Care Home: Homer Lodge Care Centre

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What the care home does well The care home offers a clean and comfortable environment for people to live in. The people staying in the home told us that they were well looked after and were happy with the services provided by the staff. They also confirmed that staff ensure their privacy and dignity is protected and help them in a caring and sensitive manner. Records provided evidence that health care needs are being met by the home and community health care services. The care home works very efficiently with Community Health Care Services and local consultants and hospitals. Staff are well trained and recruited safely using the updated recruitment procedure of the care home. Staff are supported and provided with formal supervision. People are happy with the menu and the quality of food provided to them which they state meets their own individual dietary needs. What has improved since the last inspection? The care home has been extended since the last inspection to provide greater facilities for people staying there. A number of bedrooms have been added with ensuite facilities. A training room/conference room has been created for staff. The outside patio area has been improved. There are a larger number of quiet areas where people can sit to read or make friends. Planned improvements have been made generally to the care home including improvements in interior lighting as part of their ongoing maintenance programme. The home holds surgery days. A new purpose-built laundry has been created on the ground floor. A kitchen area has been created upstairs where visitors are welcome to make a drink. What the care home could do better: The home has identified a number of areas for planned improvements. They plan to develop a pre-admission information pack which will include an updated brochure. The company is to installation a second lift from the ground floor to 1st floor. Key inspection report Care homes for older people Name: Address: Homer Lodge Care Centre 23-26 Monson Street Lincoln Lincs LN5 7RZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ken Hague     Date: 1 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Homer Lodge Care Centre 23-26 Monson Street Lincoln Lincs LN5 7RZ 01522530108 01522511291 Homerlodge23@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Premierbell Limited care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 47. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home 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 33 single bedrooms , 14 of which have ensuite facilities. There are also 8 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 Care Homes for Older People Page 4 of 24 Over 65 47 0 Brief description of the care home 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. The home charges £ 350 to £1130 depending on the identified needs of residents. Care Homes for Older People Page 5 of 24 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The service has been awarded a three star rating. This means that the outcome for people is excellent. The service did not know we were coming to carry out an inspection. This is referred to as an unannounced inspection. We visited on 11 November 2009. The inspection lasted five hours. The inspection was carried out by a single inspector. The purpose of the visit was to establish how the care home is functioning and the outcomes for people who use the service. We also checked that the practices are safe and that staff understand how to recognise abuse and report it appropriately. Any previous information held by the Care Quality Commission about the care home was taken into account. Before the visit the provider returned the Annual Quality Assurance Assessment (AQAA). This document enables us to have additional information about how the home is meeting the needs of people using the resources of Care Homes for Older People Page 6 of 24 the service. We did send out surveys to people who use the service but these were not returned before this report was written due to postal strike difficulties. The method of inspection used in this report is case tracking which involves selecting a proportion of the people who use the service and tracking the care they receive. For this visit we case tracked four people who use the service. This was done by the checking of records, discussion with them and staff who care for them, and observations of care practice. During this visit we spoke to people using the service, the staff and senior management. This gives us an overview of the service and enabled us to make a judgement and award the star rating as shown above. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive initial assessment is carried out so that people can be sure that their personal and social care needs can be met. Evidence: Care records for four residents being case tracked as part of this inspection were examined. All files contained a detailed assessment carried out prior to the resident being admitted to the care home. The assessments set out in detail their medical needs including current medication and the social needs of individual residents including their hobbies, personal interests and details of family members. Each person had a detailed record of their individual care needs and how these were to be met ensuring that the dignity and privacy of each resident was maintained. Files contained the likes and dislikes of people staying in the home in respect of diet, and social lifestyle. Detailed risk assessments have been completed for care and social needs. Risk management strategies were in place when any individual risk was Care Homes for Older People Page 10 of 24 Evidence: identified to reduce the level of risk or to remove it completely. There was evidence that people were involved in the initial assessment which was signed by the assessor and the individual resident. Staff confirmed that all residents have an initial assessment before being admitted. Residents being case tracked confirmed that they had been involved in their own individual assessment. The Annual Quality Assurance Assessment states that is the policy of the care home to complete assessments before admitting any new person into the home. The deputy manager confirmed that once an assessment is completed a formal letter is sent to each person confirming that their needs can be met by the resources of the care home. The home does offer a dedicated intermediate care service working closely with the community healthcare services and local hospital. The assessments for people receiving intermediate care had been completed to the same standard of people being admitted for long-term care. Care records were filed in the same manner with a common index at the beginning of each file. Staff confirmed that in their opinion the initial assessment immediately provided them with enough information to meet peoples identified needs safely. Care Homes for Older People Page 11 of 24 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans guide staff as to how peoples needs can be met safely. The updated medication procedure of the home ensures the safe administration and storage of medication. Evidence: The care records for four residents were viewed. We found that information obtained at the initial assessment had been used to complete an initial care plan for all four individuals. The care plans instruct staff how to ensure the identified needs of each person are met safely and in the way each person would prefer care to be provided. Staff were instructed as part of each care task to ensure that the personal privacy and dignity of people is maintained and that care is provided in a sensitive and patient manner. The deputy manager stated that privacy and dignity must be always considered when helping people in the care home. She stated that new staff receive specific training in this area at their initial induction. Staff confirmed these statements to be correct and the AQAA Annual Quality Assurance Assessment also states these principles. Care Homes for Older People Page 12 of 24 Evidence: Care plans set out peoples needs in terms of personal care which included maintaining tissue viability and providing each person with an appropriate diet which meets their individual choice of food. People have access to a GP of their choice and local community health care services where appropriate. Peoples individual needs in terms of eye care, dental care and chiropody were recorded on each persons file. Detailed risk assessments had been completed prior to care plans being written. Where any risk was identified staff were instructed what steps to take to reduce or remove the risk. The level of mobility of each person was found recorded on care plans. Care plans included details of the equipment and the number of staff needed to help someone mobilise safely. Staff were observed given medication at the lunchtime period and they follow the updated procedure of the care home to ensure medication was prescribed safely. A sample of records were viewed aand these had been completed acurately. The deputy manager confirmed that medication stocks are checked monthly and that there has been no mal-administration of medication in the last 12 months and no medication has been lost. There was evidence of people being involved in the writing of their own individual care plans. These documents were dated and signed by the assessor and the individaul staying in the home. Four residents were interviewed; each resident confirmed that they were involved in the writing of their individual care plans which stated their care needs, their choice and wishes for activities and diet, and the manner in which they would wish their care to be provided. Care Homes for Older People Page 13 of 24 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People living in the home are offered activities that are meaningful to them. People are assisted to make choices about activities and food and this enhances their life. Evidence: The care home offers a range of activities which take place within the home and in the local community. An activity organiser is in post who provides group and one-to-one activities. People who live at the home stated we are consulted about activities to ensure we enjoy what we are doing. The residents meetings are used to discuss future activities and for the planning of social events. Care Homes for Older People Page 14 of 24 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Policy and procedures are in place to ensure that complaints are listened to and people are safeguarded. Staff are trained to protect residents from any potential abuse. Evidence: Four residents spoken to all had copies of the homes complaints procedure. They confirmed that they felt able to raise any concerns with the managers of the home. The complaints procedure was also displayed in the reception area. The deputy manager stated that everyone in the home is given a personal copy of a complaints procedure which is explained to them. Staff confirmed this to be the case. A resident said staff are very helpful and do listen to us and we can raise any concerns we have with them. I can also bring up problems at the residents meetings, I know the registered manager will look into things and deal with any problems. No complaints had been made to the home or the Care Quality Commission since the last key inspection. There have been no safeguarding investigations carried out in respect of this home since the last key inspection. Staff stated that they had received training in protecting people from potential abuse. Training records confirmed these statements to be correct. Members of staff stated that they would have no hesitation in using the whistleblowing Care Homes for Older People Page 15 of 24 Evidence: procedure or a complaints procedure if they have any concerns. The Care Quality Commission has received no information which would suggest people in the home are not being protected from potential abuse. Care Homes for Older People Page 16 of 24 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and well maintained environment. The health and safety policy and infection control procedure is being followed which keeps the residents and staff safe. Evidence: We inspected maintenance records and found that equipment was being serviced. There were records which demonstrated that fire extinguishers and emergency lighting had been serviced. Hoists and the shaft lift had been serviced this year. Staff stated that lighting systems have been improved. The home was clean and free of any odour. People staying in the home told us that it was always clean and tidy. They stated that staff ensured that their individual bedrooms were clean and tidy. One person stated this home is always clean and I am very happy with the way they look after my room. A second individual commented we have fun here the lounge area allows us to do lots of activities. There were no health and safety issues or infection control issues identified at this inspection. Care Homes for Older People Page 17 of 24 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in the home in sufficient numbers and with the appropriate skills to ensure peoples needs can be met safely. Evidence: People staying in the home told us that staff are well trained and help everyone in a sensitive and caring manner. One person stated staff are great here they look after us well and are very kind A second person stated staff cannot help you enough here they are always cheerful and pleased to help you. People living in the home stated that staff help them quickly if they have problems. They felt that staff understand their needs and treat them with courtesy and protect their dignity at all times. The deputy manager showed us training records which evidenced that 57 of staff held an a National vocational qualification (NVQ) level II in care or an equivalent qualification. The training records provided evidence that specialised training has been provided to staff in addition to essential training which ensures care practice is safe. Staff stated that they have received training to enable them to understand the new Mental Capacity Act. A sample was taken of recruitment records for new staff. We found that the necessary Care Homes for Older People Page 18 of 24 Evidence: information required by the Care Home Regulations had been obtained before employment had been offered. This included criminal record bureau checks, two written references and proof of identity. Each staff members file also contained notes made at the initial interview. Individual recruitment files contained evidence that all new members of staff have been given an induction. The deputy manager confirmed that recruitment procedure of the home has been reviewed to ensure that staff are recruited safely. We interviewed three members of staff. They confirmed that supervision is provided six times a year and a yearly appraisal is carried out. The annual quality assurance assessment confirmed this is the policy of the care home. Staff stated that in their opinion there are always sufficient staff on duty with the appropriate skills to ensure peoples needs are met safely. Staff stated that their morale is high and they enjoy working at the home. Staff were able to describe the needs of the four residents being case tracked. They were able to tell us about their personal care. Staff knew the details of the extended family for the people being case tracked. There were able to state the hobbies and interests of each resident. Staff told us that they have been trained in protecting people from potential abuse. They stated that management are very supportive and great emphasis is placed on everyone who works in the home, ensuring that peoples dignity and privacy is protected and that they are kept safe. Staff were able to describe the complaints procedure of the care home and the whistleblowing procedure. All members of staff spoken to confirmed they would be able to raise concerns with any manager of the care home and would have no hesitation in using the whistleblowing procedure should it be necessary. Care Homes for Older People Page 19 of 24 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a management structure in place which ensures care is provided in a dignified and safe manner. Evidence: People staying in the home stated that the home is managed well and that all managers and staff are very approachable and supportive. A resident stated we have good managers here you can approach them if you have any concerns. They listen to us at the residents meeting and act if we have any concerns. Staff told us we have managers who support and encourage us to provide a high standard of care practice. The expectation is that we will respect the dignity and privacy of people at all times. Supervisions, appraisals and staff training including National vocational training opportunities are being provided to all staff. Staff stated that new staff are recruited safely and always provided with an induction. Staff stated this is a safe home in which to work. People staying in the home stated Care Homes for Older People Page 20 of 24 Evidence: the home is well run and offers security and safety. There are policies and procedures in place to protect any money held by the home on behalf of the resident. A sample was taken of financial records which have been completed correctly by members of staff and the appropriate corresponding money was found in the residents personal container. Managers have a quality assurance system which starts with individual one-to-one discussions and includes residents meeting and questionnaires which are sent to individual residents and families. A sample of quality assurance documents were seen; they all contained positive comments only. All of the records sampled within the home which included care records, maintenance records, medication records, and quality insurance documents had been written and completed to a good standard. Care Homes for Older People Page 21 of 24 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 Older People Page 22 of 24 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 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. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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