Care Home: Holm Lodge

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What the care home does well Holm Lodge offers the residents a comfortable and homely place to live. The residents spoken with said they are `happy at the home`, and they were very positive about the support they receive. They are able to make choices about all aspects of their day to day lives, and are able to talk to the manager and staff about anything. What has improved since the last inspection? There were no requirements following the last inspection. What the care home could do better: No requirements have been made as a result of this inspection. However a number of concerns were highlighted and have been included in the body of the report. These are concerned with the care plans, medication records, moving and handling training, and providing safe systems for keeping residents bedroom doors open if they prefer. The manager and proprietor said they would address these as soon as possible, and would write to the Commission advising when they have been completed. CARE HOMES FOR OLDER PEOPLE Holm Lodge Lewes Road Ringmer East Sussex BN8 5ES Lead Inspector Kathy Flynn Unannounced Inspection 10:40 27 August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holm Lodge Address Lewes Road Ringmer East Sussex BN8 5ES Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01273 813393 Mr Sri Ratnasinkam Mrs Saraswarthy Ratnasinkam Mrs June Woolley Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 16. Date of last inspection 6th September 2006 Brief Description of the Service: Holm Lodge is a large detached house set over two floors with a newly completed extension; this has subsequently increased accommodation space from nine to fourteen beds, whilst adding a further dinging room and lounge area. Resident bedroom accommodation comprises of fourteen single bedrooms all with en-suite facilities, located on the ground and first floor. On the ground floor are two lounges, two dining rooms, with small conservatories at the rear and extension side of the home. The first floor is accessible by a stair lift. Holm Lodge is situated off the main road in Ringmer, close to Lewes town, and within easy reach of local facilities. There is a car park at the front of the home, and a large garden at the rear. Information is provided to prospective residents and others by a comprehensive statement of purpose and service user guide whilst interested parties can contact the home via the telephone; the home also keep a copy of the most recent inspection report on site. At the time of the inspection visit fees at the home ranged from £337 to £500 per week with additional charges for such services as hairdressing, chiropody and personal magazines etc. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Holm Lodge will be referred to as ‘residents’. The unannounced inspection visit took place on the 27th September and lasted approximately 4 hours. At the time of the inspection the home were accommodating 14 residents. The Inspection included a tour of the premises, both inside and out, and it’s facilities with many residents agreeing for their bedrooms to be viewed. Records and documents were viewed including care plans, staff files, medication records and the accident book. The manager, two care staff and the cook were spoken with and were happy to talk about the care provided at the home. 8 residents and a visiting social worker were spoken with during the inspection. Ten surveys were completed by residents prior to the inspection, and these were viewed prior to completing this report. What the service does well: What has improved since the last inspection? There were no requirements following the last inspection. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A pre-admission assessment is completed with the involvement of prospective residents, relatives and representatives, to ensure the home can meet their individual needs. EVIDENCE: The manager assesses all prospective residents, with the residents and their relatives or representatives, to ensure that the home can meet their needs. The five viewed had information about mobility, communication as well as medical and social history, and this information is then used as the basis of the care plans. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 9 The home has an open door policy and this is an important aspect of the homes support system that has to be considered when assessing prospective residents. Prospective residents can visit the home to meet staff and residents, stay for lunch, or stay for a trail period before they decide if they would like a room permanently. Some residents have stayed at Holm Lodge for respite and decided to remain there. Residents spoken with said their relatives or a representative had visited the home for them, they were very pleased with the choice and are comfortable at the home. Contracts and terms and conditions are provided for all residents, and some relatives were looking after these. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system provides staff with basic information about the needs of the residents, training in the management and administration of medicines is provided for staff to protect residents. EVIDENCE: Five care plans were viewed and found to contain information about the physical, social and psychological needs of the residents. Risk assessments were in place and highlighted those residents who required additional assistance, and daily records are kept of the support offered to each of the residents in the home. However some of the information had not been reviewed when the residents needs had changed; there are systems to record the involvement of relatives Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 11 or representatives for care plan reviews but these were not completed, and there was no evidence that they had been consulted or are involved in decisions with the residents. The manager said that the care plans should be updated but she had not been able to do this since May, but she will be looking at delegating some of this work when she has had the opportunity to discuss this with senior care staff in the home. Although the records did not reflect the needs of the residents the staff were able to discuss the extra support that some need and felt that they were able to offer appropriate care. Residents are registered with GPs and visits are arranged with allied health professionals, including District Nurses and Social Workers as required, records are kept of any visits to the home. Those visiting during the inspection said that the home provides very good care and they are happy to place people in the home. The medicines are kept in a locked cupboard in the dining room, the home does not have a separate cupboard for controlled drugs, and there were no controlled drugs prescribed for residents at the time of the inspection. The legislation regarding the storage of controlled medicines has changed and the manager advised that she is not aware of these, however advice is available, and she said that she would access this so that if required the home will be able to provide the appropriate secure system. Medicine administration record charts (MAR) were viewed and it was noted that staff were not completing them correctly when residents did not want their medication, there were some gaps and incorrect symbols were used. The manager advised that she would be reviewing this practice and ensuring staff followed the correct procedures. Communication between residents, staff and visitors was relaxed and open, the residents spoken with said the staff are very good, they offer the support we need and are very comfortable at the home, I like my room and have brought my own things with me and they stated that we have no complaints, no reason to complain. The residents spoke very positively about the two small dogs at the home, one was seen to be playing with one on the decking and others were stroking them or the dogs just sat near them. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to decide what activites are provided at the home, the meals are good and choices are available, specific diets can be provided and staff assist residents as required. EVIDENCE: Residents spoken with said that they make the decisions about how they spend their time, some join in the motivation classes, which have been arranged fortnightly at the request of the residents, while others prefer to read or watch TV. Several prefer to have a rest in the afternoon, and most spend the evenings in their own rooms. The manager arranges to take residents shopping and to local places of interest, and churches visit the home regularly. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 13 Relatives and friends can visit the home at any time, with the agreement of the resident concerned, and some of those spoken with said they enjoy regular visits from family members. The lunch was well presented and looked appetising, residents said the meals are very good and the cook knows what they like. Fresh fruit and vegetables are provided daily as well as home cooked puddings and cakes. Soft diets are available, staff assist residents if required, and the manager confirmed that all have attended the food hygiene course. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An appropriate complaints procedure is in place, and training is provided for staff to protect residents from harm. EVIDENCE: The home has a suitable complaints procedure, which is displayed in the lounge and the manager confirmed it is included in the statement of purpose. Residents said that they did not have anything to complain about and if they were concerned they would talk to the June (manager) or the staff. The manager said that there have been no complaints since the last inspection, and no complaints have been made to the Commission. Training is provided for staff with regard to protecting vulnerable adults, and those spoken with have attended this and are aware of the action they should take if they have any concerns. Appropriate policies and procedures are in place. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Holme Lodge provides a comfortable and homely environment for residents, and infection control training is provided for staff to protect residents. EVIDENCE: The home provides residents with well maintained communal space, and individual bedrooms that have ensuite facilities. Residents have personalised their rooms with ornaments and pictures and those spoken with said they like their rooms and are comfortable. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 16 The home was found to be clean and tidy, although it was noted that some furniture was rusty with chipped veneer, the manager said these would be replaced. A stair lift enables residents to have access to the first floor. Infection control training is provided for staff and those spoken with have attended. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The training programme enables staff to be aware of their roles and responsibilities, and the home follows appropriate recruitment procedures to protect residents. EVIDENCE: The manager confirmed that there are sufficient staff working at the home to provide residents with the care they need. The staff spoken with said they enjoyed working at Holm Lodge and have been employed there for 6 to 14 years. The manager advised that new staff are required to complete an induction programme in line with skills for care, although there have been no new members of staff for two years. They are also encouraged to work towards National Vocational Qualifications (NVQ) and some have completed NVQ Level 2. A programme of training is provided and includes, first aid, fire training, infection control, adult protection, food hygiene and support for people with Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 18 dementia. The manager said staff are required to attend and the members of staff spoken with said they have attended training arranged at the home. Appropriate recruitment procedures are in place, which include two references and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. The manager discussed the necessity for these if the applicant was known at the home, but confirmed that she would be ensuring all the necessary information has been collected before they are offered employment. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is open and encourages the involvement of residents, staff and relatives in decisions about the support provided. EVIDENCE: The registered manager of Holm Lodge has considerable experience in providing care for older people, she keeps up to date with current training, and has completed the NVQ Level 4 in Care and Management. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 20 Residents spoke positively about the management of the home, and communication between the manager, staff and residents was friendly, relaxed, and on first name terms. Residents spoken with said they can talk to the manager about anything. The manager discussed the quality assurance system used in the home, which consists of questionnaires to obtain feedback from residents, and the comments are positive. The last inspection suggested reviewing the system to include reviewing care practices, such as the care planning system and medication. This has not yet been done and the manager said that she would look again at extending the quality assurance programme. The home is not responsible for the residents finances, although some money is kept in the home for a few residents to pay for the hairdresser or the chiropodist, the manager said records are kept for all payments. The manager confirmed that health and safety systems are in place, including maintenance of the stair lift and appropriate fire checks. During discussions with staff it was noted that some staff use an unsafe lift to transfer a resident, although they have attended training. The manager stated that the planned training would be brought forward to ensure staff are aware of the correct procedures to follow. The manager and proprietor stated that the safe systems to keep residents doors open will be put in place as soon as possible. Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A 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 3 X 3 X 3 X X 2 Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 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 Holm Lodge DS0000021139.V369170.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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