions of abuse. Designate specific staff to kitchen duties in the evenings so that the senior workers other tasks are not compromised. Arrange for staff to have recorded supervision meetings at least six times a year with their senior or manager. 2 3 20 23 4 5 32 36 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - 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. 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