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Inspection on 21/04/06 for Homer Lodge Care Centre

Also see our care home review for Homer Lodge Care Centre for more information

This inspection was carried out on 21st April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents are cared for in a safe, well-maintained, homely environment by staff, who are aware of their needs. Care plans identify residents` needs in detail and this helps staff to provide consistent care. People who use the service are happy with the care they receive. The home offers intermediate care working closely with the community health care team. The service prevents some hospital admissions and enables residents to return to their own homes in the community in a planed manner within set timescales. The staff team work well together and have established an excellent working relationship with the community health care teams and local GPs.

What has improved since the last inspection?

At the last inspection in January 2006 there were requirements identified. The company continue to ensure that the environment of the care home is maintained and meets the National Minimum Standards. It continues to develop its intermediate care services. A plan is in place to increase the number of intermediate care beds from four to eight in the near future.

What the care home could do better:

There were no areas identified at this inspection where the National Minimum Standards were not being met.

CARE HOMES FOR OLDER PEOPLE Homer Lodge Care Centre 23-26 Monson Street Lincoln Lincs LN5 7RZ Lead Inspector Mr Ken Hague Key Unannounced Inspection 21st April 2006 08.30 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 Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Homer Lodge Care Centre Address 23-26 Monson Street Lincoln Lincs LN5 7RZ 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) 01522 530108 01522 511291 Premierbell Limited Mrs Angela Ryan Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number registered - one service user can be accommodated within the OP category aged 62 years and over. Date of last inspection Brief Description of the Service: Homer Lodge is a care home, which provides both personal care and nursing care for older people. It is a purpose-built home situated in a residential area close to the centre of the City of Lincoln and is within walking distance of local shops and facilities. The home is situated off a main bus route and there is off street car parking to the front of the home. The homes own car park has limited space at the rear of the home and alternatively there is public car park nearby. Accommodation is provided in 15 single and 10 twin bedrooms on the ground, first and second floor levels. Rooms to the first and second floor are served by a lift. The home is in a residential part of the city, it does not have a garden area, but there is a block-paved terrace leading out of the ground floor lounge which is accessible by wheelchairs and service users are able to sit. The homes service users guide states that, Homer Lodge aims to create and maintain a happy, safe and homely environment and to establish a partnership with service users in planning and implementing their care. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6.5 hours. A tour of the premises was undertaken with the assistance of the deputy manager and discussion and feedback was given at the end of the inspection. The main method of inspection used was called ‘case tracking’ which involved selecting four residents and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and residents and related care practices. A sample of care records was inspected. Two members of staff were interviewed and the opinions of four residents were sought. There were two members of the community healthcare services visiting the home during the site visit. Both professionals were interviewed. One was a tissue viability nurse working with the intermediate care team. The second professional being a intermediate care nurse who worked closely with the home making placements in the intermediate care beds. Their comments and observations are reflected within this inspection report. What the service does well: What has improved since the last inspection? What they could do better: There were no areas identified at this inspection where the National Minimum Standards were not being met. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 6 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. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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 Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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): 3&6 Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to this service. A detailed assessment, which includes a risk assessment, is carried out before any new resident is admitted to the care home. The intermediate care service helps resident to maximise their independence and return home. EVIDENCE: A sample of four resident’s files was viewed as part of the case tracking process. They all contained a comprehensive assessment including a risk assessment completed prior to the resident coming to stay in the care home. The interviews with staff and discussion with residents provided evidence that the assessment had identified all of the needs of each individual person. The Inspector spoke to a tissue viability nurse visiting the home to check on the progress of a resident in intermediate care. The tissue viability nurse discussed the care provided by the home to a resident receiving intermediate care. This resident had been admitted 11 days ago with a pressure sore which might have required hospital treatment and surgery. The care provided to this Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 9 resident by the staff at the care home supported by the community tissue viability nurse had resulted in the pressure sore being reduced in size and very good progress is being made towards it healing completely. As a result a plan was being put in place for this resident to return home. The tissue viability nurse stated “we would not be in a position today to consider this resident returning home without the excellent work carried out by the staff. The wound is now significantly better”. A second discussion was held with a community nurse who works closely with the care staff directly involved in intermediate care. This professional admits residents to the home, monitors their progress and arranges their return to the community. The nurse stated that the home provides excellent care and is very successful in enabling residents to return home. In addition, some admissions to the home are made to avoid a hospital admission. The home has been very successful in her opinion in preventing some hospital admissions. It was the opinion of both nurses that the quality of care being provided within the intermediate care unit exceeded the standard of care being provided in other homes, even where these homes met the National Minimum Standards. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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 & 10 Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to this service. Care plans contain comprehensive information, which identify the care needs and personal preferences of the residents. Risk assessments are of a good quality, providing management strategies that enable residents to be as independent as possible EVIDENCE: Care records contained all of the assessed needs identified in the assessment. These included care and social needs and the wishes and choices of each resident. Care plans provided evidence of involvement of community health services district nurses, chiropodist and opticians. The care plans were easy to read which enables staff to understand the total needs of individual residents. In the case of the four residents being case tracked where a risk was identified the management of that risk was recorded. The wishes and choices of individual residents in relation to their personal life are recorded on their care plans. All files inspected were tidy with information been filed in a consistent Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 11 manner. Staff stated the care records were working documents easy to use and helpful to all staff. All sampled records viewed as part of the care tracking process were exceptionally easy to follow. All files contained a common index which started with the assessment process moved on to the care plan, risk assessment management of identified need ending with daily record and reviews. All care records were very detailed but the quality of the recording enables the reader to understand the needs of each resident and not to become confused due to the amount of information recorded. A resident stated in informal discussions “this is a very nice home. No one could fault it, the staff care a lot and will do anything for you. All of my needs are being met by this home” The staff are following the home’s medication procedure. The Inspector observed medication being given out at lunchtime and carried out a spot check of the controlled drug storage facility and records. The registered manager stated that only qualified staff give our medication. This statement was confirmed to be correct by staff in their formal interviews. Two of the residents spoken to during this inspection confirmed that they were allowed to self Medicate. The registered manager confirmed that residents who wish to self Medicate are offered the opportunity to do so after a risk assessment has been completed. Residents on intermediate care are encourage to selfmedicate where the risk assessment stated this is appropriate in preparation for their return home. The Inspector observed staff knocking before entering resident bedrooms. The conversations between staff and residents were sensitive staff listened and took time to ensure residents understood conversations and discussions. Resident stated staff are helpful, kind and sensitive. A resident stated “you cant find better staff”. Staff demonstrated a detailed knowledge of the residents being case tracked in their formal interviews. The discussions regarding the manner in which they provided personal care produced evidence that the dignity and privacy of the residents is always considered. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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 & 15 Quality in this outcome area is Good. This judgement has been made using the available evidence including a visit to this service. Service users are encouraged to keep in contact with their family and friends. All visitors are made welcome by staff at the care home. Catering arrangements for the home reflects the service users choices, preferences and personal dietary needs. Service users with a special diet are provided with a menu which takes their personal needs into account. EVIDENCE: The home has a visiting policy displayed in the reception area. The visitors book shows that many visitors come to the home on a daily basis. Visitors came into the home during this inspection and staff made them welcome. The whole offers a range of social activities to meet the needs of all residents. Activities were taking place on the day of the inspection at lunchtime residents were celebrating the 80th birthday of the Queen and had a social drink. Residents prefer to use the main lounge and a home as it is the focus of social activity. There is a quiet lounge available on the second floor should any resident wish for privacy and a private discussion with their relative or family. One resident interviewed stated I am writing a poem for the Queen. A second resident stated “I like to spend some time in my own room I can sit and read then go into the mains lounge when I want company”. These wishes and Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 13 choices were recorded within his care plan. Another resident said “my home is this room I am very happy here”. The choices and wishes of each resident in respect of their menu is recorded in their individual care plan. There is a details document on residents individual files which states the likes and dislikes of each individual resident this includes their dietary needs. The Inspector observed residents being offered a choice of menu at lunchtime. The food was observed to be served in a presentable manner. All residents interview stated their satisfaction with the home’s menu. One resident stated “you get good food here”. Staff stated the menu is rotated over a seven-day period. We ensure all residents are provided with choice and special dietary needs are met. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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 & 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents are protected and are able to voice opinions by procedures in place for handling complaints and any allegations of adult abuse. The staff are clear on what action to take in event of this occurring ensuring that the Residents are safe. Residents are confident in being able to raise any concerns with members of staff or through residents meetings. EVIDENCE: The complaints policy is displayed in the care home. Residents stated that they felt confident to raise any concerns with any member of staff or the registered manager. The home holds residents meetings where the opinions of people using the service are sought by the members of staff. Residents spoken to as part of this inspection confirmed that they were aware of the formal complaints procedure. Staff stated in formal interviews that they had received training in the recognition and prevention of abuse. They were able to describe the action appropriate to take in respect of two scenarios given to them by the Inspector. Both members of staff stated they had read a copy of the Lincolnshire County Council’s Adult Abuse Policy, which is in the home’s policy and procedures manual. All residents spoken to as part of this inspection stated that they felt the home is a safe place in which to stay. There have been no complaints made to the home since the last inspection. The Commission for Social Care Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 15 Inspection has not carried out any investigation or received any complaint in respect of this home since the last inspection. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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 & 26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents live in a comfortable, homely, clean environment with a choice of communal areas and personalised bedrooms. The infection control policy of the home is being followed. EVIDENCE: A tour was made of the care home all areas were very clean and smelt fresh. There was evidence of ongoing maintenance, all areas have been decorated to a high standard. Fixture and fittings were the domestic nature and furniture was arranged in a sensitive manner to present a homely and domestic environment. Residents spoken to confirmed their total satisfaction with the environment of the care home. The bedrooms viewed during this visit had furniture and fittings which met the National Minimum Standards and contained personal possessions belonging to individual residents. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides training for all care staff and encourages NVQ training. There are always sufficient staff on duty to provide essential care for service users. Staff are recruited in accordance with the company recruitment policy. EVIDENCE: Staff stated that they felt there always sufficient staff on duty to be able to meet the needs of Residents. The registered manager stated that if there is a need identified for additional staff, then staffing levels are increased. A resident stated “staff can not do enough for you”. All the residents spoken to felt there was sufficient staff on duty to meet their needs. The staff confirmed that staffing levels are not reduced below that stated on the homes staffing rota. The home has a staff training programme in place using internal trainers and external consultants. Staff confirmed training which includes specialised training is being offered. Staff stated in the formal interviews that supervisions and appraisals are being carried out in accordance with the National Minimum Standards. They stated that their individual training and development needs are being linked into the home’s yearly training programme. There were three individual files for no members of staff examine during this visit. They were all found to contain the information set out in the care home regulation, which employers must obtain before offering employment. This Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 18 included two written references and criminal record bureau checks. All staff have contracts of employment the dates on each contract confirmed that staff only started after the recruitment procedure had been completed. The individual employees files were all filed in a consistent manner. There was a summary at the front of each file giving information details of information and checks made prior them commencing employment. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, & 38 Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to this service. The home is well run, with good leadership and guidance from the registered manager who has worked for many years in the provision of community care. The health and safety and welfare service users is promoted. EVIDENCE: Staff stated that the registered manager is very supportive and consistent in the guidance she gives to all staff They stated that she encourages them to be involved in NVQ training and to take advantage of appropriate training courses. Residents stated that the registered manager is very approachable and listens to their comments regarding the services provided at the home. They stated Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 20 that the home holds regular residents meetings. Residents confirmed that staff treat them as individuals and they feel that there personal needs are being met. There were no health and safety issues identified at this inspection. Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 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 X X X X X X 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 4 X 3 X X X X 3 Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 22 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. Refer to Standard Good Practice Recommendations Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Homer Lodge Care Centre DS0000002609.V290058.R01.S.doc Version 5.1 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!