About the service:

Holme Lodge is a residential home that provides accommodation with personal care for up to 19 people who live with physical disability. At the time of our inspection, there were 18 people using the service. Holme Lodge is an extensively extended former family home in a residential area of West Bridgford.

What life is like for people using this service:

People were safe living at Holme Lodge. Staff understood how to keep people safe from harm and abuse. People received their medicines on time and as prescribed. Medicines were safely stored and managed.

People were supported by an experienced staff team who had the relevant training and support to meet people’s needs. Staff supported people with their nutritional needs, though we found that food storage was disorganised and people were not always able to have what they wanted.

People had access to health services when they needed them.

People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polices and systems in the service supported this practice.

Staff were kind and treated people with dignity and respect. People were supported to make their own choices and were encouraged to be as independent as possible. Staff understood people’s preferences and care was delivered in line with people’s wishes and needs.

People had individual activities schedules. They were supported to follow their interests and hobbies and to participate in social activities with others.

The management team were approachable and people knew how to make a complaint. The registered manager and deputy manager carried out health and safety checks of the premises and equipment. Accidents and incidents were recorded and action taken where necessary to keep people safe.

More information is in the full report.

Rating at last inspection:

At our last inspection (report published 12 May 2016) all the key questions were rated Good and the service was rated as Good overall. The overall rating has not changed, but we have rated Effective as requiring improvement because of what we saw in relation to how people were supported with their nutritional needs.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

This inspection took place on 8 March 2016 and was unannounced.

Accommodation for up to 18 people is provided in the home over two floors. The provider is currently registered to provide accommodation for 20 people but due to changes in the premises is now only able to accommodate 18 people. We have asked the provider to apply to make the necessary changes to their registration. The service is designed to meet the needs of people with a physical disability. There were 18 people using the service at the time of our inspection.

At the previous inspection on 12 March 2015, we asked the provider to take action to make improvements to the areas of need for consent and good governance. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection on 8 March 2016 we found that improvements had been made in both areas.

There was a registered manager but she was unavailable during the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Hazardous materials were not always stored securely. Sufficient staff were not always on duty to meet people’s needs and medicines management required improvement.

People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. Staff were recruited through safe recruitment practices.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received personalised care that met their needs; however they did not always receive support promptly. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff were confident raising any concerns with the registered manager and that they would take action. There were systems in place to monitor and improve the quality of the service provided.

This inspection took place on 12 March 2015 and was unannounced.

Accommodation for up to 20 people is provided in the home over two floors. The service is designed to meet the needs of people with a physical disability.

There is a registered manager and she was available throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they received medicines safely; however, we found that safe management of medicines did not always take place. Systems were in place for staff to identify and manage risks and respond to accidents and incidents, however, these systems were not fully followed in practice which could place people at risk. The premises and equipment were safely maintained. Sufficient staff were on duty to meet people’s needs and were recruited through safe recruitment practices.

People’s rights were not fully protected under the Mental Capacity Act 2005. Staff received appropriate induction and training but did not always receive regular supervision and appraisal. Nutritional risks were not consistently assessed, however, the home involved outside professionals in people’s care as appropriate.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them and people were involved in their care where appropriate.

Information was available to support staff to meet people’s needs and people who used the service told us they knew who to complain to if they needed to.

There were systems in place to monitor and improve the quality of the service provided, however, these were not effective. The provider had not identified the concerns that we found during this inspection.

People and their relatives were involved or had opportunity to be involved in the development of the service. Staff told us they would be confident raising any concerns with the management and that the registered manager would take action.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the time of this inspection there were 17 people living at Holme Lodge.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

This was an unannounced inspection. We spoke with five people who used the service. We also spoke with the manager and two members of staff. We looked at written records, which included copies of people's care records, medication storage and administration systems, staff personnel files and quality assurance documentation.

Is the service safe?

We found the home to be warm and clean. The accommodation was adapted to meet the needs of the people living there, was suited to caring for people with limited mobility and was properly maintained.

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents, which enabled them to deliver appropriate and safe care. People were protected by safe and effective recruitment processes.

Is the service effective?

People we spoke with were satisfied with the care and support they received. This was consistent with positive feedback reported in the provider's own annual quality assurance survey.

People were given information and support to help them understand the care and support available to them and were encouraged to increase and promote their independence.

Is the service caring?

We spoke with five people who used the service. We were not able to speak with some of the people due to their communication needs. One person said to us, "The staff here are kind and nice. I like it here, especially when the bar is open so I can have a drink." Another person said, "They're really good to me here. I'm well looked after." Another person said to us, "The smoking area is good, as I don't have to go outside to smoke."

There was a positive atmosphere throughout the home and a friendly rapport between staff and the people who lived there. We witnessed the care and attention people received from staff. All interactions we saw were respectful, kind and friendly and staff were attentive to people's needs. People were treated with dignity and respect.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Care plans and risk assessments were regularly reviewed. People were supported to take part in a range of activities that they wished to participate in.

Two staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service.

Is the service well led?

Staff said that they felt well supported by the manager and they were able do their jobs safely. The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

When we inspected the service in November 2012 we asked the registered provider to make some improvements in relation to the service. The provider sent us an action plan telling us how the improvements to the service would be made and by when. We found that improvements had been made.

On the day of inspection there were 14 people living in the service and two people visiting for a short stay.

We spoke with three people who lived in the service. They all told us that they were happy with their care plan and they were included in reviewing it. One person said, “I’m happy with the way everything’s going. I am involved in reviewing my care plan. My sister can come too.”

We found that people’s needs were not always assessed and care and treatment was planned and delivered in line with their individual care plan.

We asked people if they thought the building was well maintained and they all said that it was. One person said, “I’m happy with the decoration in my bedroom.” Another person said, “We’re getting a new kitchen.” We also asked them if there were any improvements they would like to make. One person said, “I haven’t spotted anything.” We found People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that there were effective recruitment and selection processes in place.

The people we spoke with told us that they had been involved in the development of their care plans; however there was evidence that people using the service were not always given the opportunity to review their care planning documents. One person said, “I should be involved with my care planning more.”

People told us that they felt they were generally well cared for and the staff members understood the needs of people well. One person said, “On the whole, the staff are very good here.”

We found people were safe and staff were supported to provide care that met people's needs. People told us they felt safe with the support they were being provided. One person said, “My belongings are safe here. I have my own safe in my room.”

During our inspection we identified a number of maintenance issues within the home. The roof on the upper level of the home was leaking and a number of areas throughout the home were in need of updating. We found a dirty carpet in the dining area in need of replacement, a shower room with a dirty floor and another bathroom with no bin.

The people we spoke with said enough staff were available to support them to fulfil their needs. One person said, “The staff respond to my buzzer. They are very good at that.”

There were no recently recorded complaints for us to review, however the people we spoke to knew how to complain if they needed to do so. Staff also said they felt comfortable raising any concerns.

We carried out this responsive inspection because we had concerns that this service had not been visited since 2009. We spoke with people who live at Holme Lodge. They told us that the service was very good. One person told us: “It’s brilliant here.” We received positive comments about the quality of the food, one person said: “If there’s something cooked that I don’t like they will make something for me that I do like.” People were very positive about the quality of support they receive from staff, one person told us: “It’s brilliant here, the staff are excellent.”

People that we spoke with told us that they felt safe. One person told us: “I feel safe here, I have no worries, the staff are brilliant.” One person told us the staff always ask for their opinions and views about what needs to improve to make services better.